Long-Term Effects of Respiratory Syncytial Virus Infection in Adults

What Is Respiratory Syncytial Virus Infection?

The respiratory syncytial virus is a contagious, airborne respiratory virus that usually causes symptoms that appear like flu (a infection of nose, throat, and lungs). The infection is common in children and involves the lungs and the respiratory tract. The symptoms are mild and mimic the common cold. The infection is highly contagious and spreads through sneezing, coughing, or kissing. The virus is airborne and can enter through the eyes, nose, or mouth. It is more severe in babies, older adults, adults with congestive heart failure, chronic obstructive pulmonary disease (COPD), or people with weak immune systems. The severity of the disease is most at the extremes of age. It causes bronchiolitis (a lung infection found in children that causes inflammation in the tiny airways called bronchioles), pneumonia, tracheobronchitis (inflammation of the trachea and bronchi), and otitis media (infection in the middle ear). It causes pneumonia and exacerbation of chronic obstructive disease and congestive heart failure in adults.

What Are the Symptoms of Respiratory Syncytial Virus Infection?

The symptoms appear within four to six days of exposure to the virus or touching contaminated objects. Respiratory syncytial virus infection (RSV) is contagious for three to eight days but may last for weeks in people with weak immune systems. It usually causes mild-cold like symptoms that may include the following;

• Dry cough.

• Fever (low-grade).

• Sore throat.

• Headache.

• Runny nose.

• Fatigue.

• Congestion in the nose.

• Sneezing.

• Difficulty in breathing.

• The bluish color of skin, nails, or lips is caused due to shortage of oxygen.

What Are the Long-Term Effects of Respiratory Syncytial Virus Infection?

Respiratory syncytial virus infection is mainly seen in adults over 65 years of age or immunocompromised. People with underlying heart and lung disease are at a higher risk of having complications from respiratory syncytial virus infection. This is due to their low respiratory reserve and reduced lung capacity.

• Older Adults - Elderly, especially those over 65 years of age and older, can get RSV infection with symptoms including runny nose, headache, and cough. It may lead to serious conditions like pneumonia (infection of the lung), aggravated symptoms of asthma, chronic obstructive disease (a chronic disease of the lungs that make it hard to breathe), or congestive heart failure (a condition when the heart fails to pump enough blood and oxygen to the body’s tissues). The gradual deterioration of the immune system due to aging is also one of the reasons why older adults are at increased risk of viral respiratory disease. Older adults who get sick from RSV infection may need to be hospitalized as they have weak immune systems.

• People with Heart Disease - RSV infections can worsen the existing symptoms of heart disease. They can exacerbate arrhythmia, heart failure, and myocardial infarction in patients with and without a history of pre-existing cardiovascular disease. The infection is known to be associated with the development of atherosclerosis (build-up of fat and cholesterol in the inner lining of the arteries).

• People with Chronic Obstructive Pulmonary Disease - Respiratory syncytial virus infection is more common in people with severe chronic obstructive pulmonary disease (COPD). The infection can exacerbate the symptoms of COPD and can be a significant factor in disease progression and mortality. RSV infection can cause severe lower respiratory complications in older adults that may lead to respiratory failure, prolonged hospitalization, and high mortality.

• Immunocompromised Adults - Numerous studies show RSV infection to be the cause of severe conditions like leukemia, bone marrow transplantation, and solid organ transplants. It is associated with significantly poor quality of life (morbidity), fatality, and a compromised immune system responsible for defense weakness. The risk of mortality increases as the infection progresses from the upper respiratory tract to the lower respiratory tract.

How to Differentiate between RSV and Influenza A?

There is a striking similarity of symptoms between respiratory syncytial virus disease and influenza A, making it impossible. Therefore, they can be differentiated only based on clinical presentation.

• Cough with sputum production accompanied by dyspnea (shortness of breath) and wheezing is a hallmark of RSV infection in all ages. A healthy adult with RSV reports less fever and dyspnea but more wheezing than an adult with influenza.

• Patients with RSV do not seek medical attention as quickly and may experience symptoms longer before hospitalization. The rapid onset of symptoms combined with high fever drives a patient with pneumonia to seek medical care sooner than patients with RSV.

• Laboratory testing is required to diagnose RSV accurately. The polymerase chain reaction (PCR) test is the diagnostic test of choice, with 85 % sensitivity in adults.

What Are the Treatment Modalities for Respiratory Syncytial Virus Infection in Adults?

RSV treatment in adults is supportive, which includes,

• Antipyretics: Medicines such as Ibuprofen and Acetaminophen may be given to relieve pain and fever.

• Supplemental Oxygen: Supplying extra oxygen can help improve breathing. The inflammation in the airway leads to less oxygen in the lungs. This results in a decrease of oxygen levels in the blood.

• Intravenous Fluids: RSV infection may make it challenging to tolerate feeding and causes vomiting. Giving a brief course of intravenous fluids can help in recovery.

• Corticosteroids: Using inhaled or systemic corticosteroids and bronchodilators for the elderly, patients with pre-existing pulmonary conditions such as asthma or chronic obstructive pulmonary disease, or acute wheezing can be beneficial.

• Antibiotics - Antibiotics must not be prescribed for patients with RSV, except in case of bacterial infections in hospitalized patients.

There is no specific treatment for respiratory syncytial virus infection in adults and no licensed vaccine to prevent the disease. The burden of the disease demands vaccines to protect the adult population, who are at increased risk of severe outcomes and complications.

How to Prevent Respiratory Syncytial Virus Infection in Adults?

Droplets and fomites primarily transmit RSV. Close contact with an infected person, environment, and autoinoculation is believed to be necessary for transmission. Various infection control strategies such as hand washing, wearing masks and gloves, social distancing, and staff education can significantly decrease the rate of transmission and acute respiratory tract infections.

Conclusion:

Increasing recognition of the burden of RSV in older adults is required to build awareness and consensus among the immunization communities about the need to protect them from infection. Evaluation of the impact of new prevention and treatment options in the interest of the general public and older patients must be done. Improved surveillance is needed to collect data about the incidence and burden of RSV, including hospitalization and intensive care unit admissions in older adults and adults with high-risk conditions. This ensures that the vaccines and other prevention options, when available, must protect the compromised population from RSV. They may be used optimally and according to public health recommendations.