Disease and Symptoms
RSV Disease Overview
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RSV – a common cause of respiratory illness
Respiratory syncytial virus (RSV) is a common cause of respiratory disease affecting all ages. Infants, young children and vulnerable adults are at greatest risk of severe RSV infection.1
RSV is the most common cause of acute lower respiratory infection in infants2
Most children have had an RSV infection by 2 years of age3
The protective immunity after RSV natural infection is not long-lasting, and re-infection occurs throughout life.4,5
Older adults are at risk of severe infection and associated complications due to age-related decline in immunity6
Adults with chronic heart, lung disease or weakened immune systems are at greater risk of severe RSV infection6
RSV is a contagious virus with multiple routes of transmission11
People infected with RSV are usually contagious for 3 to 8 days.11 Within families, RSV has been shown to spread rapidly, with older siblings or parents the most likely source of infant RSV infections.12,13
There are multiple routes of transmission11:
Coughing or sneezing spreads virus-filled droplets that then come into contact with other peoples’ noses, mouths or eyes
Direct contact with nasal or oral secretions from infected people
Indirect contact with nasal or oral secretions from infected people: RSV can survive on hard surfaces for many hours
Typically, RSV infections in adults result in mild, cold-like symptoms which may be indistinguishable from those of other respiratory infections.14
Frequency of clinical manifestations of respiratory viral infections in older adults, by virus15*
*These results were published by Kodama F et al. 2017.15 The table was independently created for GSK from the original data
However, RSV can lead to serious conditions, such as:6,16
RSV seasons vary by region, peaking during winter in temperate climates17,18
Globally, seasonal RSV epidemics within most regions remain relatively consistent with some year-to-year variation. In the US, RSV season onset, duration, and peak incidence varies.
Graph above was reproduced from Baker RE et al. Nat Commun 2019, under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).
Neutrophils and eosinophils contribute to RSV pathogenesis19
RSV replicates almost exclusively in apical ciliated epithelial cells
RSV causes a neutrophil-intensive inflammation of the airways.
The degree of inflammation correlates with severity of infection.
Lower airway obstructions are caused by cellular inclusions consisting of mucus, DNA, and cell debris that mainly derives from this neutrophil infiltration.
RSV infection can also be accompanied by eosinophilia, which is particularly marked in the most severe cases.
Humoral and cell-mediated immune responses are necessary to clear RSV infection19-21
Neutralizing antibodies (nAbs) help prevent RSV infection through the inhibition of viral replication. nAbs inhibit the entry and spread of RSV in the human airway epithelium.21
RSV specific T-cell response reduces disease severity through promotion of viral clearance21
APC = antigen-presenting cell; CD8+ T cell = cytotoxic T cell; IgA/E/G = immunoglobulin A/E/G.
Republished with permission of American Society for Microbiology, from Russell CD et al. Clin Microbiol Rev 2017;30:481–502.
Learn more about RSV disease and its burden in adults:
Abbreviations
COPD, chronic obstructive pulmonary disorder; CHF, congestive heart failure; DNA, deoxyribonucleic acid
References
- Walsh EE. Clin Chest Med 2017;38:29–36.
- Nair H et al. Lancet 2010;375:1545–1555.
- CDC, 2020. RSV in infants and young children. https://www.cdc.gov/rsv/high-risk/infants-young-children.html. Accessed July 2022.
- Graham BS. Immunol Rev 2011;239:149–166.
- Anderson LJ et al. Vaccine 2013;31S:B209–B215.
- CDC, 2020. RSV in older adults and adults with chronic medical conditions. https://www.cdc.gov/rsv/high-risk/older-adults.html. Accessed July 2022.
- McLellan JS et al. Curr Top Microbiol Immunol 2013;372:83–104.
- Mejias A et al. Ann Allergy Asthma Immunol 2020;125:363–346
- Tian J et al. J Gen Virol 2013;94:1691–1700.
- Battles MB, McLellan JS. Nat Rev Microbiol 2019;17:233–245.
- CDC, 2018. RSV transmission. https://www.cdc.gov/rsv/about/transmission.html. Accessed July 2022.
- Barr R et al. Ther Adv Infect Dis 2019;6:1–9.
- Heikkinen T et al. Open Forum Infect Dis 2015;2:ofu118.
- CDC, 2018. RSV – For Healthcare Providers. https://www.cdc.gov/rsv/clinical/index.html. Accessed July 2022.
- Kodama F et al. Infect Dis Clin North Am 2017;31:767–790.
- CDC, 2022. Older Adults Are at High Risk for Severe RSV Infection. https://www.cdc.gov/rsv/factsheet-older-adults.pdf. Accessed October 2022.
- Lehners N et al. PLoS One 2016;11:e0148258
- Baker RE et al. Nat Commun 2019;10:5512.
- Griffiths C et al. Clin Microbiol Rev 2017;30:277–319.
- Russell CD et al. Clin Microbiol Rev 2017;30:481–502.
- Openshaw PJM et al. Annu Rev Immunol. 2017 Apr 26;35:501-532.
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NX-GBL-RSA-WCNT-220002 | January 2023