Orthopneumovirus hominis
Electron micrograph of filamentous RSV particles
Virus classification
(unranked):	Virus
Realm:	Riboviria
Kingdom:	Orthornavirae
Phylum:	Negarnaviricota
Class:	Monjiviricetes
Order:	Mononegavirales
Family:	Pneumoviridae
Genus:	Orthopneumovirus
Species:	Orthopneumovirus hominis
Synonyms[1]
Human respiratory syncytial virus (hRSV) Respiratory syncytial virus (RSV)

Respiratory syncytial virus (RSV),^[a] also called human respiratory syncytial virus (hRSV) and human orthopneumovirus, is a contagious virus that causes infections of the respiratory tract. It is a negative-sense, single-stranded RNA virus.^[2] Its name is derived from the large cells known as syncytia that form when infected cells fuse.^[2][3]

RSV is a common cause of respiratory hospitalization in infants, and reinfection remains common in later life though often with less severity. It is a notable pathogen in all age groups. Infection rates are typically higher during the cold winter months, causing bronchiolitis in infants, common colds in adults, and more serious respiratory illnesses, such as pneumonia, in the elderly and immunocompromised.^[4]

RSV can cause outbreaks both in the community and in hospital settings. Following initial infection via the eyes or nose, the virus infects the epithelial cells of the upper and lower airway, causing inflammation, cell damage, and airway obstruction.^[2] A variety of methods are available for viral detection and diagnosis of RSV including antigen testing, molecular testing, and viral culture.^[3]

The main recommended prevention measures include hand-washing and avoiding close contact with infected individuals.^[5] The detection of RSV in respiratory aerosols,^[6] along with the production of fine and ultrafine aerosols during normal breathing, talking,^[7] and coughing,^[8] and the emerging scientific consensus around transmission of all respiratory infections,^[9] airborne precautions may also be required for reliable protection. In May 2023, the US Food and Drug Administration (FDA) approved the first RSV vaccines, Arexvy (developed by GSK plc) and Abrysvo (Pfizer).^[10][11]

Treatment for severe illness is primarily supportive, including oxygen therapy and more advanced breathing support with continuous positive airway pressure (CPAP) or nasal high flow oxygen, as required. In cases of severe respiratory failure, intubation and mechanical ventilation may be required. Ribavirin is an antiviral medication licensed for the treatment of RSV in children.^[12]

History

Origin

Respiratory syncytial virus (RSV) was discovered in 1956 from a laboratory chimpanzee with upper respiratory tract disease. When 14 chimpanzees were observed with cold-like symptoms, Morris and colleagues discovered a new virus they initially named the "chimpanzee coryza agent" (CCA). Later, Chanock and colleagues showed that this virus also caused respiratory illness in humans by isolating it from two children, one with a throat and voice box infection and the other with a lung infection. They found that this virus was similar to CCA. When a specific antibody against CCA was found in most school-aged children, the virus was renamed "respiratory syncytial virus" to better reflect its effects on health and laboratory findings.^[13] The discovery of this disease is extremely important as it identifies a new virus that affects animals and humans.

Through the discovery of neutralizing antibodies in children and confirmation that the virus causes respiratory illness, this disease was named as respiratory syncytial virus. This name also emphasizes a characteristic observed during infection which is fused cells. RSV belongs to the Mononegavirales group which is viruses with nonsegmented negative-sense RNA genomes. RSV also falls under the family Paramyxoviridae which is a family of single-stranded RNA viruses causing different types of infections in vertebrates.^[14] Furthermore, RSV is part of a subfamily named Pneumovirinae which are viruses primarily affecting the respiratory tract.

Environmental conditions such as temperature and pH can lead to decreased infectivity because RSV is sensitive to them. Studies have researched RSV's survival capabilities on environmental surfaces and found that RSV can survive for many hours on nonporous surfaces and can be transmitted through respiratory droplets and direct contact.^[13]

RSV treatment and prevention globally

The burden of respiratory syncytial virus is high in younger children in low and middle-income countries. The "PROUD (Preventing Respiratory Syncytial Virus in underdeveloped countries) taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in low- and middle-income countries (LMIC)s, including vaccine and newer preventive measures." ^[15] RSV and lower respiratory tract infections (LRTI) cause over "3 million hospitalizations and over 100,000 deaths in children under 5 years every year." ^[15] Around "90%" of these mortality rates occur in LMICs "where RSV has been reported to be the most frequent cause of mortality among infants beyond the neonatal period."^[15] In the past two decades, the World Health Organization has made it their priority for RSV and LRTI prevention measures. However, even with "60 years of research," the "preventive measures for RSV disease remain limited to good hygiene and the use of palivizumab, a monoclonal antibody used only for high-risk children, including premature infants (≤35 weeks' gestational age) and those with congenital heart disease and bronchopulmonary dysplasia."^[15]

One of the main concerns is securing access to different types of intervention at a sustainable and affordable cost for "improving the management of RSV in LMICs."^[15] Even with the administration of vaccines and "monoclonal antibodies," lower and middle-income countries have access to limited health care and have a "lack of awareness/understanding of the public health impact of RSV among healthcare professionals (HCPs)."^[15] There is also a "lack of reliable local/regional epidemiological and disease burden data to inform cost-effectiveness assessment and guide preventive efforts, and lack of access to point-of-care tests."^[15] The PROUD taskforce of 24 global RSV was developed to aid in "understanding and propose solutions to these challenges."^[15] The goal of the taskforce is to pressure policymakers, influential health providers, public health organizations, and associations to work together to fight RSV in lower and middle-income countries.^[15] One of the many first steps the PROUD taskforce took to achieve its goal was creating a "detailed assessment of the key considerations and priorities for the prevention and management of RSV infection in LMICS."^[15] They did this through a "global, online based survey of HCPS."^[15]

Differences in treatment and prevention vary globally and RSV symptoms and prevalence varies culturally as well. In an article titled, Comparisons between ethnic groups in hospitalizations for respiratory syncytial virus bronchiolitis in Israel, "Ethnic disparities in RSV bronchiolitis have been documented A study from the United States showed higher rates of RSV hospitalizations in black children than white children aged 12–23 months; yet differences were not found in incidence rates in the first year of life, nor in the severity of disease."^[16] The ways that certain areas of the world handle RSV and other viruses vary due to cultural reasons as well as medical preferences. For example, preventative measures may be viable sources in one area of the world such as vaccines and staying up to date on doctor visits, but in other places, preventative care may not be such a large option or opportunity for everyone. Socioeconomic status may also play a role in this disparity of care as certain places have more medical assistance and resources present than others. Zdroj:https://en.wikipedia.org?pojem=Respiratory_syncytial_virus
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