Respiratory Syncytial Virus (RSV)

Reporting Criteria
Individual cases of RSV are not reportable by law in Texas.

Respiratory syncytial virus (RSV) 

School-aged children who are infected with RSV and have a mild upper respiratory tract infection often introduce RSV into the home. RSV can spread when a person with the virus coughs or sneezes into the air.  Virus-containing droplets generated from these activities may cause infection when they come into contact with another person’s nose, mouth, or eyes. 

Infection can also result from direct and indirect contact with nasal or oral secretions from infected persons, such as kissing an infected child’s face or touching a common surface (e.g., a doorknob) on which viruses have been deposited. People infected with RSV can spread the virus for 3 to 8 days. However, some infants and people with weakened immune systems can spread the virus for up to 4 weeks. 

Symptoms of RSV are similar to other respiratory infections. Illness begins 4 to 6 days after being exposed to the virus. In adults and older children, typical RSV symptoms include a low-grade fever, congested or runny nose, cough, sore throat, headache, fatigue, and occasionally wheezing. In children younger than age 2, RSV can cause a lower respiratory tract illness such as bronchiolitis or pneumonia; more severe cases can result in respiratory failure. For people with severe illness, symptoms may include a worsening croupy cough, unusually rapid breathing, difficulty breathing, and a bluish color of the lips or fingernails caused by low levels of oxygen in the blood. RSV can cause middle ear infections (otitis media) in preschool children.

The majority of children hospitalized for an RSV infection are under the age of six months. The elderly (those 65 years of age and older), premature infants, persons with chronic lung or heart problems, and persons with weak immune systems are at higher risk for developing serious illness. Those who are exposed to tobacco smoke, attend daycare, live in crowded conditions, or have school-aged siblings could also be at higher risk. 

Treatment & Prevention 
A drug called palivizumab is available to prevent severe RSV illness in certain infants and children who are at high risk. The drug can help prevent development of serious RSV disease, but it cannot prevent infection with RSV or help cure or treat children already suffering from serious RSV disease. There is no vaccine available yet to prevent RSV. Researchers are working to develop RSV vaccines. However, there are steps that can be taken to help prevent the spread of RSV. Covering coughs and sneezes, practicing frequent hand washing, refraining from kissing other people, and disinfecting surfaces may help stop the spread of RSV. Persons with RSV illness should not share cups or eating utensils with others, and persons with cold-like symptoms should not interact with high-risk children. When possible, limiting the time that high-risk children spend in child-care centers or other potentially contagious settings may help prevent infection and spread of the virus during the RSV season. 

School Exclusion Criteria 
Children with a fever should be kept out of school or childcare until they are fever free for 24 hours without the use of fever suppressing medications. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7 for schools and Rule 746.3603 for childcare. 

Recent Texas Trends 
RSV activity typically begins to increase in Texas in September or October and peaks in December or January. The timing of the RSV season and the seasonal peaks can vary by region in Texas. For surveillance reports, see the Data link.
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