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Respiratory Syncytial Virus and the Use of Ribavirin

R espiratory syncytial virus (RSV) accounts for one-half of all hospital admissions for respiratory diseases in infants and is the major viral cause of nosocomial illness in pediatric inpatients (1,2). RSV can cause both upper and lower respiratory disease and is the major cause of bronchiolitis and pneumonia in infants less than one year old. Complications of respiratory failure, apnea, and death occur more frequently in high-risk infants with prematurity, perinatal complications, congenital heart disease, pulmonary dysplasia, and immunosuppression. Mortality rates for children with heart disease approach 30 percent and 70 percent with heart disease and pulmonary complications (3). Seasonal in occurrence, RSV occurs in annual epidemics between December and April. Although it affects any age group, RSV is found with greatest severity in small children and infants less than two years of age. By age two, nearly 100 percent of children will have acquired RSV infection. Immunity to this pathogen is short-lived and children can become reinfected later in life, even into adulthood (4). RSV is an RNA-containing myxovirus first isolated in chimpanzees in 1956 and later in humans in 1957 (5). RSV is transmitted through viral shedding by large droplet nuclei from injected respiratory secretions and by self-inoculation after touching contaminated surfaces (6). Although considered a labile virus sensitive to pH and temperature changes, it can remain viable on skin surfaces at room temperature for at least eight hours, countertops after six hours, and tissue paper after 30 minutes (7). Studies have shown that inoculation can occur through the eyes or nose, but not the mouth. Aerosolization may occur within three feet (8). In other words, inoculation through aerosolization (sneezing) is possible within three feet of an infected person. Infection control for RSV involves limiting nosocomial transmission of the virus by hospital staff and susceptible infants and children, particularly those at high risk. Hospital personnel caring for infected infants need to avoid caring for uninfected infants, or at least limit contact with high-risk patients, such as those with congenital heart disease or pulmonary dysplasia. Researchers recommend careful handwashing, the use of disposable gloves, gowns, masks, and goggles when providing direct care for infected children. Researchers also suggest isolating infected patients one to a room, but consider grouping these patients permissible (9).