Demystifying RSV: beyond a mild cold for many

Long before your first childhood memory, you were probably already unknowingly infected with RSV (Respiratory Syncytial Virus). But this is the virus that keeps on giving, because unfortunately, most individuals can and will get RSV over and over again throughout their lifetime.But why do we need a vaccine for a virus that causes little more than the symptoms of a mild cold for the majority of us? Read on to learn more. It is true that an estimated 86% of people are infected with the Respiratory Syncytial Virus (RSV) at least once by the time they reach 3.5 years of age. In the United States, this generally “mild” virus, however, causes 60,000 to 120,000 hospitalizations each year, and up to 6,000 to 10,000 deaths. These staggering numbers, combined with the lack of information surrounding RSV, inspired us to create an educational video about the ins and outs of why this virus should be taken seriously, and why some individuals are at greater risk than others.Let’s break down some of the details. For those who enjoy a more visual learning experience, access to our full video can be found here: RSV in Adults (Respiratory Syncytial Virus): What You Need to Know (youtube.com)What type of virus is this?RSV is a single-stranded enveloped RNA virus, which uses its surface proteins to attach to the airway mucosa. Similar to other viruses, after gaining entry into the cell, it then replicates itself within the host causing a myriad of virus copies that lead to RSV infection. The virus has 2 subtypes-A & B and a multitude of subtypes. For this reason, immunity to RSV is short-lived and incomplete causing recurrent infections.RSV affects some groups of individuals disproportionatelyMost immunocompetent adults who are infected with RSV will present with mild, self-limiting symptoms. However, the individuals listed below are at greater risk and could potentially have severe implications when infected:Babies less than 6 months old (especially if they were born prematurely.)Immunocompromised individualsIndividuals with underlying cardiovascular or lung diseaseIndividuals over the age of 60 years due to a natural aging of the immune system known as immunosenescence. (See explanation below.)How and when is RSV transmitted?RSV viral activity usually starts in the fall and peaks during winter. The amount of activity varies every year within different regions. We know that RSV can survive on hands for one hour and on surfaces for three-30 hours. Transmission is via respiratory droplets and contaminated surfaces, hence prevention strategies include frequent hand-washing, disinfecting high-contact surfaces and wearing a mask during respiratory season for at-risk individuals.RSV symptoms are usually similar to other respiratory illnessesIn healthy adults, these symptoms include runny nose, sore throat and headache.In children older than a year the infection is usually mild and self-limiting, but teens and adults can remain completely asymptomatic yet still be contagious.In older adults, symptoms may include increased sputum production, wheezing, shortness of breath and chest congestion. In general, for mild cases, the absence of fever and fatigue distinguishes RSV from influenza. In individuals 65 years and older however, symptoms can quickly proceed to the lower respiratory tract and become severe.Immunosenescence and age-related complicationsImmunosenescence refers to an age-related decline in immunity due to decreased quality and quantity of T-cells in the body required for clearing off infections.Additionally, our lung tissue changes as we age. As the body ages, we know that one will experience reduced lung tissue elasticity, a decline in the quality of the protective mucosal barrier and a decrease in ciliary function, thus impeding the ability of the body to physically remove or clear the virus before it is able to cause infection. As a result, for older individuals, especially those who have one of the above-mentioned risk factors, RSV can lead to complications such as:PneumoniaAsthma and COPD exacerbationsPoor control in Congestive Heart Failure (CHF)Cardiovascular injury leading to increased risk of heart attacks, arrhythmias, and plaque destabilization due to the inflammation caused by the virus.RSV is a vaccine-preventable disease!Two types of vaccines are currently available in Canada for RSV: Arexvy and Abrysvo. These are protein-based inactivated vaccines currently approved for a single dose.Arexvy is an adjuvanted vaccine approved for individuals 60 years of age and older. The effectiveness for prevention of severe symptoms sits at 85% for the first season, then drops to 67% for the second season. Most common side effects include injection site pain, fatigue, muscle and joint aches, and headaches.Abrysvo, on the other hand, is non-adjuvanted, approved for those 60 years of age and older as well as for pregnant individuals to provide protection in infants for their first year of life. Studies have shown effectiveness for prevention of severe lower respiratory tract infections in infants up to 81.8% within 90 days of birth, dropping to 69.4% within 180 days of birth. The most common side effects in pregnant individuals were reported to include injection site pain, headache, muscle aches and nausea, while those 60 years of age and older may experience fatigue, headaches, muscle aches and injection site pain. (Please see product monographs for a full list of possible side effects.)For a more comprehensive overview of RSV, refer to the full video on the Friendly Pharmacy 5 Channel here.Finally, there is emerging evidence that probiotics and the gut microbiome may have protective effects towards respiratory tract infections such as RSV, influenza and even COVID-19. Though this is new science and is certainly not a replacement for prevention via vaccination, we have another video which discusses this issue exclusively and can be accessed here: How COVID-19 Attacks the Gut and Causes Long-Term Symptoms (youtube.com)Access expert interviews and evidence-based health content at your fingertips on the Friendly Pharmacy 5 Channel, also on Spotify and Apple PodcastsLindsay Dixon is a pharmacist, educator, health content creator, and public health ambassador for Heart Pharmacy Group. She is also the Founder of Friendly Pharmacy 5 & CreateRx. For collaborations or consulting services: friendlypharmacy5@gmail.comShaheena Fakir is a registered community pharmacist in Ontario, practising as a pharmacy manager in Waterloo, ON. She obtained her BPharm from Rhodes University South Africa. She is also immunizations and injections certified, specialty molecules injection trainer, CDE (Certified Diabetes Educator) and currently completing a certification in PGx (Pharmacogenomics) through APMA. Additionally, she is a preceptor for EPE/APPE rotations for University of Toronto PharmD students, and also serves as a volunteer on IVPN-Personalized medicine listserv. education core team.

Demystifying RSV: beyond a mild cold for many

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