Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.3 Respiratory Tract Infections

7.3.8 Respiratory Syncytial Virus (RSV) Attendance of Children with Respiratory Syncytial Virus (RSV) Respiratory Tract Infection

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in infants and young children, although infection in all ages may occur. Children with known RSV infection may return to child care once symptoms have resolved, temperature has returned to normal, the child can participate in child care activities and the child’s care does not result in more care than the staff can provide without compromising the health and safety of other children.

Parents/guardians and staff need to be aware that the period of RSV shedding is usually three to eight days but shedding may last longer, especially in young infants from whom virus can be shed in nasal secretions and saliva for three to four weeks following infection.

RSV is a well-known cause of respiratory tract illness in children. Almost all children are infected at least once with RSV by two years of age and reinfection is common. In contrast to older children and adults who develop upper respiratory tract infections, RSV is one of the most frequent causes of lower respiratory tract infections including bronchiolitis (fever, cough, wheezing, and increased respiratory rate) or pneumonia in infants and young children less than two years of age.

RSV is responsible for greater than one hundred twenty-five thousand hospitalizations, mostly in infants and young children each year. Some 1% to 2% of previously healthy infants require hospitalization for bronchiolitis and up to 5% of these infants may require mechanical ventilation. Infants and children with weakened immune systems, specific types of heart problems, and those born prematurely have even greater difficulty with this infection (1,2).

Because RSV circulation is most common in the U.S. during a defined time period (generally November to March), and increased levels of RSV-specific antibody have been shown to decrease disease severity and/or prevent lower respiratory tract involvement, some infants and young children who meet specific criteria as outlined by the American Academy of Pediatrics (AAP) may benefit from receiving monthly injections (prophylaxis to prevent disease) of a monoclonal antibody (palivizumab) (2). Palivizumab does not treat someone already infected with RSV. For most patients infected with RSV, the disease is self-limited; no anti-viral therapy is available.

During an outbreak of RSV in a child care setting, most children and staff will be exposed before the occurrence of specific symptoms. Most viral respiratory tract illnesses, including RSV infections, are self-limited and go undiagnosed.

Transmission of virus occurs through close contact with respiratory tract secretions (2). Infants with chronic heart and lung problems and immunocompromised children may be at high risk for complications. Parents/guardians of such children should be alerted that a child with RSV has been diagnosed in their group.

Limiting the spread of RSV by using good hand hygiene practices, prohibiting sharing of food; bottles; toothbrushes; or toys, and disinfecting surfaces will be important to reducing the risk of RSV transmission in such situations.

RSV is a major viral illness in children, especially children two years of age and younger. A critical aspect of RSV prevention among high risk infants is education of parents/guardians and other care providers about the importance of decreasing exposure to and transmission of RSV. Preventive measures may include limiting, where feasible, exposure to contagious settings, hand hygiene and avoidance of contact with people with respiratory tract infections.

For additional information regarding RSV, consult the current edition of the Red Book from the AAP.

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RELATED STANDARDS Inclusion/Exclusion/Dismissal of Children
  1. Peters, T. R., J. E. Crowe, Jr. 2008. Respiratory syncytial virus. In Principles and practice of pediatric infectious diseases, eds. S. S. Long, L. K. Pickering, C. G. Prober, 1112-16. 3rd ed. Philadelphia: Churchill Livingstone.
  2. American Academy of Pediatrics, Committee on Infectious Diseases. 2009. Policy statement: Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics 124:1694-1701.