Respiratory syncytial virus (RSV) is the most common cause of viral lower respiratory tract disease in infancy and early childhood, during yearly winter epidemics. High-risk groups for severe disease are children born prematurely, children with congenital heart disease or Down syndrome. Patients with cellular immune deficiencies are at risk of severe RSV pneumonia. The mortality of RSV bronchiolitis is less than 1%. However, in the risk groups it can be as high as 3–4%. A subgroup of patients needs to be admitted to the paediatric intensive care unit. Some recent evidence suggests these babies have a different disease entity than children admitted with bronchiolitis on medium care facilities. RSV bronchiolitis during infancy is linked epidemiologically to symptomatic childhood asthma. Epidemiological evidence suggests that viruses other than RSV can cause a similar clinical syndrome, especially human metapneumovirus, human bocavirus and some strains of newly discovered coronaviruses. Finally, no effective treatment for RSV bronchiolitis is available. Ribavirin has not lived up to the original expectations suggesting a more rapid recovery of disease. Bronchodilators can be used on a trial and error basis. Corticosteroids cannot be advocated except maybe in the most severe, mechanically ventilated patients. A vaccine is not to be expected in the near future. However, passive prophylaxis of high-risk children with hyperimmune anti-RSV immunoglobulins or monoclonal antibodies (palivizumab) reduces the hospitalisation rate by 50% or more, making prevention feasible in children experiencing most of the disease.
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