Continuing Education Activity

Respiratory syncytial virus (RSV) represents the leading global cause of acute respiratory infection requiring hospitalization in young children, frequently progressing from upper respiratory symptoms to bronchiolitis with small-airway obstruction, respiratory failure, or apnea. Recent preventive advances—maternal vaccination with the bivalent prefusion F vaccine and long-acting monoclonal antibodies such as nirsevimab and clesrovimab—have transformed infant protection, while supportive care continues to anchor management in the absence of an effective antiviral therapy. This course reviews RSV pathophysiology, diagnostic strategies, complications, and prevention, which remains essential to optimize the care of infants and young children.

This activity outlines up-to-date evidence on RSV epidemiology, clinical presentation across disease severity, appropriate diagnostic use, evidence-based management, and current prevention strategies. Participants will gain an in-depth understanding of clinical decision-making regarding hospitalization criteria, respiratory support, hydration, and avoidance of ineffective therapies, while also advancing competency in maternal vaccination counseling, monoclonal antibody use, and infection-control practices. This activity for healthcare professionals is designed to enhance the learner's competence in identifying RSV infection, performing the recommended evaluation, and implementing an appropriate interprofessional approach to manage this condition, thereby improving outcomes for vulnerable pediatric populations.

Objectives:

• Apply current guidelines to identify eligible children for respiratory syncytial virus prevention strategies.
• Differentiate the clinical presentations of respiratory syncytial virus bronchiolitis in children from those of other respiratory illnesses to determine which patients require hospitalization.
• Evaluate diagnostic testing strategies for respiratory syncytial virus in children. 
• Collaborate with interprofessional team members to implement coordinated respiratory syncytial virus prevention strategies in children to optimize immunization rates and improve outcomes.

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Introduction

Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infection requiring hospitalization in children worldwide. RSV most commonly presents as an upper respiratory tract infection but frequently progresses to bronchiolitis in young infants—a lower respiratory tract illness characterized by small airway obstruction that may lead to respiratory failure, apnea, or death. In the United States, RSV is responsible for over 58,000 hospitalizations annually in children younger than 5 years.[1][2]

Recent advances have revolutionized RSV prevention through the development of maternal vaccines and long-acting monoclonal antibodies. The approval of maternal RSV vaccination with the bivalent prefusion F vaccine and use of monoclonal antibodies, including nirsevimab and clesrovimab, represents a paradigm shift in protecting vulnerable infants.[3][4] The mainstay of RSV treatment remains supportive care, as currently no safe and effective antiviral therapy has been developed.

Etiology

RSV, a nonsegmented, negative-sense, single-stranded RNA virus, belongs to the genus Orthopneumovirus within the family Pneumoviridae. This same family includes another common respiratory pathogen, human metapneumovirus (hMPV). First identified in chimpanzees in 1955 and later recognized as a human pathogen, RSV emerged as a medium-sized virus containing multiple structural proteins essential for infection.

The glycoproteins G and F play central roles in viral entry and pathogenesis. The G glycoprotein mediates attachment to respiratory epithelial cells and displays genetic variation that produces 2 antigenic subgroups, RSV-A and RSV-B. The F protein drives fusion between infected and adjacent cells, generating multinucleated syncytia that facilitate viral spread. However, both glycoproteins serve as critical targets for antiviral therapy and vaccine development.[5]

Epidemiology

RSV infects approximately 90% of children within the first 2 years of life, with recurrent infections throughout adulthood due to limited durable immunity.[6] In 2015, global estimates documented 33.1 million RSV-related acute lower respiratory infections, 3.2 million associated hospital admissions, and 59,600 deaths in children younger than 5 years. Current data reflect an annual worldwide burden of roughly 3.6 million hospitalizations and close to 100,000 deaths in children younger than 5 years, with most fatalities occurring in low- and middle-income countries.[1]

RSV follows a distinct seasonal pattern, with temperate regions experiencing winter-spring peaks that commonly span October through March in the Northern Hemisphere. The COVID-19 pandemic temporarily altered this pattern, although typical seasonality has largely reemerged.[7][8]

Elevated morbidity and mortality affect premature infants born before 29 weeks of gestation, children with chronic cardiac or pulmonary conditions, and immunocompromised patients. Recent evidence also highlights a significant disease burden in adults older than 60, with mortality rates approaching those observed in young children.[9][10]

Pathophysiology

RSV spreads through respiratory droplets and follows an incubation period of 2 to 8 days. After inoculation through the nasopharynx or conjunctiva, the virus targets ciliated epithelial cells within the respiratory tract. Furthermore, viral replication, combined with the host immune response, produces epithelial necrosis, leading to small airway obstruction due to mucus, cellular debris, and inflammatory edema.[11][12] This obstruction subsequently contributes to wheezing, air trapping, atelectasis, and hypoxemia characteristic of bronchiolitis. The immune response to RSV is characterized by type 2 (T helper 2)-biased inflammation and diminished interferon activity, which may contribute to the subsequent development of recurrent wheezing and asthma.[13]

Histopathology

Histopathology contributes minimally to RSV diagnosis. RSV infection of respiratory epithelial cells promotes cell fusion and formation of multinucleated syncytial giant cells. Typical histopathologic findings include sloughed epithelial cells, mucus plugging, necrosis, and peribronchiolar lymphocytic inflammation. Severe disease is characterized by more extensive respiratory epithelial cell death, airway edema, and prominent immune cell infiltration, with polymorphonuclear cells predominating early in the illness and lymphomononuclear cells emerging later.

History and Physical

Clinical Features of Upper Respiratory Involvement of Respiratory Syncytial Virus Infection in Children

RSV confined to the upper respiratory tract often produces nonspecific viral symptoms, including rhinorrhea, nasal congestion, cough, sneezing, and low-grade fever. These manifestations mirror those of many other viral respiratory infections, creating notable clinical overlap with routine childhood illnesses.[14] Mild upper airway disease may precede more significant lower airway involvement, particularly in young infants, and warrants close observation for early signs of progression.

Clinical Features of Lower Respiratory Involvement (Bronchiolitis) of Respiratory Syncytial Virus Infection in Children

Progression to bronchiolitis occurs most frequently in infants younger than 2 years of age, with heightened vulnerability in those who possess underlying risk factors, eg, prematurity or chronic cardiopulmonary disease. Classic findings include tachypnea and increased work of breathing marked by subcostal, intercostal, or suprasternal retractions, nasal flaring, wheezing, and prolonged expiration. Worsening disease may lead to hypoxemia and respiratory failure, prompting the need for timely clinical intervention.[15]

Clinical Features of Severe Manifestations of Respiratory Syncytial Virus Infection in Children

Severe RSV infection can present with apnea, particularly in very young or premature infants, along with lethargy, poor feeding, and significant respiratory distress. Cases of advanced disease may culminate in respiratory failure that requires escalation of care, including supplemental oxygen, high-flow respiratory support, or mechanical ventilation to stabilize gas exchange and prevent further deterioration.[9]

Evaluation

The diagnosis of RSV bronchiolitis relies primarily on clinical evaluation, with confirmatory testing generally reserved for situations where results would influence patient management, eg, cohorting or infection-control measures. Clinical assessment focuses on characteristic signs and symptoms, including tachypnea, increased work of breathing, wheezing, and hypoxemia, particularly in infants and high-risk populations.

When diagnostic testing proves necessary, rapid antigen assays provide results in under 1 hour at low cost, demonstrating 80% to 90% sensitivity in infants during outbreak periods. Sensitivity declines in older children and adults due to lower viral loads.[16] Reverse transcription polymerase chain reaction (RT-PCR) offers superior sensitivity, detects multiple respiratory pathogens simultaneously, and remains the preferred method for older children and adult patients. Routine chest radiography is not recommended and is not beneficial in cases of uncomplicated bronchiolitis, as this modality may yield nonspecific findings if performed. Common radiographic features include hyperinflation, patchy atelectasis, and peribronchial thickening, which rarely alter management decisions but may assist in evaluating atypical or severe presentations.[17]

Table

Pause and Reflect A 6-week-old full-term infant presents to the emergency department in January with 3 days of rhinorrhea and cough, now with increased work of breathing. The infant was born to a mother who declined RSV vaccination during pregnancy, and (more...)

Treatment / Management

Supportive Management

Supportive care remains the cornerstone of RSV management, as no safe and effective antiviral therapy exists for routine use.[15][16] Optimal supportive care focuses on maintaining adequate oxygenation, hydration, and ventilation while minimizing the risk of complications. Clinical management requires individualized strategies based on patient age, disease severity, and underlying risk factors, with careful monitoring for signs of respiratory distress or deterioration. 

Mild cases often require only careful monitoring and at-home symptom management, including ensuring adequate oral intake, maintaining comfort, and addressing nasal congestion. Supportive care also encompasses ongoing monitoring for complications, eg, apnea, secondary infections, or worsening hypoxemia. Evidence-based practices emphasize avoiding ineffective treatments, including routine bronchodilators, corticosteroids, and antibiotics in otherwise healthy infants, to reduce unnecessary interventions and improve overall outcomes.

Hydration

Hydration involves encouraging oral feeding when tolerated without significant signs of respiratory distress, using nasogastric tube feeding for infants with poor oral intake, and administering intravenous fluids for patients experiencing moderate to severe dehydration. Maintaining hydration supports airway clearance and prevents metabolic complications associated with reduced intake.

Oxygen therapy and respiratory support

Oxygen therapy targets hypoxemia with supplemental oxygen, generally maintaining oxygen saturation at a target typically between 90% and 92%. Respiratory support escalates according to need, beginning with a high-flow nasal cannula for increasing oxygen requirements and advancing to continuous positive airway pressure or mechanical ventilation in cases of respiratory failure.

Airway clearance

Airway clearance relies on gentle nasal suctioning and saline drops, avoiding deep suctioning due to potential prolongation of hospitalization.

Hospitalization Criteria

Patients with the following clinical factors should meet the criteria for inpatient management:

• Hypoxemia
• Inability to maintain hydration at home
• Young age (<3 months) with significant symptoms
• High-risk comorbidities (eg, prematurity, cardiac disease, and chronic lung disease)

Nonroutine Management Approaches

Evidence-based guidelines recommend against routine use of bronchodilators (eg, albuterol), hypertonic saline, and antibiotics in otherwise healthy infants, as these interventions do not improve clinically significant outcomes, length of stay, or hospitalization rates. Epinephrine is not routinely recommended, as patients show only transient improvement, with no change in hospitalization rates or length of stay. Furthermore, corticosteroids have been demonstrated to be ineffective for typical bronchiolitis.

Antibiotics have not been shown to be beneficial in most cases of RSV, as the risk of concurrent bacterial infection in healthy infants with RSV is less than 2%. Additionally, aerosolized ribavirin, approved for severe RSV in the 1980s, is rarely used today due to limited efficacy, administration challenges, and safety concerns, and remains reserved for select immunocompromised patients.[18][19]

Prevention Strategies

Nosocomial RSV prevention relies on structured infection-control programs. Early identification of suspected cases and rapid isolation reduces hospital-acquired transmission and protects high-risk patients.[20] Furthermore, RSV prevention strategies include maternal vaccination with the bivalent prefusion F vaccine administered between 32 and 36 weeks of gestation during September through February in the Northern Hemisphere. This approach provides robust protection for infants through 6 months of age, with real-world data demonstrating reduced hospitalizations and no significant increase in preterm birth beyond expected background rates.[3][21]

Additionally, long-acting monoclonal antibodies, including nirsevimab and the recently approved clesrovimab, confer approximately 5 months of protection and significantly reduce RSV-related hospitalizations. The Cents for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices guidance recommend these agents for all eligible infants, including certain high-risk children entering their second RSV season. Monthly palivizumab prophylaxis was discontinued in 2025 due to the superior convenience of long-acting agents. Despite these advances, uptake remains suboptimal, reflecting ongoing challenges in awareness, access, and implementation.[4]

Table

Pause and Reflect A clinician is counseling a pregnant woman at 33 weeks of gestation during her October prenatal visit. She asks about RSV prevention for her baby. Her insurance covers both maternal RSV vaccination and infant nirsevimab. Her due date (more...)

Differential Diagnosis

Differential diagnoses that should also be considered when evaluating patients with clinical features of RSV include:

• Viral bronchiolitis caused by other respiratory viruses (rhinovirus, metapneumovirus, influenza, parainfluenza)
• Asthma/reactive airway disease
• Bacterial or viral pneumonia
• Croup (laryngotracheobronchitis)
• Foreign body aspiration
• Congestive heart failure (in patients with cardiac disease)

Prognosis

Most infants and children with RSV infections improve on their own over time without requiring hospitalization. Children hospitalized for RSV usually recover without long-term sequelae. Typical hospitalization is 3 to 7 days. High-risk infants have more extended stays and higher rates of intensive care admission.[9] Overall mortality in the United States is less than 1%, with fewer than 400 annual deaths. Infants with congenital heart disease, extreme prematurity, or chronic lung disease have the highest mortality risk.[2]

RSV-infected individuals are contagious for 3 to 8 days, although some infants and immunocompromised patients may shed virus for up to 4 weeks.[11] Substantial evidence links severe early-life RSV infection with subsequent development of recurrent wheezing and childhood asthma. Studies show a 2- to 12-fold higher asthma risk in children with a history of RSV lower respiratory infection. Children without RSV infection in the first year have a 26% lower risk of asthma at age 5.[22][23]

Complications

RSV infection can lead to several complications, particularly in young infants, premature neonates, and individuals with underlying cardiopulmonary disease. The most common complications include dehydration due to poor feeding, acute otitis media, and progression to lower respiratory tract involvement, eg, bronchiolitis or pneumonia. Severe disease may cause apnea in young infants, acute respiratory failure requiring ventilatory support, and, less commonly, secondary bacterial infections. Long-term sequelae include recurrent wheezing and an increased risk of asthma development in later childhood, especially after severe early-life RSV infection. 

Extrapulmonary complications, while less common, may include cardiac (eg, myocarditis and arrhythmias) and neurologic events (eg, seizures and encephalopathy) and have been detected in both children and adults. Neurologically, recent data indicate RSV can directly infect nerve cells, triggering inflammation and potentially leading to long-term neurocognitive effects.[24] In critically ill infants, systemic signs, eg, troponin-elevated myocardial injury, arrhythmias, hyponatremia, and hepatitis have been documented.[25]

Deterrence and Patient Education

Effective deterrence of RSV in children relies on a combination of infection-control measures, environmental precautions, and immunoprophylaxis. Hand hygiene remains the single most important preventive strategy. Families should wash hands thoroughly before and after infant contact, regularly disinfect frequently touched surfaces, and avoid close interaction with individuals exhibiting respiratory symptoms.[26] Minimizing tobacco smoke exposure in the home is also critical, as smoke increases the risk of severe RSV disease and respiratory complications in infants.[27] Encouraging exclusive breastfeeding for at least 6 months provides additional protection by enhancing the infant’s immune defenses and reducing overall morbidity from respiratory infections, including RSV.[28]

Patient education should emphasize recognition of early RSV symptoms, understanding indications for medical evaluation, and awareness of preventive interventions such as maternal vaccination and long-acting monoclonal antibodies. Families should receive guidance on appropriate hydration, supportive care, and infection-control practices to limit household transmission. By combining these strategies with evidence-based clinical management, healthcare providers can empower caregivers to reduce RSV incidence, protect high-risk infants, and mitigate severe disease outcomes.

Enhancing Healthcare Team Outcomes

RSV is the leading cause of acute respiratory infections requiring hospitalization in young children worldwide. Most infections begin in the upper respiratory tract, presenting with nonspecific viral symptoms, but progression to bronchiolitis occurs frequently in infants younger than 2 years, especially those with prematurity or chronic comorbidities. Severe disease can cause apnea, hypoxemia, and respiratory failure. Management relies on supportive care, including hydration, oxygen therapy, respiratory support, and gentle airway clearance, while avoiding ineffective interventions such as routine bronchodilators, corticosteroids, or antibiotics. Prevention strategies, including maternal vaccination with the bivalent prefusion F vaccine, long-acting monoclonal antibodies, hand hygiene, breastfeeding, and avoidance of tobacco smoke, significantly reduce morbidity and hospitalizations, yet uptake remains suboptimal, highlighting the need for comprehensive clinician and caregiver education.

Effective management of RSV requires coordinated interprofessional care. Physicians, advanced practitioners, and general practitioners assess disease severity, determine the need for hospitalization, and initiate evidence-based supportive care. Nurses and respiratory therapists monitor vital signs, provide airway clearance, and administer oxygen or high-flow support while educating families on hydration, symptom monitoring, and infection-control practices. Pharmacists support safe administration of monoclonal antibodies and manage medication counseling, while infection-control teams implement measures to prevent nosocomial transmission. Collaboration across disciplines ensures consistent patient education, timely intervention, and adherence to guidelines, enhancing patient-centered care, reducing complications, and improving team performance and overall outcomes.

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References

1.

Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, Madhi SA, Omer SB, Simões EAF, Campbell H, Pariente AB, Bardach D, Bassat Q, Casalegno JS, Chakhunashvili G, Crawford N, Danilenko D, Do LAH, Echavarria M, Gentile A, Gordon A, Heikkinen T, Huang QS, Jullien S, Krishnan A, Lopez EL, Markić J, Mira-Iglesias A, Moore HC, Moyes J, Mwananyanda L, Nokes DJ, Noordeen F, Obodai E, Palani N, Romero C, Salimi V, Satav A, Seo E, Shchomak Z, Singleton R, Stolyarov K, Stoszek SK, von Gottberg A, Wurzel D, Yoshida LM, Yung CF, Zar HJ, Respiratory Virus Global Epidemiology Network. Nair H., RESCEU investigators. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022 May 28;399(10340):2047-2064. [PMC free article: PMC7613574] [PubMed: 35598608]

2.

Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, Auinger P, Griffin MR, Poehling KA, Erdman D, Grijalva CG, Zhu Y, Szilagyi P. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009 Feb 05;360(6):588-98. [PMC free article: PMC4829966] [PubMed: 19196675]

3.

Kampmann B, Madhi SA, Munjal I, Simões EAF, Pahud BA, Llapur C, Baker J, Pérez Marc G, Radley D, Shittu E, Glanternik J, Snaggs H, Baber J, Zachariah P, Barnabas SL, Fausett M, Adam T, Perreras N, Van Houten MA, Kantele A, Huang LM, Bont LJ, Otsuki T, Vargas SL, Gullam J, Tapiero B, Stein RT, Polack FP, Zar HJ, Staerke NB, Duron Padilla M, Richmond PC, Koury K, Schneider K, Kalinina EV, Cooper D, Jansen KU, Anderson AS, Swanson KA, Gruber WC, Gurtman A., MATISSE Study Group. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023 Apr 20;388(16):1451-1464. [PubMed: 37018474]

4.

Jones JM, Fleming-Dutra KE, Prill MM, Roper LE, Brooks O, Sánchez PJ, Kotton CN, Mahon BE, Meyer S, Long SS, McMorrow ML. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Aug 25;72(34):920-925. [PMC free article: PMC10468217] [PubMed: 37616235]

5.

Kaler J, Hussain A, Patel K, Hernandez T, Ray S. Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus. 2023 Mar;15(3):e36342. [PMC free article: PMC10111061] [PubMed: 37082497]

6.

Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986 Jun;140(6):543-6. [PubMed: 3706232]

7.

Obando-Pacheco P, Justicia-Grande AJ, Rivero-Calle I, Rodríguez-Tenreiro C, Sly P, Ramilo O, Mejías A, Baraldi E, Papadopoulos NG, Nair H, Nunes MC, Kragten-Tabatabaie L, Heikkinen T, Greenough A, Stein RT, Manzoni P, Bont L, Martinón-Torres F. Respiratory Syncytial Virus Seasonality: A Global Overview. J Infect Dis. 2018 Apr 11;217(9):1356-1364. [PubMed: 29390105]

8.

Eden JS, Sikazwe C, Xie R, Deng YM, Sullivan SG, Michie A, Levy A, Cutmore E, Blyth CC, Britton PN, Crawford N, Dong X, Dwyer DE, Edwards KM, Horsburgh BA, Foley D, Kennedy K, Minney-Smith C, Speers D, Tulloch RL, Holmes EC, Dhanasekaran V, Smith DW, Kok J, Barr IG., Australian RSV study group. Off-season RSV epidemics in Australia after easing of COVID-19 restrictions. Nat Commun. 2022 May 24;13(1):2884. [PMC free article: PMC9130497] [PubMed: 35610217]

9.

Reeves RM, Hardelid P, Panagiotopoulos N, Minaji M, Warburton F, Pebody R. Burden of hospital admissions caused by respiratory syncytial virus (RSV) in infants in England: A data linkage modelling study. J Infect. 2019 Jun;78(6):468-475. [PubMed: 30817978]

10.

Savic M, Penders Y, Shi T, Branche A, Pirçon JY. Respiratory syncytial virus disease burden in adults aged 60 years and older in high-income countries: A systematic literature review and meta-analysis. Influenza Other Respir Viruses. 2023 Jan;17(1):e13031. [PMC free article: PMC9835463] [PubMed: 36369772]

11.

Hall CB, Douglas RG. Modes of transmission of respiratory syncytial virus. J Pediatr. 1981 Jul;99(1):100-3. [PubMed: 7252646]

12.

Russell CD, Unger SA, Walton M, Schwarze J. The Human Immune Response to Respiratory Syncytial Virus Infection. Clin Microbiol Rev. 2017 Apr;30(2):481-502. [PMC free article: PMC5355638] [PubMed: 28179378]

13.

Zhivaki D, Lemoine S, Lim A, Morva A, Vidalain PO, Schandene L, Casartelli N, Rameix-Welti MA, Hervé PL, Dériaud E, Beitz B, Ripaux-Lefevre M, Miatello J, Lemercier B, Lorin V, Descamps D, Fix J, Eléouët JF, Riffault S, Schwartz O, Porcheray F, Mascart F, Mouquet H, Zhang X, Tissières P, Lo-Man R. Respiratory Syncytial Virus Infects Regulatory B Cells in Human Neonates via Chemokine Receptor CX3CR1 and Promotes Lung Disease Severity. Immunity. 2017 Feb 21;46(2):301-314. [PMC free article: PMC7128247] [PubMed: 28228284]

14.

Meissner HC. Viral Bronchiolitis in Children. N Engl J Med. 2016 Jan 07;374(1):62-72. [PubMed: 26735994]

15.

Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017 Jan 14;389(10065):211-224. [PMC free article: PMC6765220] [PubMed: 27549684]

16.

Ralston SL, Lieberthal AS, Meissner HC. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014;134(5):e1474-e1502. Pediatrics. 2015 Oct;136(4):782. [PubMed: 26430140]

17.

Chartrand C, Tremblay N, Renaud C, Papenburg J. Diagnostic Accuracy of Rapid Antigen Detection Tests for Respiratory Syncytial Virus Infection: Systematic Review and Meta-analysis. J Clin Microbiol. 2015 Dec;53(12):3738-49. [PMC free article: PMC4652120] [PubMed: 26354816]

18.

Ohmit SE, Moler FW, Monto AS, Khan AS. Ribavirin utilization and clinical effectiveness in children hospitalized with respiratory syncytial virus infection. J Clin Epidemiol. 1996 Sep;49(9):963-7. [PubMed: 8780603]

19.

Ventre K, Randolph AG. Ribavirin for respiratory syncytial virus infection of the lower respiratory tract in infants and young children. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD000181. [PubMed: 17253446]

20.

Karanfil LV, Conlon M, Lykens K, Masters CF, Forman M, Griffith ME, Townsend TR, Perl TM. Reducing the rate of nosocomially transmitted respiratory syncytial virus. Am J Infect Control. 1999 Apr;27(2):91-6. [PubMed: 10196485]

21.

Fleming-Dutra KE, Jones JM, Roper LE, Prill MM, Ortega-Sanchez IR, Moulia DL, Wallace M, Godfrey M, Broder KR, Tepper NK, Brooks O, Sánchez PJ, Kotton CN, Mahon BE, Long SS, McMorrow ML. Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Oct 13;72(41):1115-1122. [PMC free article: PMC10578951] [PubMed: 37824423]

22.

Rosas-Salazar C, Chirkova T, Gebretsadik T, Chappell JD, Peebles RS, Dupont WD, Jadhao SJ, Gergen PJ, Anderson LJ, Hartert TV. Respiratory syncytial virus infection during infancy and asthma during childhood in the USA (INSPIRE): a population-based, prospective birth cohort study. Lancet. 2023 May 20;401(10389):1669-1680. [PMC free article: PMC10367596] [PubMed: 37086744]

23.

Zar HJ, Cacho F, Kootbodien T, Mejias A, Ortiz JR, Stein RT, Hartert TV. Early-life respiratory syncytial virus disease and long-term respiratory health. Lancet Respir Med. 2024 Oct;12(10):810-821. [PubMed: 39265601]

24.

Riccò M, Cascio A, Corrado S, Bottazzoli M, Marchesi F, Gili R, Giuri PG, Gori D, Manzoni P. Occurrence of Central Nervous System Complications of Respiratory Syncytial Virus Infections: A Systematic Review with Meta-Analysis. Epidemiologia (Basel). 2024 Jul 19;5(3):421-455. [PMC free article: PMC11270441] [PubMed: 39051211]

25.

Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review. Crit Care. 2006;10(4):R107. [PMC free article: PMC1751022] [PubMed: 16859512]

26.

Hall CB. The nosocomial spread of respiratory syncytial viral infections. Annu Rev Med. 1983;34:311-9. [PubMed: 6344761]

27.

Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res. 2011 Jan 10;12(1):5. [PMC free article: PMC3022703] [PubMed: 21219618]

28.

Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006 Feb;117(2):425-32. [PubMed: 16452362]

Disclosure: Phani Prabhakara Srinivasa Sastry Chamarthi declares no relevant financial relationships with ineligible companies.

Disclosure: Venkata Sushma Chamarthi declares no relevant financial relationships with ineligible companies.

Disclosure: Sharon Daley declares no relevant financial relationships with ineligible companies.