SeminarRespiratory syncytial virus infection
Section snippets
Epidemiology
RSV causes a substantial amount of illness in young infants and elderly people. It is a seasonal virus, with peak rates of infection occurring annually in the cold season in temperate climates, and in the rainy season, as temperatures fall, in tropical climates. It affects about 90% of infants and young children by the age of 2 years; peak rates occur in infants aged 6 weeks to 6 months, but particularly in those under 3 months of age. Infection rates in Houston, USA, were 68·8 per 100
RSV and the immune response to infection
The RSV genome comprises a single strand of negative-sense RNA, 15 222 nucleotides in length,14 which yields ten major proteins. The F (fusion) and G (attachment) glycoproteins are the major surface antigenic determinants. Other proteins are primarily structural: the small hydrophobic proteins, matrix proteins, and the 22 kDa protein are associated with the viral envelope, and the nucleoprotein, phosphoprotein, and large nucleoprotein are found in the nuclear capsule. The function and
Clinical manifestations and diagnosis
The most common infection caused by RSV is of the upper respiratory tract; such infections are characterised by rhinitis, cough, and sometimes fever. Acute otitis media occurs in up to a third of children with RSV illness; both RSV and bacterial pathogens have been isolated from the middle ears of children with RSV. Croup also occurs with RSV infection, but bronchiolitis and pneumonia are the commonest manifestations in children. Signs of upper-respiratory-tract involvement commonly precede
Management
Infection of the lower respiratory tract with RSV is a self-limited condition in most cases. In normal infants with RSV lower-respiratory-tract infection, the inflammatory response has a greater effect on severity than does viral replication, and there is no unequivocal evidence to suggest that any antiviral or anti-inflammatory agents (alone or in combination) can reduce the length of RSV-related hospital stays in normal infants and young children. There is, therefore, much variation in the
Prevention
A vaccine for RSV is needed, and a protective live, attenuated vaccine administered at or around birth would be ideal. However, problems such as insufficient attenuation of the vaccine strain of RSV,42 its thermolability, and the need to include A and B strains in each vaccine have hindered trials in infants under 3 months of age. Furthermore, since repeated infections with RSV occur in children, any vaccine will need to be more immunogenic than wild-type RSV itself. Several vaccine strains42,
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