1. RSV Breanna Fretwell

2. History of RSV  DISCOVERED IN 1956  ONE OF THE MOST COMMON CAUSES OF CHILDHOOD ILLNESS  A MEMBER OF THE FAMILY PARAMYXOVIRIDAE AND THE SUBFAMILY PNEUMOVIRINAE  IT IS AN ENVELOPED RNA VIRUS AND TWO STRAINS ( SUBGROUPS A AND B ) ARE RECOGNIZED

3. Case Study – Twin A  Our patient is an ex-36 wk, now 1-month old (twin A) girl with a 3-day history of cough and nasal congestion.  She presented to her PMD with decreased activity, sleepiness, cough and nasal congestion  On the day of her admission, she was seen by her doctor and noted to be hypothermic to 101.3 F, lethargic  She was admitted for further evaluation and treatment.

4.  Because of her nasal discharge and cough, RSV and Flu-A nasal washings were sent.  Nasopharyngeal washing for RSV was positive  The team initiated racemic epinephrine and nasal suctioning  Her respiratory symptoms resolved over the course of a week  The child was discharged home

6. Paramyxoviridae Pneumovirinae Morphology:Spherical or filamentous, pleomorphic Envelope:Yes Diameter (nm):90-350 Length (nm):90-10,000 Structural components: NucleocapsidNucleocapsid, envelope with transmembrane viral spikes Buoyant densityBuoyant density (g/mL):1.18-1.20 Lipid composition: Envelope lipids are derived from plasma membrane of host cell Additional information: Surface glycoprotein spikes are 11-20 nm long; dense internal nucleocapsid; infectivity unstableinfectivity FAMILYSUBFAMILY

7. Virulence  Nucleocapsid protein  associates with genomic RNA  protects the RNA from nuclease digestion  Requirement for a neutral pH for fusogenic activity.  The cell attachment proteins  span the viral envelope  project from the surface as spikes  bind to proteins on the surface of target cells to facilitate cell entry  Can survive on hard surfaces such as tables and crib rails for many hours  Softer surfaces like tissues and clothes for shorter period of time

8. What does RSV do?  Attacks:  Mucous membranes of nose and throat especially trachea, bronchi, bronchioles, and alveoli  Speed:  3-5 day incubation; progression over 1-7 days  Who does it affect?  Can affect anyone of any age. The severest infections usually occur in infants, the elderly, or people with weakened immune systems

9.  RSV can cause:  upper respiratory infections (such as colds)  lower respiratory tract infections (such as bronchiolitis and pneumonia).  In children under 1 year of age, RSV is the most important cause of bronchiolitis, an inflammation of the small airways in the lung.  Show symptoms within 4 to 6 days of infection. Most recover in 1 to 2 weeks  Even after recovery, very young infants and children with weakened immune systems can continue to spread the virus for 1 to 3 weeks.

10. How RSV affects human cells

11. How do you catch RSV?  often introduced into the home by school-aged children who have a mild upper respiratory tract infection, such as a cold.  RSV can be spread when droplets containing the virus are sneezed or coughed into the air by an infected person  direct and indirect contact with nasal or oral secretions from infected persons.  Direct contact: wiping childs nose  Indirect contact: touching door knob that the person with RSV touched and then wiping your eyes, nose or mouth

12. How do you know if you have it?  Nasopharyngeal washing for RSV  Dr. cultures a sample of mucous from your nose  Usually diagnosed by symptoms and by knowing whether there is an outbreak of the infection in your area

13. Prevention  Wash your hands often  Disinfect hard surfaces  Do not share cups or eating utensils  Isolate person with RSV

14. Treatment  Palivizumab  Drug for the prevention of RSV in high risk people  Does not lessen the infection if it has already been transmitted  Drug treatments are in progress, but none are available yet  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  Infection will go away on its own in a week or so

15. Prevalence of RSV  Almost all children will have had an RSV infection by their second birthday.  When infants and children are exposed to RSV for the first time, 25% to 40% of them have signs or symptoms of bronchiolitis or pneumonia, and 0.5% to 2% will require hospitalization.  Most children hospitalized for RSV infection are under 6 months of age.  Specific number of people with this infection is unknown, but about 125,000 per year diagnosed  In temperate climates, tends to be an epidemic during winter season  In tropical climates, tends to be an epidemic during rainy season

16. In the United States…

17. In Oregon…

18. Why is RSV important?  RSV will affect the majority of people in their lifetimes at least once if not multiple times  Anybody of any age can get RSV  Though many cases are not serious, they are just seriously uncomfortable, some cases are very serious with the possibility or occuring of death. If death is even a possibility, it should be researched

20. References  Case Presentation: Respiratory Synctial Virus (RSV) Infection. Sutter Health CPMC. May 2003. Accessed July 14, 2013. http://www.cpmc.org/advanced/pediatrics/physicians/pedpage- 503rsv.html  History of RSV. Center for Disease Control and Prevention. January 14, 2010. Accessed July 15, 2013. http://www.cdc.gov/rsv/research/history.html  SpringerReference. Pneumovirus. 2013. Accessed July 14, 2013 http://www.springerreference.com/docs/html/chapterdbid/311139.h tml  Stanford edu. 2000. Accessed July 15, 2013. http://www.stanford.edu/group/virus/rhabdo/2000/RSV.html  Center for Disease Control and Prevention. January 14, 2010. Accessed July 15, 2013. http://www.cdc.gov/rsv/about/symptoms.html