Respiratory Syncytial Virus Infection in Children: Multidisciplinary Respiratory Care, Radiologic Assessment, Public Health Surveillance, Laboratory Diagnostics, and Healthcare Professionals.
Abstract
Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in infants and young children, contributing to significant global morbidity and mortality. Despite advances in prevention, RSV remains a major pediatric health challenge.
Aim: To review the multidisciplinary aspects of RSV infection in children, including pathophysiology, clinical evaluation, management strategies, and emerging preventive measures.
Methods: A comprehensive synthesis of current evidence and guidelines was conducted, focusing on epidemiology, diagnostic approaches, supportive care, and immunoprophylaxis innovations.
Results: RSV infects nearly all children by age two, with severe disease concentrated in infants under one year and those with comorbidities. Clinical management remains primarily supportive, emphasizing hydration, oxygen therapy, and escalation to high-flow or mechanical ventilation when needed. Routine use of bronchodilators, corticosteroids, and antibiotics is not recommended. Preventive strategies have evolved with maternal vaccination and long-acting monoclonal antibodies (nirsevimab, clesrovimab), offering season-long protection and reducing hospitalization rates.
Conclusion: RSV continues to impose a substantial global burden, particularly in resource-limited settings. Integration of maternal immunization and infant prophylaxis into public health programs, combined with vigilant clinical care and infection control, is essential to reduce morbidity and mortality.
Full text article
References
Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, Madhi SA, Omer SB, Simões EAF, Campbell H, Pariente AB, Bardach D, Bassat Q, Casalegno JS, Chakhunashvili G, Crawford N, Danilenko D, Do LAH, Echavarria M, Gentile A, Gordon A, Heikkinen T, Huang QS, Jullien S, Krishnan A, Lopez EL, Markić J, Mira-Iglesias A, Moore HC, Moyes J, Mwananyanda L, Nokes DJ, Noordeen F, Obodai E, Palani N, Romero C, Salimi V, Satav A, Seo E, Shchomak Z, Singleton R, Stolyarov K, Stoszek SK, von Gottberg A, Wurzel D, Yoshida LM, Yung CF, Zar HJ, Respiratory Virus Global Epidemiology Network, Nair H, RESCEU investigators. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet (London, England). 2022 May 28:399(10340):2047-2064. doi: 10.1016/S0140-6736(22)00478-0.
Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, Auinger P, Griffin MR, Poehling KA, Erdman D, Grijalva CG, Zhu Y, Szilagyi P. The burden of respiratory syncytial virus infection in young children. The New England journal of medicine. 2009 Feb 5:360(6):588-98. doi: 10.1056/NEJMoa0804877.
Kampmann B, Madhi SA, Munjal I, Simões EAF, Pahud BA, Llapur C, Baker J, Pérez Marc G, Radley D, Shittu E, Glanternik J, Snaggs H, Baber J, Zachariah P, Barnabas SL, Fausett M, Adam T, Perreras N, Van Houten MA, Kantele A, Huang LM, Bont LJ, Otsuki T, Vargas SL, Gullam J, Tapiero B, Stein RT, Polack FP, Zar HJ, Staerke NB, Duron Padilla M, Richmond PC, Koury K, Schneider K, Kalinina EV, Cooper D, Jansen KU, Anderson AS, Swanson KA, Gruber WC, Gurtman A, MATISSE Study Group. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. The New England journal of medicine. 2023 Apr 20:388(16):1451-1464. doi: 10.1056/NEJMoa2216480.
Jones JM, Fleming-Dutra KE, Prill MM, Roper LE, Brooks O, Sánchez PJ, Kotton CN, Mahon BE, Meyer S, Long SS, McMorrow ML. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report. 2023 Aug 25:72(34):920-925. doi: 10.15585/mmwr.mm7234a4.
Kaler J, Hussain A, Patel K, Hernandez T, Ray S. Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus. 2023 Mar:15(3):e36342. doi: 10.7759/cureus.36342.
Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. American journal of diseases of children (1960). 1986 Jun:140(6):543-6
Obando-Pacheco P, Justicia-Grande AJ, Rivero-Calle I, Rodríguez-Tenreiro C, Sly P, Ramilo O, Mejías A, Baraldi E, Papadopoulos NG, Nair H, Nunes MC, Kragten-Tabatabaie L, Heikkinen T, Greenough A, Stein RT, Manzoni P, Bont L, Martinón-Torres F. Respiratory Syncytial Virus Seasonality: A Global Overview. The Journal of infectious diseases. 2018 Apr 11:217(9):1356-1364. doi: 10.1093/infdis/jiy056.
Eden JS, Sikazwe C, Xie R, Deng YM, Sullivan SG, Michie A, Levy A, Cutmore E, Blyth CC, Britton PN, Crawford N, Dong X, Dwyer DE, Edwards KM, Horsburgh BA, Foley D, Kennedy K, Minney-Smith C, Speers D, Tulloch RL, Holmes EC, Dhanasekaran V, Smith DW, Kok J, Barr IG, Australian RSV study group. Off-season RSV epidemics in Australia after easing of COVID-19 restrictions. Nature communications. 2022 May 24:13(1):2884. doi: 10.1038/s41467-022-30485-3.
Reeves RM, Hardelid P, Panagiotopoulos N, Minaji M, Warburton F, Pebody R. Burden of hospital admissions caused by respiratory syncytial virus (RSV) in infants in England: A data linkage modelling study. The Journal of infection. 2019 Jun:78(6):468-475. doi: 10.1016/j.jinf.2019.02.012.
Savic M, Penders Y, Shi T, Branche A, Pirçon JY. Respiratory syncytial virus disease burden in adults aged 60 years and older in high-income countries: A systematic literature review and meta-analysis. Influenza and other respiratory viruses. 2023 Jan:17(1):e13031. doi: 10.1111/irv.13031.
Hall CB, Douglas RG Jr. Modes of transmission of respiratory syncytial virus. The Journal of pediatrics. 1981 Jul:99(1):100-3
Russell CD, Unger SA, Walton M, Schwarze J. The Human Immune Response to Respiratory Syncytial Virus Infection. Clinical microbiology reviews. 2017 Apr:30(2):481-502. doi: 10.1128/CMR.00090-16.
Zhivaki D, Lemoine S, Lim A, Morva A, Vidalain PO, Schandene L, Casartelli N, Rameix-Welti MA, Hervé PL, Dériaud E, Beitz B, Ripaux-Lefevre M, Miatello J, Lemercier B, Lorin V, Descamps D, Fix J, Eléouët JF, Riffault S, Schwartz O, Porcheray F, Mascart F, Mouquet H, Zhang X, Tissières P, Lo-Man R. Respiratory Syncytial Virus Infects Regulatory B Cells in Human Neonates via Chemokine Receptor CX3CR1 and Promotes Lung Disease Severity. Immunity. 2017 Feb 21:46(2):301-314. doi: 10.1016/j.immuni.2017.01.010.
Meissner HC. Viral Bronchiolitis in Children. The New England journal of medicine. 2016 Jan 7:374(1):62-72. doi: 10.1056/NEJMra1413456.
Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet (London, England). 2017 Jan 14:389(10065):211-224. doi: 10.1016/S0140-6736(16)30951-5.
Ralston SL, Lieberthal AS, Meissner HC. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014;134(5):e1474-e1502. Pediatrics. 2015 Oct:136(4):782. doi: 10.1542/peds.2015-2862.
Chartrand C, Tremblay N, Renaud C, Papenburg J. Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis. Journal of clinical microbiology. 2015 Dec:53(12):3738-49. doi: 10.1128/JCM.01816-15.
Ohmit SE, Moler FW, Monto AS, Khan AS. Ribavirin utilization and clinical effectiveness in children hospitalized with respiratory syncytial virus infection. Journal of clinical epidemiology. 1996 Sep:49(9):963-7
Ventre K, Randolph AG. Ribavirin for respiratory syncytial virus infection of the lower respiratory tract in infants and young children. The Cochrane database of systematic reviews. 2007 Jan 24:(1):CD000181
Karanfil LV, Conlon M, Lykens K, Masters CF, Forman M, Griffith ME, Townsend TR, Perl TM. Reducing the rate of nosocomially transmitted respiratory syncytial virus. American journal of infection control. 1999 Apr:27(2):91-6
Fleming-Dutra KE, Jones JM, Roper LE, Prill MM, Ortega-Sanchez IR, Moulia DL, Wallace M, Godfrey M, Broder KR, Tepper NK, Brooks O, Sánchez PJ, Kotton CN, Mahon BE, Long SS, McMorrow ML. Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report. 2023 Oct 13:72(41):1115-1122. doi: 10.15585/mmwr.mm7241e1.
Rosas-Salazar C, Chirkova T, Gebretsadik T, Chappell JD, Peebles RS Jr, Dupont WD, Jadhao SJ, Gergen PJ, Anderson LJ, Hartert TV. Respiratory syncytial virus infection during infancy and asthma during childhood in the USA (INSPIRE): a population-based, prospective birth cohort study. Lancet (London, England). 2023 May 20:401(10389):1669-1680. doi: 10.1016/S0140-6736(23)00811-5.
Zar HJ, Cacho F, Kootbodien T, Mejias A, Ortiz JR, Stein RT, Hartert TV. Early-life respiratory syncytial virus disease and long-term respiratory health. The Lancet. Respiratory medicine. 2024 Oct:12(10):810-821. doi: 10.1016/S2213-2600(24)00246-7.
Riccò M, Cascio A, Corrado S, Bottazzoli M, Marchesi F, Gili R, Giuri PG, Gori D, Manzoni P. Occurrence of Central Nervous System Complications of Respiratory Syncytial Virus Infections: A Systematic Review with Meta-Analysis. Epidemiologia (Basel, Switzerland). 2024 Jul 19:5(3):421-455. doi: 10.3390/epidemiologia5030031.
Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. Critical care (London, England). 2006:10(4):R107
Hall CB. The nosocomial spread of respiratory syncytial viral infections. Annual review of medicine. 1983:34():311-9
Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respiratory research. 2011 Jan 10:12(1):5. doi: 10.1186/1465-9921-12-5.
Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006 Feb:117(2):425-32
Authors
Copyright (c) 2025 Jaffar Hassan Almadhary, Naif Madallah Alanazi, Maryam Meashal Alharby, Safyah Hassan Madkhali, Reem Hilal Break Al-Otaibi, Nawaf Fadhel Alshammari, Salem Ali Aldhafeeri, Hesham Mohammad Ahmad Faqihi, Fatima Mohammed Hussein Madkhali, Nouf Muhaimid Al-Mutairi, Abdulelah Alhassan Mohammed Hendi
This work is licensed under a Creative Commons Attribution 4.0 International License.