Respiratory syncytial virus, or RSV, is a respiratory virus that infects the lungs and breathing passages. Although it can affect anyone, RSV is generally considered as the most frequent cause of lower respiratory tract infections in infants and young children. Each year about 125,000 infants are hospitalized with RSV in the United States. For more information on this infection, please visit: http://www.cdc.gov/rsv/.
General RSV Information
RSV, or respiratory syncytial virus, is a very common cause of respiratory infections in infants and children. In the US, RSV season occurs most often in the winter, while it can occur year round in tropical climates. RSV typically starts like other viral upper respiratory infections, but can evolve to more severe lower respiratory infection or viral pneumonia – seen most commonly with primary infection in infants. RSV can cause infection repeatedly over the first few winters of life, as well as cause URI’s in older persons, but recurrent RSV infection is usually mild. RSV lower respiratory infection sometimes results in transient dyspnea requiring support with oxygen and IV fluids in some infants. It can result in severe disease with respiratory failure in a few infants, especially those with chronic lung disease from prematurity, or with hemodynamically significant congenital heart disease.
Though there is not an effective vaccine to prevent RSV infection at present, there are means to create passive immunity with the use of anti-RSV antibodies. These methods have evolved over the years from high titer anti-RSV IVIG to monoclonal anti-RSV antibody given IM. This prophylaxis is given to high risk infants monthly during the time they are most at risk for severe RSV disease. In 2009, The AAP refined guidelines for prevention of RSV in high risk infants.
In the US, RSV season usually starts in mid-November, and prophylaxis is usually started November 1st. However, it is important to note that the start of RSV season can vary based on geographic location and may not be consistent across seasons – as is often the case in Texas. In many regions in the state, RSV activity starts in October - making October 1st a reasonable date to start prophylaxis in parts of Texas. Variation in the timing of the RSV season may be related to temperature and humidity.
Summary of RSV season as of 12/20/16:
The RSV season in Texas started statewide in the last week of October, similar to last year. It started first in the Houston and Galveston area, DSHS Region 6, with low level activity in late September and increasing through October and November, with 30-35% positive PCR testing in November. The official start of RSV in Region 6 was in the week ending October 15. The RSV season has next begun in the DFW area, DSHS Region 3, in the last 2 weeks of October, based on PCR testing, and it has continued to grow. The season began in South East Texas/Beaumont, DSHS Region 5, in the week ending 10/29/16. DSHS Region 7, the Austin and Temple area, has discordant testing with positive RSV antigen testing but not positive PCR testing until 11/19/16 when they had over 10% positive antigen testing and positive PCR testing as well to confirm a start to the season that week. Upper East Texas/Tyler, DSHS Region 4, The Rio Grande Valley, DSHS Region 11, and Upper South Texas/San Antonio, DSHS Region 8, started their RSV season in the week ending 11/26/16 based on current data. Region 1, the high plains and panhandle of TX had the start of their season in the week ending 12/03/16. We do not have data for Region 10, El Paso area. We do not have signs of RSV yet in DSHS Regions 2, Wichita Falls and 9, Midland/Odessa. We encourage reporting of RSV and influenza testing data from laboratories serving significant numbers of children in all areas of Texas to the CDC NREVSS program. We need better RSV data from El Paso, Wichita Falls, Midland, Odessa. We need more RSV testing results to be reported from centers in El Paso, Midland, Odessa, and Wichita Falls. There is more information on the TPS website and at Texas DSHS.
2/14/17 Update: RSV activity in Texas this winter peaked around January 1 and is declining. At present there are no signs indicating a late end to the RSV season this year.
To get more info or register for RSV alerts, please visit www.rsvtexas.org. The most recent Texas data can be found at https://www.dshs.texas.gov/IDCU/disease/rsv/Data.doc.
Please direct questions or suggestions to Donald Murphey, MD, Dell Children’s Medical Center, firstname.lastname@example.org, 512-628-1820, or Kellie Dees, Texas Pediatric Society, email@example.com, 512-370-1509.