RSV

Question 1

RSV
- Baltimore Class
- RNA/DNA
- ss/ds

Answer 1

Baltimore class V
negative sense RNA

Question 2

At risk of severe disease from RSV

Answer 2

• <6/12
• infants with immunodeficiency, neuromuscular conditions, congential cardiac abnormalities and severe lung disease
• Frail elderly

Question 3

incubation and likely infectious period of RSV. Classical presentation in young

Answer 3

• 4-7 days incubation
• Contagious for 1 - 2 days prior to symptoms
• Virus disappearing from system by the time symptoms arrive
• Symptoms start in UTRI
  ○ Nasal congestion, rhinorrhoea
• Progress to lower resp tract
  ○ Bronchiolitis
  ○ Wheeze
  ○ Increased WOB
  ○ Tracheitis
  Apneic episodes

Question 4

RSV antigenic vaccine/MAB target

Answer 4

F protein (both pre and post fusion forms targeted)

Question 5

RSV - who gets vaccinated in the UK

Answer 5

Pregnant women at 28 weeks gestation
Adults at 75 (single dose)

Question 6

RSV - who gets MAB prophylaxis

Answer 6

• MAB immunisation
  ○ Mod or severe chronic lung disease of prematutity (AKA bronchopulmonary dysplasia)
  ○ High risk infants at the start of RSV season (usually on o2)
  § Pulmonary hypoplasia
  § Interstital lung disease
  § Congenital lung abnormalities
  ○ SCID
  ○ Haemodynamically significant congenital heart disease
  ○ “Where clinical judgement of other indvidual patient circumstances strongly suggests that prophylaxis would prevent serious RSV infection”

Question 7

If a baby’s mother was immunised in pregnancy but the baby was in a high risk category, would it still receive MAB prophylaxis?

Answer 7

yes - “this should be offered regardless of whether the mother was vaccinated during pregnancy”

Question 8

Treatment of severe RSV

Answer 8

Supportive
Nebulised ribavirin (v poor evidence)
IVIG (even poorer evidence)