Respiratory syncytial virus infection: Therapy and prevention

Very little is available in the way of specific therapy for RSV infection. Bronchodilators, corticosteroids and ribavirin are certainly not cost-effective measures. Fortunately most infants with RSV infection can be successfully managed with fluid resuscitation and supplemental oxygen. Even in cases of respiratory failure, mortality is uncommon if assisted ventilation is provided early on in the course of illness. New approaches to treatment may involve combinations of antiviral compounds and immune modulators, or may be addressed at relieving the prominent mucus plugging of the airway in bronchiolitis. However the critical immunologic pathways to be upregulated or inhibited have yet to be identified. A key element of treatment strategies may be intervention during the time when the child is experiencing only URI symptoms, before wheezing begins. Serious RSV-related illness can be prevented in high-risk infants with the use of passive prophylaxis. However this option is far too expensive to apply to infants with only an average risk of hospitalisation for RSV infection. The advent of an effective RSV vaccine is many years in the future. Specific measures to prevent RSV infection are therefore not available. Parents should be instructed in the practice of hand washing before having contact with their newborn infants, and older siblings with URI symptoms should be kept away from infants. In multicenter studies of RespiGam and palivizumab, the incidence of RSV hospitalisation in control groups declined over the years that studies were conducted (Figure 2). This suggests that education of parents in basic infection control techniques can prevent serious RSV infection in infants.