A Cold "Gone Bad"
‘Tis the Season for Respiratory Syncytial Virus

Newborn Alyssa Templet came home from the hospital a normal, healthy baby. Two weeks later she was back, fighting for her life in the intensive care unit.

Doctors at Texas Children’s Hospital quickly diagnosed Alyssa with respiratory syncytial (sin - sish - al) virus, or RSV, a virus that can be fatal to infants, but merely causes annoying cold symptoms in most adults and children over the age of two.

"It all happened so quickly," says Ann Kokx-Templet, Alyssa’s mother. "We went to the pediatrician’s office because Alyssa had a bad cold that wasn’t getting any better. The doctor took one look at her and asked, ‘How quickly can you get her to Texas Children’s Hospital?’"

That’s the tricky nature of RSV, says Dr. Michael Speer, director of quality outcomes at Texas Children’s, and professor of pediatrics at Baylor College of Medicine’s neonatology section. The virus may masquerade as a cold, but in some infants, it has much more serious consequences ... it’s really a cold ‘gone bad,’" he says.

What is RSV?

RSV attacks the mucous membranes of the human respiratory tracts - the nose, throat, windpipe, and the bronci and bronchioles (the air passages of the lungs). It causes infections of the upper respiratory tract - like a cold - and the lower respiratory tract - like pneumonia.

The term "syncytial" means that the virus causes cells - in this case, cells of the mucous membranes - to merge together into larger cells, which don’t work as well as the non-infected cells.

An RSV infection can range from very mild to life-threatening or even fatal, particularly in children under nine months of age.

Alyssa, who contracted the virus 18 days after birth from her 2-year-old brother who had a mild cold at the time, remained in the hospital for 10 days while receiving oxygen therapy, humidified air and medication to aid breathing, and intravenous fluids to prevent dehydration.

"She struggled to breathe. It was a very frightening experience ... you never want to go through this," said Alyssa’s mother, Ann.

In most children, symptoms appear similar to a cold, with lots of clear nasal drainage. About half of the infections result in lower respiratory tract and middle ear infections. More severe cases of RSV occur most often in children born prematurely, or in those with weak immune systems, heart, or lung disease.

"The secretions that this virus causes can plug up the airways. Because babies and their air passages are small, an RSV infection can be extremely dangerous if not quickly treated. The lungs can ultimately collapse," Dr. Speers says.

Alyssa had none of the usual risk factors, but contracted a severe form of RSV anyway.

"We can’t always predict how every child will react to the virus. That’s why it’s so important to protect very young infants from sources of potential infection" said Dr. Speers.

How is RSV Prevented?

RSV occurs every year in Houston, beginning most often in October and lasting through April. In other parts of the country, the virus strikes in fall, winter and early spring as well, except for southern Florida, where it is present year round.

At Texas Children’s Hospital, health care professionals in the virology lab keep an eye on various viruses that emerge throughout the year.

"When we start seeing an upswing in RSV infections, that’s when we kick in to prevent the disease’s spread," Dr. Speer said.

Prevention involves administering a medication called Synagis (generic name palivizumab) to children at increased risk for acquiring a severe form of the disease, predominantly those born prior to 35 weeks’ gestation. Other infants at risk for RSV may be considered on a case-by-case basis, especially if certain risk factors are present, such as multiple birth, a crowded household (particularly one that includes other young children or smokers), day care attendance, or additional medical problems.

Synagis is administered with a once-a-month injection just prior to and during RSV season. The drug neutralizes the virus, rendering it impotent.

McKenna Callahan, 7 1/2 months, has had two doses of Synagis so far and will continue until RSV season is over. Parents Jill and Kevin wanted to take no chances with the health of their daughter, born prematurely at 33 weeks’ gestation.

"I have wonderful peace of mind knowing she’s protected. The medication causes no side effects ... she doesn’t even cry when she gets the shots," said Jill.

How Common is RSV?

RSV is extremely common. By age two, virtually 100 percent of children have had at least one case of RSV infection. The majority recover within eight to 15 days without fanfare, and parents usually write the experience off as a childhood cold. During their first RSV infection, between 25 and 40 percent of infants and young children have signs of pneumonia or bronchiolitis (inflammation of the small airways of the lungs in which wheezing occurs), and .5 to 2 percent require hospitalization. The majority of children hospitalized are under six months of age. Last year alone, the virus was responsible for 90,000 hospitalizations, and about 2 percent of those patients died.

Illness begins most frequently with low-grade fever, runny nose, croupy "seal bark" cough, and sometimes wheezing. A bluish discoloration of the skin caused by lack of oxygen may also result.

For children with mild disease, no specific treatment is necessary, other than acetaminophen to reduce fever. Children with severe disease may require oxygen therapy and sometimes mechanical ventilation to assist with breathing.

Frequent handwashing is the easiest and most effective way to decrease the spread of RSV, Dr. Speers said.

"RSV can stay on hands alive for up to one-half hour. Soap and water can eliminate the virus," he said.

Don’t share items such as cups, glasses, and utensils, and avoid kissing infants on or about the mouth or on the hands, he advised, because infants almost always put their hand in their mouths.

"And by all means, keep babies less than nine months of age away from people with colds."

The Templet family is very conscious about the importance of these measures. Alyssa is now a healthy two-year old, full of curiosity and spunk.

"She’s an RSV survivor, thanks to her will to live and the expert care she received," said her mom Ann.

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©2006 Texas Medical Center

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