We are now seeing fewer devastating infections due to the robust childhood immunisation programme enforced by most nations.

However, one of the threats faced by children and families is the persistence of infections that are associated with childhood respiratory tract problems as well as wheezing disorders.

One of these is Respiratory Syncytial Virus (RSV). As a paediatrician, I have witnessed firsthand the distress that RSV can cause in our young patients, the anxiety it creates for their families, and the long-term effects that the condition can cause, making the conversation around RSV even more important.

RSV is present year-round and typically peaks toward the end of the year (September to December) with cases often extending into January the following year.

Like many other respiratory diseases, it is highly contagious – among infants, two out of three children experience their first infection before 12 months of age, however, many parents may not have been made aware of its existence.

An overlooked threat

RSV can infect anyone, of any age, spreading through droplets from infected persons, and causing only mild symptoms in healthy older children and adults.1

However, its impact on young children is much more severe. In Malaysia, RSV is the most commonly identified respiratory virus in children aged six months and below, accounting for 81 per cent of viral respiratory tract infections (RTI).1

A typical daily paediatric ward round will most certainly have an infant with an RSV-related RTI. Infants who are born premature and those with congenital disorders such as congenital cardiac malformations, neurological disorders, or other comorbid conditions are more likely to experience severe illness.

However, healthy babies born at full term are not spared, as more than 80 per cent of severe cases involve children with no underlying health conditions.

Parents may find that symptoms such as cough, runny nose, and fever overlap with other common childhood illnesses, making RSV difficult to be distinguished from other respiratory diseases.

Infants and young children may also exhibit poor appetite or lethargy. While these may be dismissed as unimportant, symptoms can rapidly worsen to include both rapid or shallow breathing, shortness of breath and spasms in the airways known as bronchospasms.

The child can look to be in distress with snuffles, chest indrawing, persistent cough, poor feeding, wheezing, rattles within the chest plus discomfort, signifying the need for medical attention, as RSV can also trigger serious complications such as pneumonia and inflammation of the small airways in the lung.

It is unsurprising, therefore, that 84.5 per cent of infected children below two years old result in hospitalisation2 and a significant proportion of these involve healthy, full-term babies. Moreover, some of these babies require urgent breathing support or ICU care.

This tells us that RSV is unpredictable and any child may be at risk.

Preventive steps, for the present and the future

Keeping young children safe from RSV, therefore, is essential. However, just as awareness of RSV remains low, so is knowledge of its lasting impact and, most importantly, of what parents can do as preventive steps.

RSV is a perennial problem and the burden of RSV can linger for a long time after the initial infection, long after a child has recovered.

Studies show that children who suffer an RSV infection face up to 12 times higher risk of developing asthma and may be affected by long-term respiratory problems such as recurrent wheezing and abnormal lung function. What’s more, getting infected once doesn’t provide immunity, so it’s possible to get infected again.

This means that we cannot afford to be complacent, and that the society must take the necessary actions to prevent RSV.

A good place to start for new parents is by ensuring that your baby is breastfed. Human milk contains numerous immune and antiviral components which can help protect infants against various infections.

A review found that infants who were not breastfed, or breastfed for shorter durations, had significantly higher risks of severe RSV-associated lower respiratory tract infections.11,12

Another essential practice is by ensuring good hygiene such as regular handwashing and wearing face masks, as well as by avoiding close contact or sharing utensils with those who are unwell.

Parents are also encouraged to keep unwell children out of school or childcare to prevent infecting other children and, by extension, their families.2

Childcare facilities should not be overcrowded as this is a known risk factor for recurrent infections. All childminders need to ensure that surfaces remain clean and disinfected and that a smoke-free environment is maintained for all babies.

As a doctor who has seen the impact of RSV on children, I urge all parents to take the first step by speaking with your paediatrician to learn about RSV prevention.

Talk about the preventive steps mentioned and immunisation options, including maternal vaccination which passes antibodies to the unborn child, and childhood immunisation with monoclonal antibodies which provides ready-made effective protection directly to babies from birth until one year old or more.

RSV infection is a preventable threat. Taking these initial steps are essential to ensure that we can prevent a lifetime of RSV-associated complications.

-- BERNAMA

Assoc Prof Dr Azanna Ahmad Kamar is a Consultant Neonatologist and Paediatrician at the Department of Paediatrics, Faculty of Medicine, Universiti Malaya.