October 7th, 2008 14:39 EST
Judyth Piazza chats with Jon Roberts, MD, Pediatric Pulmonologist about RSV
Jon Roberts, MD is a pediatric pulmonologist at Winthrop University Hospital in Mineola, NY. He is a graduate of the Sophie Davis School of Biomedical Education at the City University of New York, and went on to receive his medical degree from New York Medical College. He completed a residency in pediatrics at Winthrop University Hospital, and then went on to complete a fellowship in Pediatric Pulmonology in the same institution.
Dr. Roberts has special interest in the areas of childhood asthma, complicated pneumonia, and bronchiolitis in infants and young children. His basic science research has focused on cystic fibrosis and respiratory viruses. He has authored peer-reviewed articles and abstracts that have appeared in journals such as Pediatrics and Pediatric Asthma, Allergy and Immunology.
Dr. Roberts is a member of the American Academy of Pediatrics, American Thoracic Society, American College of Chest Physicians, and the European Respiratory Society. He is also fluent in Spanish which has allowed him to set up a clinic in a predominantly-Hispanic community five miles from his primary hospital. He has expanded his interest in the health care of the Hispanic community as a member of a not-for-profit organization known as Pediatricians for Central America`s Children. The group travels each year to El Salvador bringing much-needed medications and equipment, and direct medical care is provided for thousands of children.
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Respiratory Syncytial Virus (RSV) Infection
What is respiratory syncytial virus infection?
Respiratory syncytial virus infection, usually called RSV, is a lot like a bad cold. It causes the same symptoms. And like a cold, it is very common and very contagious. Most children have had it at least once by age 2.
RSV is usually not something to worry about. But it can lead to pneumonia or other problems in some people, especially babies. So it`s important to watch the symptoms and call your doctor if they get worse.
What causes RSV infection?
A virus causes RSV infection. Like a cold virus, RSV attacks your nose, eyes, throat, and lungs. It spreads like a cold too, when you cough, sneeze, or share food or drinks.
There are many kinds of RSV, so your body never becomes immune to it. You can get it again and again throughout your life, sometimes during the same season.
What are the symptoms?
RSV usually causes the same symptoms as a bad cold, such as:
· A cough.
· A stuffy or runny nose.
· A mild sore throat.
· An earache.
· A fever.
Babies with RSV may also:
· Have no energy.
· Act fussy or cranky.
· Be less hungry than usual.
Some children have more serious symptoms, like wheezing. Call your doctor if your child is wheezing or having trouble breathing.
How is RSV diagnosed?
Doctors usually diagnose RSV by asking about your or your child`s symptoms and by knowing whether there is an outbreak of the infection in your area.
There are tests for RSV, but they aren`t usually needed. Your doctor may want to do testing if you or your child may be likely to have other problems. The most common test uses a sample of the drainage from your nose.
How is it treated?
RSV usually goes away on its own. For most people, home treatment is all that is needed. If your child has RSV:
· Prop up your child`s head to make it easier to breathe and sleep.
· Suction your baby`s nose if he or she can`t breathe well enough to eat or sleep.
· Control fever with acetaminophen or ibuprofen. Never give aspirin to someone younger than age 20, because it can cause Reye`s syndrome.
When a person with RSV is otherwise healthy, symptoms usually get better in a week or two.
RSV can be serious when the symptoms are very bad or when it leads to other problems, like pneumonia. Certain people are more likely to have problems with RSV:
· Babies younger than 6 months, especially those born early (prematurely)
· People with immune system problems
· People with heart or lung problems
· Adults older than 65
These people sometimes need treatment in a hospital. So it`s important to watch the symptoms and call your doctor if they get worse.
Can you prevent RSV infection?
It`s very hard to keep from catching RSV, just like it`s hard to keep from catching a cold. But you can lower the chances by practicing good health habits. Wash your hands often, and teach your child to do the same. See that your child gets all the vaccines your doctor recommends.
Medicines to prevent RSV may be given to babies and children who are more likely to have problems with the infection. Sometimes these medicines don`t prevent RSV, but they may keep symptoms from getting serious.
The ABCs of RSV: Fundamentals for protecting preemies
Respiratory syncytial virus is common virus that affects most children before the age of two. RSV is easily spread so it`s important for parents to understand what it is, how it`s spread, how it`s prevented and how it`s treated.
Respiratory syncytial virus (RSV) affects almost all children before the age of two
· Approximately two thirds of all infants are infected with RSV during the first year of life and almost 100% are infected by the age of 2,
· Nationwide, it has been estimated that RSV infection causes up to 125,000 hospitalizations annually, , ,
· Severe RSV infections may cause up to 500 infants deaths annually in the United States
Most RSV infections cause minor upper respiratory illness and cold-like symptoms
· Studies have shown that RSV is associated with bronchiolitis and pneumonia, two leading causes for hospitalizations in children.
· The duration of symptoms can usually last 7-12 days
· Other symptoms include:
· Persistent coughing or wheezing
· Rapid, difficult, or gasping breaths
· Blue color on the lips, around the mouth, or under the fingernails
· A fever over 100.4 degrees in the first three months of age, over 101 degrees between three and six months of age, or more than 103 degrees after six months of age
Infants born prematurely represent a large group at higher risk for severe complications due to RSV infection
· For babies born at 35 weeks gestational age (GA) or less, or with heart or lung problems, RSV can lead to serious infections and hospitalization
· Although many premature infants appear healthy, studies show that they may suffer from interrupted lung development, underdeveloped lungs at birth, altered lung development and immature immune systems due to their early arrival
· Among premature infants hospitalized with RSV, an average of 34% were admitted to the ICU, with close to 15% requiring mechanical ventilation
· At birth, the lungs of a premature infant have decreased air capacity, inhibiting their breathing
According to the American Academy of Pediatrics (AAP), key RSV risk factors include: Child care attendance, school-age siblings, exposure to environmental air pollutants, congenital airway abnormalities, and severe neuromuscular disease
· Additional risk factors include: Young chronological age, crowded living conditions, exposure to tobacco smoke, low birth weight and family history of wheezing or asthma
RSV is very common and easily spread, but can be prevented
· Transmission occurs by contact with infectious secretions through hand contamination and self-inoculation of the eyes, nose, or mouth.
· Transmission can be prevented by frequent hand washing by parents and healthcare providers, isolating infants from people with upper respiratory infections, and avoiding crowds and young siblings during the RSV season.
· Short-term prevention reduces hospitalization rates
· Reinfection is also common, because infection does not provide long-lasting immunity.
· Some children may become infected during three or four successive RSV seasons
Most infants and children overcome RSV infections, which are often asymptomatic and therefore unnoticed. However, those with more serious infections may be susceptible to the development of long-term pulmonary sequelae.
· Reactive airway disease and pulmonary function deficits are two conditions known to strike those who have suffered from RSV bronchiolitis in their first year of life, even in children whose initial illness did not require hospitalization.
· Wheezing and asthma have also been identified in children 10 years after suffering an RSV lower respiratory tract infection in infancy. This susceptibility to asthma and wheezing may have been caused by the early infection damaging the growing lung.
The RSV season varies regionally (duration of season, complications receiving coverage based on AAP guidelines)
Although cases of RSV peak during the winter months, there is no exact length or time of on set in any particular place. Parents and doctors must refer to local virology day to determine when there is a higher risk for RSV.
The AAP guidelines defines the timing of the RSV season by several factors:
· The typical RSV season falls between November and March, but in some areas, RSV can be at epidemic levels year-round
· The severity of the season, the time of onset, the peak of activity, and the end of the season cannot be predicted
· The onset of the RSV season varies in timing of community outbreaks, from year to year and region to region
· Florida has an earlier season onset and a longer season than the rest of the United States
It has been estimated in some U.S. communities that between 50% and 80% of bronchiolitis hospitalizations from November through April are due to RSV disease
Myth of the healthy preemie (babies born between 32-35 weeks gestational age are still at risk)
The health risk associated with premature babies born between 32-35 weeks gestational age are often over looked or misunderstood by parents because they appear to be healthy but they are still more vulnerable to mortality and complications than full-term infants. Parents must work with doctors to ensure their child remains healthy.
In 2005, there were 373,652 late preterm births in the United States, representing 9.1% of live births.
· Between 1995 and 2005, the rate of infants born late preterm in the United States increased more than 18%.
· California: In 2005, there were 41,040 late preterm births in California, representing 7.8% of live births. Between 1995 and 2005, the rate of infants born late preterm in California increased nearly 7%.
· Florida: In 2005, there were 22,113 late preterm births in Florida, representing 9.8% of live births. Between 1995 and 2005, the rate of infants born late preterm in Florida increased more than 19%.
· Illinois: In 2005, there were 16,396 late preterm births in Illinois, representing 9.2% of live births. Between 1995 and 2005, the rate of infants born late preterm in Illinois increased 15%.
· Kentucky: In 2005, there were 6,225 late preterm births in Kentucky, representing 11.0% of live births. Between 1995 and 2005, the rate of infants born late preterm in Kentucky increased more than 34%.
· Louisiana: In 2005, there were 6,924 late preterm births in Louisiana, representing 11.4% of live births. Between 1995 and 2005, the rate of infants born late preterm in Louisiana increased more than 22%.
· New York: In 2005, there were 21,034 late preterm births in New York, representing 8.5% of live births. Between 1995 and 2005, the rate of infants born late preterm in New York increased more than 16%.
· North Carolina: In 2005, there were 11,692 late preterm births in North Carolina, representing 9.5% of live births. Between 1995 and 2005, the rate of infants born late preterm in North Carolina increased 13%.
· Ohio: In 2005, there were 13,695 late preterm births in Ohio, representing 9.2% of live births. Between 1995 and 2005, the rate of infants born late preterm in Ohio increased 18%.
· Tennessee: In 2005, there were 8,424 late preterm births in Tennessee, representing 10.4% of live births. Between 1995 and 2005, the rate of infants born late preterm in Tennessee increased nearly 17%.
· Texas: In 2005, there were 37,886 late preterm births in Texas, representing 9.8% of live births. Between 1995 and 2005, the rate of infants born late preterm in Texas increased 21%.
While severe complications appear less frequently in infants born near-term " between 3-6 weeks early " all preemies experience disrupted development on some level that put them at risk for a wide range of health and developmental problems " even if they look healthy ? and have normal birth weights.
Late preterm babies often weigh between 4 1/2 and 6 pounds, and they may still appear thinner than full-term babies. Most of these babies can be breast- or bottle-fed, although some (especially those with mild breathing problems) may need tube-feeding for a brief time.
It is estimated that at 35 weeks gestation, the weight of the brain is only around 60 percent that of term infants. Late preterm babies are unlikely to develop serious disabilities resulting from premature birth, but they may be at increased risk for subtle learning and behavioral problems.
Even late preterm infants, those born between 33 and 36 weeks gestational age, have increased problems with breathing, feeding, temperature instability, jaundice and other issues.
Mortality rates for infants born even a few weeks early, or late preterm ? (between 34-36 weeks of gestation), were three times the rates for full-term infants.
As a result of being born prematurely, infants born before 36 weeks gestational age possess significantly less maternal antibody (IgG)
The transfer of maternal antibodies to the fetus occurs after the 28th week of pregnancy, during the third trimester. Premature birth interrupts this transfer, leading to lower levels of maternal antibody at birth. As a result, infants born prematurely have significantly less protection from RSV infections
· Babies born at 32-35 weeks` gestational age (GA) have 53% fewer serum antibody levels than full-term infants
Despite the fact that many premature infants appear healthy, it has been observed that abnormal airway development in premature infants leads to a significant reduction in lung function in childhood. Significant reductions have been documented at 1 year of age and as late as 6 to 7 years of life ,
· 32-35 week gestational age (GA) infants are within the same stage of lung development as 28-32 week GA infants
Potential problems can include respiratory ailments, such as respiratory syncytial virus (or RSV), because of underdeveloped lungs and lack of antibodies they need to fight off infections due to their early arrival.
· RSV, a common virus that can be potentially serious for at-risk babies like preemies, becomes much more common starting this time of year, but there are many easy steps parents can take to help protect their children.
· RSV hospitalization rates have been shown to be twice as high for preterm infants born at 33 to 35 weeks gestational age (GA) as they were for low-risk, full-term infants, and hospitalization rates for infants born at 33 to 35 weeks GA were similar to rates for infants less than or equal to 32 weeks GA
Minorities/Hispanic Community- Preemies and RSV
The rate of preterm birth in the United States is highest for black infants (18.1%), followed by Native Americans (13.8%), Hispanics (12.0%), whites (11.5%) and Asians (10.5%).
· California: During 2003-2005 (average) in California, preterm birth rates were highest for black infants (15.3%), followed by Native Americans (12.6%), Hispanics (10.8%), Asians (9.9%) and whites (9.8%).
· Florida: During 2003-2005 (average) in Florida, preterm birth rates were highest for black infants (18.2%), followed by Native Americans (14.4%), Asians (12.6%), Hispanics (12.5%) and whites (11.9%).
· Illinois: During 2003-2005 (average) in Illinois, preterm birth rates were highest for black infants (19.1%), followed by Native Americans (15.1%), whites (11.8%), Hispanics (11.8%) and Asians (10.3%).
· Louisiana: During 2003-2005 (average) in Louisiana, preterm birth rates were highest for black infants (20.6%), followed by Native Americans (15.1%), Hispanics (13.1%), whites (12.7%) and Asians (11.3%).
· New York: During 2003-2005 (average) in New York, preterm birth rates were highest for black infants (16.5%), followed by Native Americans (13.1%), Hispanics (12.4%), whites (10.2%) and Asians (9.7%).
· North Carolina: During 2003-2005 (average) in North Carolina, preterm birth rates were highest for black infants (18.7%), followed by Native Americans (15.4%), whites (12.1%), Hispanics (12.0%) and Asians (11.1%).
· Ohio: During 2003-2005 (average) in Ohio, preterm birth rates were highest for black infants (17.7%), followed by Native Americans (14.2%), Hispanics (12.6%), whites (11.8%) and Asians (10.5%).
· Tennessee: During 2003-2005 (average) in Tennessee, preterm birth rates were highest for black infants (18.9%), followed by Native Americans (13.7%), whites (13.6%), Hispanics (11.7%) and Asians (10.7%).
· Texas: During 2003-2005 (average) in Texas, preterm birth rates were highest for black infants (19.0%), followed by Hispanics (13.4%), Native Americans (13.1%), whites (12.8%) and Asians (11.4%).
Resources you can direct people to:
· RSV Protection: www.rsvprotection.com
· RSV Surveillance web site- CDC: http://www.cdc.gov/surveillance/nrevss/rsv-data.htm
· March of Dimes: www.marchofdimes.com
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