RSV, How Pharmacists Can Help Patients Prevent and Manage Infections

January 18, 2023 - As respiratory syncytial virus (RSV), influenza (flu), and COVID-19 cases surge across the United States, pharmacists are encouraged to use their advanced healthcare role to educate patients and caregivers about preventing the transmission of RSV to reduce health burdens and prevent mortality, especially in infants, children, immunocompromised individuals, and older adults (65+).

“With a host of respiratory illnesses circulating right now, including influenza, COVID-19, and RSV — prevention is key,” emphasized Nishita Hira, PharmD, CSP, Clinical Program Manager at AllianceRx Walgreens Pharmacy, in an interview with PharmaNewsIntelligence.

The tripledemic, a combined rise of COVID-19, RSV, and influenza infections, has resulted in many unfavorable clinical outcomes. With the ongoing COVID-19 pandemic, RSV and influenza infections have been significantly higher this season than in previous years, causing a shortage of hospital beds and medications and placing a strain on the pharmaceutical supply chain.

“Pharmacists, especially specialty pharmacists, can play an integral role in the fight against RSV by educating patients on using best practices for prevention, recognizing early symptoms, and helping patients decide when to call their healthcare provider,” explained Anastasia Abramson, PharmD, MBA, Pharmacy Supervisor, Patient Management Services at AllianceRx Walgreens Pharmacy. “Through the relationship pharmacists build with their patients, they have the opportunity to identify and tailor education needs dependent upon each person's situation.”

What Is RSV?

Respiratory syncytial virus, most frequently referred to as RSV, is a common respiratory virus that causes annual outbreaks accompanied by mild, cold-like symptoms in people of all ages. Although most people recover in 7–14 days, this virus can be severe or life-threatening for some, especially infants, young children, older adults, and immunocompromised individuals.

According to the American Lung Association, RSV is the leading cause of hospitalization in all infants. It is recognized as a common cause of childhood illnesses — so common that most children are infected with RSV by age 2. In the US, pulmonary infections such as bronchiolitis and pneumonia are most commonly caused by RSV infections in children younger than 12 months.

According to the CDC, infants (from premature to 6 months) and children with the following underlying conditions are at high risk of infection:

• chronic lung or congenital heart disease (for children younger than 2)
• a suppressed immune system
• neuromuscular disorders

Because RSV infections can exacerbate underlying heart and lung conditions, “RSV can be just as dangerous for adults who are over 65, have a chronic heart or lung condition, or have a weakened immune system,” Hira added.

Additionally, RSV infections are associated with significant mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients.

Symptoms

Signs and symptoms of an RSV infection, including congestion, runny nose, dry cough, low-grade fever, sore throat, sneezing, headache, wheezing, and a decrease in appetite, usually appear within 4–6 days after initial exposure.

“In adults and children, it is important to be aware of the progression of symptoms. For example, what may start with typical cold-like symptoms — runny nose, sneezing, fever, and cough — can turn into severe symptoms such as difficulty breathing, dehydration, and decreased appetite,” Hira warned.

Because RSV, influenza, and SARS-CoV-2 are all contagious respiratory viruses that exhibit similar signs and symptoms, RSV infections may be mistaken for COVID-19 or the flu without the proper diagnosis. Additionally, RSV may lower a person’s immunity and increase their risk of catching other respiratory infections.

Diagnosis

“RSV can be confirmed through clinical laboratory tests — most commonly, real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) and antigen testing,” explained Hira. “However, it is important for healthcare providers to consider a potential diagnosis based on presenting symptoms, especially during the RSV season.”

Although laboratory and imaging tests are not required to diagnose RSV patients, they may be useful to diagnose RSV complications by ruling out other conditions that mimic similar respiratory infection symptoms.

These tests may include blood tests that verify white cell counts or identify viruses, bacteria, and other pathogens; chest X-rays that check for lung inflammation; oral or nasal swabbing that detects viral loads; or pulse oximetry that detects lower-than-normal levels of oxygen in the bloodstream.

Treatment

“Because there is no specific medication therapy for an active RSV infection, the treatment of RSV is centered around symptom management,” explained Hira.

According to Hira, patients should drink plenty of fluids to prevent dehydration. Additionally, most doctors recommend over-the-counter pain relievers and fever reducers for treating RSV symptoms and associated discomfort.

“As always, parents and caregivers should consult with a healthcare provider before giving their child an over-the-counter medication,” cautioned Hira.

Researchers are in the process of developing an array of treatments, including vaccines, monoclonal antibodies, and antiviral therapies, to help protect infants, young children, older adults, immunocompromised individuals, and pregnant people and their unborn babies from severe RSV infections.

“If an individual is experiencing worsening symptoms, it is important to seek prompt medical attention,” Hira continued. “And for some infants and young children who may be at an increased risk of developing severe RSV infection, parents and caregivers should ask their child’s healthcare provider about a medication called palivizumab, which may help protect against severe RSV disease.”

Palivizumab, a monoclonal antibody available for the prevention of pediatric respiratory tract infections, is also recommended by the American Academy of Pediatrics (AAP) for high-risk infants and young children.

Prevention

“Throughout the RSV season, pharmacists can explain the importance of taking extra care with frequent hand washing, keeping hands away from the face, avoiding contact with others who are ill, covering coughs and sneezes, and frequently cleaning/disinfecting high-touch surfaces to help minimize the risk of spread,” mentioned Abramson.

Additionally, Hira noted that parents and caregivers could do the following to protect their children from RSV and other respiratory illnesses:

• avoid close contact with sick people
• avoid sharing cups, utensils, bottles, and toys with others
• wash hands frequently with soap and water for at least 20 seconds
• cover coughs and sneezes with a tissue or upper arm, not your hands
• avoid touching the face with unwashed hands
• wear a mask when sick
• clean highly touched surfaces and mobile devices often

“Also, when possible, limit the amount of time children spend in a daycare center or other contagious environments during times of increased RSV activity. Older adults and those at risk for severe illness from RSV should follow these same measures,” advised Hira.

The Role of the Pharmacist

Many pharmacists are in a key position to support and educate patients and their families affected by RSV.

“While some most commonly think of high-risk infants as the target population for RSV management, it is important to remember that many specialty pharmacy patients have certain chronic conditions, are adults over 65 with heart or lung disease or weakened immune systems, and are also at increased risk for complications,” highlighted Abramson.

“Even if a particular patient does not fall into these categories, the specialty pharmacist can identify through conversation whether someone may be a caregiver to an older high-risk relative or grandparent to a new infant and can benefit from additional education on disease prevention,” Abramson suggested.