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Respiratory Syncytial Virus (RSV)

What is RSV?

Respiratory Syncytial Virus causes respiratory tract illness in people of all ages. Most RSV infections are mild and consistent with cold-like symptoms. However, RSV can also cause severe illness requiring hospitalization. Older adults, young children, and infants are at greatest risk of severe illness from RSV. RSV may be more common in the late fall, winter, and early spring. Almost all children will be infected with RSV by their second birthday, and it is possible to become infected with RSV more than once. 

Signs and symptoms

  • Similar to the common cold (runny/stuffy nose, sneezing, coughing)
  • Fever
  • Sore throat
  • Decreased appetite (in children)
  • Wheezing
  • Fatigue
  • Chills
  • Headache
  • Infants may only have symptoms of irritability, poor feeding, decreased activity, and difficulty breathing 

Incubation period

Ranges from 2-8 days (usually 4-6 days)

Contagious period and spread

  • RSV is spread by inhaling or having contact with virus-containing droplets (typically through the mouth, nose, or eyes) produced by a person with infection when talking, coughing, and sneezing. Virus-containing droplets do not stay in the air for very long, but they can settle on surfaces that are touched by others and live on hard surfaces for several hours and soft surfaces, such as tissues and hands, for shorter amounts of time. Contact with hands, tissues, and other articles contaminated with nose/throat discharges of people who are ill and then touching your face before washing your hands can spread the virus, as well as direct contact with the virus, like kissing the face of someone who has RSV. 
  • People with infection are usually contagious for 3-8 days. People with weakened immune systems may be contagious for four weeks or longer.

Public health reporting requirements

  • Individual cases of RSV infection are not reportable. RSV-associated hospitalizations and RSV-associated pediatric deaths are reportable statewide as of June 18, 2023. Suspected and confirmed outbreaks of RSV in school or child care settings are reportable to state or local public health statewide.
  • Case definition for RSV-associated outbreaks in a school or child care setting:
    • Suspected RSV outbreak: One student or child with a positive test for RSV, among one or more other students or children with undiagnosed respiratory illness with symptom onset occurring within a one-week period. 
    • Confirmed RSV outbreak: Two or more positive cases of RSV among students or children with symptom onset occurring within a one-week period.
  • Report the infection to the facility director, school nurse, or child care health consultant. Discuss child health concerns with the school nurse or child care health consultant. Consultation with the state or local public health agency is also available.
  • If the child develops more severe symptoms or experiences ongoing symptoms, refer them to a health care provider. 
  • More information on outbreak response for RSV and other respiratory illnesses in schools and child care is on CDPHE’s website under the link titled “Guidance for Prevention & Control of Viral Respiratory Illnesses in School and Childcare Settings.”

Control of spread

  • Encourage frequent handwashing and proper hand-hygiene techniques.
  • Encourage children to cover their nose and mouth with a tissue or upper arm sleeve when they cough or sneeze, and throw away the tissue after they use it.
  • Clean potentially contaminated surfaces, like doorknobs, tables, handrails, etc. See Disease Prevention: The Facility Environment.
  • Avoid sharing cups and eating utensils and touching your face with unwashed hands. 
  • Stay home when sick.
  • People with respiratory symptoms should not interact with people at high-risk for severe disease. 
  • Provide adequate ventilation to occupied spaces. Increase filtration of indoor air through HVAC and/or with HEPA portable air cleaners. 
  • Consult with local public health for assistance with implementation of control measures. 

Vaccination:

RSV immunization is recommended for infants and children, pregnant people, and older adults. 

Treatment

There is no specific treatment for RSV infection, and it usually resolves on its own. Antibiotics should not be used to treat viral infections, such as RSV. Acetaminophen-containing medicines (such as Tylenol®) can be used to lower temperature or reduce discomfort. Aspirin and other salicylate-containing products (such as Pepto Bismol®) should not be given to anyone aged 18 years and younger as it increases the risk of Reye syndrome, a rare but very serious complication.

Exclusion

The facility should follow the appropriate response measures for an RSV outbreak if testing done through a health care provider confirms the RSV diagnosis among one or more children. 

  • If a student or child has symptoms of respiratory illness, schools, and child care centers should refer to the guidance and exclusion criteria for respiratory illness and CDC’s Preventing Spread of Respiratory Viruses When You’re Sick.
  • Exclude symptomatic children and staff from school/child care until they are fever-free for at least 24 hours without the use of fever-reducing medications (fever defined as a temperature of 100.4oF or higher) and all other symptoms of respiratory illness, including cough, are resolved or improved for at least 24 hours before returning to school or child care.
  • Supervise and separate child and students who are ill from others until they can be picked up by a parent or guardian. 

Additional precautions are recommended for at least five days following the return of anyone recovering from respiratory symptoms, including increased hand and respiratory hygiene, improved ventilation, masking, physical distancing, and testing. 

Additional exclusion criteria are listed in a previous section: Exclusion Guidelines for Children and Staff.

Role of teachers, caregivers, and family

  • Encourage routine immunization of eligible children and staff.
  • Report the infection to the designated staff member who is responsible for making decisions and taking actions related to the care of children who are ill. That person, in turn, notifies possibly exposed family and staff members to watch for symptoms.
  • Practice control measures listed above at home and in group care settings.

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