Tuesday, March 3, 2015

So what is RSV?

I’ve been writing about it for a while now, but what exactly is RSV?  Have you heard of it? No? Not surprised, neither had I.  

Respiratory Syncytial Virus, or RSV, is as common as the common cold — in fact, it’s so common that most of us get it each year and merely acknowledge it as a prolonged, miserable cold rather than by name.  But while RSV can be dismissed with a few tissue boxes and a degree of annoyance by us adults, little guys with little airways are at a greater risk of complication and may require hospitalization due to the severity of its symptoms.  What makes it all the more terrifying, in my opinion, is that most of us aren’t even aware of RSV as an illness until we’re standing in the ER confronted with it in it’s full severity despite the fact that the CDC reports that all children - and therefore all parents - will have had at least one RSV infection by their second birthday. 

When a child is exposed to the virus, it takes 3 to 6 days of incubation before symptoms really begin to appear.  Initial symptoms of RSV are consistent with a minor cold:  runny nose, decreased appetite, cough, sleepiness and irritability.  Although this is sometimes all that occurs, in premature babies and infants under the age of six months the virus’ mucus begins to build up in their tiny airways and inhibits their ability to breath. So as the virus keeps escalating in severity until day 5 to 7 after symptoms first appear, it isn't surprising that the CDC reports as many as 25 to 40 of every 100 cases progress into full on respiratory infections such bronchiolitis or pneumonia with additional symptoms of fever, wheezing, rapid or difficult breathing and a blue-gray “dusky” tinge to their skin due to a lack of oxygen.  And seeing as infants are unable to adequately move mucus from their lungs on their own and home suctioning techniques have a limited scope of efficacy after a certain point in the virus’ intensification, it is estimated that there are over 125,000 infant hospitalizations for RSV in the United States on an annual basis.  And out of these acute cases, as many as 25 out of every 10,000 cases result in the death of babies under the age of 12 months. 

For those children who survive the average 1 to 3 week hospital stay for RSV(+), the long term consequences for such early exposure to it leaves them vulnerable to repeat infection and additional medical complications later in life, particularly asthma.   Unfortunately because RSV is a persistent virus that is contractable at any time of year there is no slack time for these little ones to develop their lungs and airways without risk of exposure — HOWEVER, there is a much lesser likelihood for those babies born between the months of May and September to become infected as newborns (defined as birth to 3 months of age) whereas those babies born in “peak season” are not only more likely to become infected but to suffer from repeat infections within the October to April timeframe.  For late RSV season babies like FG, the risk of infection does diminish for the summer months, but as they’re still infants for the majority of the subsequent RSV season and their respiratory systems are left vulnerable from the first infection, their risk for another severe infection is again heightened and worthy of professional concern.  

So, what can we do about RSV? 

Treatment wise, you’ve seen pretty much what there is to offer with the support FG is currently receiving:  external oxygen, breathing treatments and suction.  Premature babies under the gestational age of 32 weeks may be able to receive a drug by the name of palivizumab that can help prevent the development of serious RSV, but it does not outright prevent infection with RSV and it cannot cure or treat children already suffering from RSV.  It is also good to know that for the majority of older babies insurances do not cover the palivizumab and it is, unfortunately, largely cost prohibitive without their financial aid.  Prevention is then the only thing we as caregivers and responsible communities can address.  

So how do we prevent RSV?

* Avoid exposure. Limit your contact with people with fevers or colds, this is especially important for premature babies and all infants in the first two months of life.  Indirect or direct contact with infected nasal or oral secretions (i.e. through kisses, shared drinking glasses or “high touch” objects) causes avoidable transmission. 

* Avoid transmission.  People infected with RSV are contagious for 3 to 8 days, however, some babies with weakened immune systems can be contagious for as long as 4 weeks.  If possible, children and adults demonstrating infectious behavior should refrain from participation in group environments and contact with high risk populations: infants, children with compromised immune systems and the elderly. Techniques to avoid transmission include: 

* Wash your hands frequently.  Do so particularly before coming into contact with babies, before and after exposure to large groups of children in a school or day care environment, and teach your children the importance of hand hygiene.  It is also a good idea to avoid touching your face between opportunities to wash your hands. 

* Cover with your elbow when coughing and sneezing. RSV can be spread when an infected person coughs or sneezes into the air, spreading virus-containing droplets that linger in the air and contaminate surrounding surfaces.  Other people become infected when the droplet particles contact their nose, mouth or eyes.  

* Keep things clean.  Make sure that all “high touch” surfaces in your home are regularly disinfected; such surfaces include kitchen and bathroom countertops, sink faucets, doorknobs, stair railings, toys and phones.  Also ensure that all used tissues are properly discarded right away. 

* Further proactive prevention techniques include avoidance of crowds, consistent disinfection of children’s toys, regular washing of bedding and clothing, distinction between “outside” clothes and “home” clothes for older siblings.  Also enforce zero tolerance for smoking in your home and around your baby as infants who are exposed to tobacco smoke are at a higher risk of contracting RSV and more severe respiratory infections. 

So what?

At this point in our crash course education on RSV, HB and I are feeling thoroughly flummoxed that something so common and universally applicable could be so utterly foreign to us as parents and as self-identifiying educated, health conscientious Americans.  I mean we pay close attention to what preservatives and chemicals go into the food we purchase, we know the difference between a carbohydrate and sugar, we use sunscreen, we model healthy exercise behavior for our children, and they regularly wash behind their ears... and yet, the sniffles have completely taken us out at the knees.  The post-traumatic correlation between ignorance and guilt that is besieging my conscience as I stand here watching FG breath in his sleep is enough to bring out the white flag of surrender and promise this little guy a lifetimes supply of cartoons and chocolate to make up for what, I feel, is an unacceptable oversight on my part.  Instead of feeling retrospectively slothful, I could have done more of the preventative steps to ensure his safety... and instead of being blind sided, I could - should - have known what we were up against and recognized the signs of danger sooner than the eleventh hour.

But, all self deprecation and guilt-assuaging aside, I know the enemy now and I sincerely want to take this opportunity to get the word out to you brave souls resiliently reading my rambling because, Lord help me, RSV is the worst thing I've endured -- and I'm not even the one who is sick!  RSV is no joke and, even if you aren't around a little guy on a daily basis, I guarantee someone you come into contact with is and they - we - cannot afford to see something as seemingly harmless as a "cold" rip our world asunder with the loss of that which is most important: our children.  Please educate yourselves and those around you about the Respiratory Syncytial Virus and, as a village, help keep these little innocents safe from this all too real, all too prevalent boogieman.

To learn more about RSV please check out these additional resources: 

        * The CDC website for RSV prevention and treatment as well as their Podcast by Dr. Eileen Schneider

        * The comprehensive RSV Protection website for premature babies and infants

        * The Mayo Clinic definition and explanation of RSV symptoms, risk factors, complications and treatments

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