1. RSV causes what in infants and what in older pts?
    lower RTIs in infants and upper RTIs in older pts
  2. how is RSV transmitted and shedding occurs when and up to?
    transmitted via direct contact or in aerolized nasal secretions, shedding 1-2 days b4 sx and up to 2 weeks after onset of sx
  3. RSV season here
    Nov 1-Mar 31st
  4. definition of bronchiolitis and a major cause
    acute viral inf of lower resp tract of infants, RSV is a major cause
  5. incidence of bronchiolitis
    most common during first yr, pk age 2-6 mo
  6. risk factors for bronchiolitis
    • passive smoke exposure
    • birth within 6 mo prior to onset of RSV season
    • day care attendance
    • school age siblings or daycare
    • multiple births
  7. risk factors for devel of severe inf of bronchiolitis
    • cyanotic or complicated congential heart disesase
    • underlying pulmonary disease (esp bronchopulmonary dysplasia)
    • immunosuppression/immunodefi
    • prematurity
  8. clinical progression of bronchiolitis
    • prodromal period
    • first sx-rhinorrhea and cough
    • progression to resp distress
  9. complications of respiratory distress w bronchiolitis
    • fever-usually only if secondary bact inf present
    • tachypnea, tachycardia
    • cyanosis
    • retrations
    • wheezing
    • may progess to dehy
  10. tx of bronchiolitis
    • o2
    • mech vent if necessary
    • fluids to prevent dehy
    • bronchodila-controversial
    • cs-not effective
    • ribavirin-only for VERY severe cases-aerolized and teratogenic
  11. prevention of bronchiolitis due to RSV most likely or parainf
    • avoidance of exposure to secretions from infected people
    • strict hand washing
    • vaccine trials being studied
    • provide passive imm
  12. AAP recommendations for RSV prophylaxis
    chronic lung disease, less than 2 and has req medical tx for CLD within previous six mo

    hemodyn significant congenital heart disease in pts less than 2

    prematurity with no lung dx
  13. gest age <=28 wks and less than one yr old at start of rsv season
    max five doses/season
  14. gest age 29 to 31-6/7 wks and less than 6 mo at start of RSV season
    max five doses/season
  15. gest age 32-0/7 to 34-6/7 wks and <=90 days at start of RSV season with at least one of the following risk factors
    -daycare attendance
    -sibling under age of 5
    max 3 doses/season or until pt greater than 90 days of age-whichever comes first
  16. gest age less than 35-0/7 weeks and less than one yr of age at the start of RSV season w congenital abnormality of the airway or nm disease that compromise the handing of resp secretions
    max five doses/season
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