Severe respiratory syncytial virus disease in children

Respiratory syncytial virus is the most important respiratory pathogen in infants and young children, accounting for substantial morbidity, occasional mortality, and considerable health care expense. Primary infection with this ubiquitous RNA virus occurs in almost all children by the age of 2 years, with symptoms ranging from mild upper respiratory infection to severe life-threatening bronchiolitis or pneumonia. Not surprisingly, therefore, this disease has been the subject of intense research aimed at elucidation of its epidemiology, pathogenesis, diagnosis, treatment, and prevention. In the past year, new information has accrued in each of these areas. Controversy and debate have continued to characterize discussion about the use of ribavirin in the treatment of respiratory syncytial virus infections. This review discusses recent studies and clinical reports that pertain to severe respiratory syncytial disease, especially that which requires intensive care management. Also considered is the management of children whose disease is not severe but who are at risk for progression to severe disease.