What are symptoms of RSV and how does it spread? Answers from a California pediatrician

In the winter months, children and older people are at higher risk of the respiratory synctial virus — or RSV — with severe symptoms leading to difficulty breathing.

RSV is surging and some parents might be dealing with it for the first time since the COVID-19 pandemic began.

In California, the numbers of both antigen and PCR positive tests are higher than last year during the peak season in December, according to the U.S. Centers for Disease Control and Prevention. The rising numbers of RSV cases has created concern of a tripledemic in California — COVID-19, the flu and RSV.

RSV is a common virus. Each year in the U.S., there are 2.1 million outpatients doctor visits among children who are 5 and younger with RSV, according to the CDC. However, an estimated 58,000 children of this age end up being hospitalized due to the virus.

The CDC states those with the greatest risk factors include: premature infants; very young infants especially those 6 months and younger; children younger than 2 with chronic lung disease or congenital heart disease; children with weakened immune systems; children with neuromuscular disorders.

The Bee spoke with Dr. Dean Blumberg, professor and chief of pediatric infectious disease at UC Davis Health to help answer questions on the topic.

The following interview was edited for clarity and brevity.

What is RSV?

Blumberg: RSV stands for respiratory syncytial virus and it’s common virus that’s transmitted in the community via the respiratory route. It causes something very similar to the common cold with a few different nuances.

What is different about RSV?

Blumberg: People are familiar with colds causing fever, runny nose, cough, sore throat as well as some other symptoms. RSV is notable because it causes a more profuse runny nose and is more associated with sneezing compared to other respiratory viruses. It tends to be more dangerous at the extremes of age. So the very young are at higher risk for severe disease and also the elderly are at higher rick for severe disease.

Who gets infected with RSV?

Blumberg: Almost everybody gets infected with RSV in the first three years of life, it’s a very common community acquired infection.

What are the symptoms?

Blumberg: It usually starts off with a runny nose, which can be quite profuse and sneezing, cough, fever sore throat — those are the most common symptoms. Then it can lead to wheezing episodes.

Should I be concerned if my child is wheezing?

Blumberg: Yes, wheezing is more concerning. There’s two common complications that RSV causes. One is that it can cause not just upper respiratory tract resulting in either pneumonia or bronchitis, which is inflammation of the airways of the lungs and the bronchiolitis can lead to the wheezing. This can make it difficult for children to breathe to get enough oxygen.

What should I do if my child gets RSV?

Blumberg: For most children, they’ll have a mild illness and have a cold and they will recover. If your child has any difficulty with breathing, those would be the concerning signs that you need to seek additional health care. So common signs of difficulty breathing would be children who are breaking very rapidly if they’re turning blue, this is usually most noticeable around the lips. Then sometimes they’re breathing so hard that you see their ribs sticking out. If you see any of these warning signs, it’s important to seek medical attention.

Do air purifiers and humidifiers work?

Blumberg: Usually the air purifiers or humidifiers or vaporizers don’t generally work. Sometimes vaporizers and humidifiers will work if a child has something like croup as a complication, but for the common complications such as pneumonia and bronchitis, they just aren’t beneficial.

How can I prevent my child from getting RSV?

Blumberg: Unfortunately, it’s very commonly transmitted and easy to transmit. If a child is going to day care or school, chances are they are going to be exposed. But keeping your child away from other children who are sick is useful; avoiding crowds; masking provides excellent protection. [RSV] can be transmitted on the hands also, after touching something that’s infected and then rubbing your eyes or your nose or putting your fingers in your mouth. So frequent hand washing is also useful.

Does kissing infants on the cheek transmit the virus?

Blumberg: You know, it can be transmitted by kissing but it can also be transmitted just by coughing or sneezing around an infant also.

Are older adults at risk for RSV?

Blumberg: [RSV can] also be dangerous to the elderly. There’s an increasing appreciation for those that are over 65 years of age. They can suffer pneumonia with RSV also. So it’s important for grandparents and other older people to take precautions to protect themselves.

Looking ahead

Blumberg: There is a preventative measure therapy that’s available, but it’s pretty clumsy to administer. It’s a monthly injection throughout the RSV season. So there’s only a very small number of children who qualify for that. And that’s mostly prematurely born children who have chronic lung problems. There are several promising RSV vaccine candidates that are pretty far along in development and they might be available as soon as next RSV season.

This story was originally published November 2, 2022 at 6:00 PM with the headline "What are symptoms of RSV and how does it spread? Answers from a California pediatrician."