The child coughs incessantly and recognizes the respiratory tract fusion virus

        When children are sick, upper respiratory tract symptoms or gastrointestinal symptoms are most common. Among them, upper respiratory tract infections may be caused by viruses or bacteria. The symptoms caused by the former, in addition to mild coughing and runny nose, may also lead to complications or severe illness. In addition to the recent severe respiratory diseases caused by influenza viruses, respiratory fusion viruses can also pose a significant threat to the health of infants and young children. After all, the immune system of infants and young children is weak, and once infected, the disease course and symptoms may develop rapidly, requiring special attention. In this issue of "Health Column", we will introduce you to respiratory fusion viruses.

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What is respiratory tract fusion virus?        

       Respiratory Syncytial Virus (RSV) is a single stranded RNA virus that causes respiratory tract infections through droplets and contact. Patients may become infected by inhaling virus droplets or coming into contact with infected individuals' mouth and nose secretions, or by touching surfaces or objects contaminated with the virus in the environment and then touching their own mouth and nose. The time for viruses to survive on the surface of objects varies, for example, they can survive for more than 30 minutes on soft surfaces and more than 24 hours on smooth hard surfaces. Therefore, cluster infections often occur in postpartum centers, kindergartens, or childcare centers, and after infection, lifelong immunity cannot be achieved. Therefore, caution should still be taken to prevent them.

        Although respiratory tract fusion virus infection is more common in winter, there are actually cases in Taiwan all year round. Humans are the only host of this virus, and it can infect people of all ages. The younger the patient, the more severe the symptoms may be. When infants and young children under one year old are infected and their small bronchioles are blocked by secretions, causing bronchiolitis, they need to seek medical treatment as soon as possible.

 

Symptoms of respiratory tract fusion virus

        The incubation period (referring to the time from infection to clinical symptoms) is about 3-5 days, usually recovering within 1-2 weeks, but patients with weakened immunity may last longer. In the early stages, the main symptoms of upper respiratory tract infection include runny nose, cough, and mild fever. Infants and young children may experience dangerous conditions such as decreased activity, cessation of breathing, or difficulty breathing. After infection, due to excessive secretion of mucus, bronchioles narrow and coughing becomes more severe, especially in infants and young children who are prone to lower respiratory tract symptoms such as wheezing. If the condition rapidly worsens, it may develop into serious conditions such as difficulty breathing or unstable blood oxygen.

 

High risk populations and risk factors for respiratory tract fusion virus infection

        According to an article by the Taiwan Pediatric Association in November 2022, the main target of infection for respiratory tract fusion virus is children under 5 years old, with the highest hospitalization rate among children under 2 years old. Other high-risk groups include premature infants, children with chronic lung disease, congenital heart disease, chromosomal abnormalities, immunodeficiency, neuromuscular diseases, and others. In addition, having siblings or infants in a daycare center at home can increase the risk of group transmission. As for having a family history of asthma and allergies, long-term exposure to secondhand smoke (including women smoking during pregnancy), and short breastfeeding time, they are also high-risk groups.

 

How to diagnose respiratory tract fusion virus?

        Medical personnel can use patients' nasopharyngeal secretions for virus culture or use PCR to detect RNA to diagnose respiratory tract fusion viruses. However, due to the long time required, rapid antigen testing (rapid screening) is currently available for screening in clinical practice.

 

How to treat respiratory tract fusion virus?

        The main approach is supportive therapy (treating symptoms), where medical personnel use medication to alleviate discomfort in children, but ultimately rely on their own immune system to resist the virus. If there are mild symptoms of aspiration, patients can take medication and sputum at home, and closely monitor their aspiration, activity, and appetite. Once they progress to rapid aspiration or other serious symptoms, they must immediately seek emergency treatment or hospitalization.

 

How to prevent respiratory tract fusion virus?

        Washing hands frequently, wearing masks, avoiding contact with sick people, reducing access to crowded public places, and maintaining appropriate social distancing are all important methods for preventing infection; Breastfeeding and reducing exposure to secondhand smoke can also lower the risk of respiratory tract fusion virus infection.

• In addition, vaccination with Palivizumab can prevent viral proliferation, protect infants and young children, and prevent RSV infection. At present, the groups eligible for health insurance coverage include:
• Premature infants born before 33 weeks.
• Premature infants born under 35 weeks old with chronic lung disease.
• Infants and young children under the age of 1 with severe congenital heart disease can consult a pediatric cardiologist.

        According to the prevention recommendations for RSV by neonatologists and pediatric infectious disease experts in 2023, premature infants born at 33-35 weeks (+6 days) and under one year of age can receive their first dose of Palivizumab after evaluation by a physician. It is recommended to receive the first dose of Palivizumab once a month, with 3-6 doses depending on the risk. This year, long-acting RSV monoclonal antibodies have been launched in Taiwan and are available for infants and young children to receive vaccination. One dose provides up to five months of protection.

 

Doctor's advice

        Children often experience cold symptoms such as coughing, runny nose, and fever. To identify the pathogenic virus or bacteria, clinical judgment and examination are necessary. In the face of respiratory tract fusion viruses, 'prevention is better than cure' is the key. If you have any needs or questions regarding monoclonal antibody vaccination, please consult at the pediatric clinic to safeguard your child's future.

 

*Dr. Guo Zimin's expertise includes the treatment and consultation of common pediatric diseases, neonatal health consultation, neonatal intensive care medicine, vaccine injection and consultation, infant and young child health examination and development assessment and screening.     

 

 

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