From the Guidelines
The plan of care for RSV infection primarily involves supportive management, with prevention strategies including palivizumab prophylaxis for high-risk infants during RSV season, as recommended by the most recent guidelines 1. The management of RSV infection is mainly focused on alleviating symptoms and supporting the body's immune response. For mild cases, this includes:
- Ensuring adequate hydration
- Using saline nasal drops to clear congestion
- Administering acetaminophen or ibuprofen for fever and discomfort, with dosing being age-appropriate: for infants, acetaminophen 10-15 mg/kg every 4-6 hours or ibuprofen 5-10 mg/kg every 6-8 hours for those over 6 months
- Maintaining good hand hygiene and isolating the infected person to prevent spread
For moderate to severe cases, especially in infants, young children, or the elderly, hospital admission may be necessary for:
- Oxygen support
- IV fluids
- Respiratory monitoring Severe cases might require high-flow oxygen therapy or mechanical ventilation.
Prevention strategies are crucial, particularly for high-risk infants, and include:
- Palivizumab (Synagis) prophylaxis during RSV season, with monthly injections of 15 mg/kg, as the most effective preventive measure against RSV infection in high-risk infants 1
- Avoiding exposure to crowds and infected individuals
- Practicing good hand hygiene
- Restricting participation in group child care during RSV season for high-risk infants whenever feasible
- Immunizing against influenza beginning at 6 months of age for all high-risk infants and their contacts
RSV is particularly concerning because it can cause significant inflammation and mucus production in the small airways, leading to breathing difficulties, especially in those with smaller airways like infants or individuals with underlying respiratory conditions. The most recent guidelines emphasize the importance of palivizumab prophylaxis for high-risk infants during RSV season, highlighting its role in reducing the risk of hospitalization due to RSV infection 1.
From the FDA Drug Label
VIRAZOLE® (Ribavirin for Inhalation Solution, USP) is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV. Treatment early in the course of severe lower respiratory tract infection may be necessary to achieve efficacy. The decision to treat with VIRAZOLE should be based on the severity of the RSV infection. RSV infection should be documented by a rapid diagnostic method such as demonstration of viral antigen in respiratory tract secretions by immunofluorescence or ELISA before or during the first 24 hours of treatment.
The plan of care for Respiratory Syncytial Virus (RSV) infection includes:
- Treatment with ribavirin (VIRAZOLE) for hospitalized infants and young children with severe lower respiratory tract infections due to RSV.
- Early treatment in the course of severe lower respiratory tract infection to achieve efficacy.
- Documentation of RSV infection by a rapid diagnostic method before or during the first 24 hours of treatment.
- Assessment of the severity of RSV infection to determine the need for treatment.
- Intensive patient management and monitoring techniques for mechanically ventilated infants, including endotracheal tube suctioning, recording of proximal airway pressure, and arterial blood gas monitoring. 2
From the Research
Plan of Care for Respiratory Syncytial Virus (RSV) Infection
The plan of care for RSV infection is primarily supportive, with a focus on preventing severe disease in high-risk populations.
- The treatment of RSV is mainly supportive, with no effective antiviral therapies available 3.
- Palivizumab, a humanized monoclonal antibody, is the only licensed agent for prevention of severe RSV infection in high-risk infants and is administered intramuscularly, every month during the RSV season 4.
- The use of palivizumab has been shown to reduce hospitalization rates in premature infants and children with chronic lung and heart diseases 5.
- Prophylaxis against RSV infections using palivizumab is recommended for children <2 years of age with chronic respiratory diseases and children <6 months old who were born before gestational week 26 6.
- Ribavirin inhalation treatment may be considered in high-risk infants with clinical symptoms indicating a serious course of an RSV infection 6.
High-Risk Populations
High-risk populations for RSV infection include:
- Preterm infants 4, 7, 5
- Children with chronic lung disease 4, 7, 5, 6
- Children with congenital heart disease 7, 5
- Children with compromised immunity 7
- Children younger than 6 weeks in otherwise healthy children 7
Prevention and Treatment
Prevention and treatment strategies for RSV infection include: