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Recent Therapeutic Developments in RSV

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Respiratory syncytial virus is the major cause of pneumonia and bronchiolitis in infants and young children, with the highest morbidity in very young infants. In infants and children, RSV accounts for 40% to 80% of all bronchiolitis, 50% of all pneumonia, and 10% to 30% of all bronchitis.^13,14 Hospitalization for RSV infection is highest for infants from 2 to 6 months of age, with 57% of the patients younger than 6 months, and 81% younger than 1 year. Until the age of 1 year, an infant with an RSV respiratory infection has a 1.6% risk of hospitalization.¹⁰

Young children, infants, and preterm infants are at risk for RSV infections and associated hospitalizations. Respiratory syncytial virus infection in the first month of life is rare. By 2 years of age, most children have been infected by RSV, and 50% contract RSV after their first exposure. Infants with a gestation age less than 36 weeks are at greater risk for RSV, especially those that required mechanical ventilation after birth. Required hospitalization for RSV infections is most likely for preterm infants with gestation ages less than 32 weeks who received oxygen more than 28 days and were discharged within 3 months of the RSV season.¹⁵ Of the children hospitalized for RSV, 81% are younger than 1 year.¹⁶

Infection with RSV requires close contact with a person who is shedding RSV or with surfaces harboring infectious secretions. Respiratory syncytial virus may remain infectious for many hours.¹⁹ Transmission of the virus appears to require a distance of less than 6 feet. Routes of entry into the body are primarily the eyes and nose through aerosol or hand contact. The incubation period averages 4 to 6 days.¹⁹ In children of all ages, viral pneumonias, including RSV pneumonia, are seen more frequently than bacterial pneumonia, and generally are associated with upper respiratory infections. Although RSV pneumonia can occur at any time, it generally is seen before a a child’s third birthday.²⁷

Respiratory syncytial virus pneumonia is the inflammation or infection of the bronchioles and alveolar spaces of the lungs. Unlike bacterial pneumonias, which circulate through the lungs in blood, RSV enters the lung from the upper respiratory tract and acts as a parasite, attacking alveoli nearest the bronchi of either or both lungs. The end result is cellular death, caused by exudate filling the alveolar spaces, then pooling and clumping, which creates consolidation in dependent lung areas.