View source for Medicine:Human orthopneumovirus

{{short description|Species of virus}}
{{Infobox medical condition (new)
| name            = Human respiratory syncytial <br/>virus infection
| synonyms        = 
| image           = RSV.PNG
| caption         = An x ray of a child with HRSV showing the typical [[Biology:Anatomical terms of location#Medial and lateral|bilateral]] perihilar fullness
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| field           = [[Medicine:Pediatrics|Pediatrics]]
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| prevention      = Hand washing, avoiding close contact with sick people<ref>https://www.nhs.uk/conditions/bronchiolitis/prevention/</ref>
| treatment       = 
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'''''Human orthopneumovirus''''' (also known as '''human respiratory syncytial virus''', or '''HRSV''', or just '''RSV''') is a [[Biology:Virus|virus]] that causes [[Medicine:Respiratory tract|respiratory tract]] infections, with the infected cells of the mucosa fusing together to form a [[Biology:Syncytium|syncytium]]. It is a major cause of [[Medicine:Lower respiratory tract infection|lower respiratory tract infection]]s and hospital visits during infancy and childhood. A prophylactic medication, [[Chemistry:Palivizumab|palivizumab]], can be employed to prevent HRSV in preterm (under 35 weeks gestation) infants, infants with certain congenital heart defects (CHD) or [[Medicine:Bronchopulmonary dysplasia|bronchopulmonary dysplasia]] (BPD), and infants with congenital malformations of the airway. Treatment is limited to supportive care, including [[Chemistry:Oxygen therapy|oxygen therapy]] and more advanced breathing support with CPAP or [[Medicine:Heated humidified high-flow therapy|nasal high flow oxygen]], as required.

In temperate climates there is an annual [[Medicine:Epidemic|epidemic]] during the winter months; in [[Earth:Tropical climate|tropical climate]]s, infection is most common during the rainy season.

In the United States, 60% of infants are infected during their first HRSV season,<ref name=Glezen86>{{cite journal |pmid=3706232 |year=1986 |last1=Glezen |first1=WP |last2=Taber |first2=LH |last3=Frank |first3=AL |last4=Kasel |first4=JA |title=Risk of primary infection and reinfection with respiratory syncytial virus |volume=140 |issue=6 |pages=543–6 |journal=American Journal of Diseases of Children |doi=10.1001/archpedi.1986.02140200053026}}</ref> and nearly all children will have been infected with the virus by 2–3 years of age.<ref name=Glezen86/> Of those infected with RSV, 2–3% will develop [[Medicine:Bronchiolitis|bronchiolitis]], necessitating hospitalization.<ref name=Hall09>{{cite journal |pages=588–98 |doi= 10.1056/NEJMoa0804877 |title=The Burden of Respiratory Syncytial Virus Infection in Young Children |year=2009 |last1=Hall |first1=Caroline Breese |last2=Weinberg |first2=Geoffrey A. |last3=Iwane |first3=Marika K. |last4=Blumkin |first4=Aaron K. |last5=Edwards |first5=Kathryn M. |last6=Staat |first6=Mary A. |last7=Auinger |first7=Peggy |last8=Griffin |first8=Marie R. |last9=Poehling |first9=Katherine A. |journal=New England Journal of Medicine |volume=360 |issue=6 |pmid=19196675 |last10=Erdman |first10=Dean |last11=Grijalva |first11=Carlos G. |last12=Zhu |first12=Yuwei |last13=Szilagyi |first13=Peter|pmc=4829966 }}</ref> Natural infection with HRSV induces protective immunity which wanes over time—possibly more so than other respiratory viral infections—and thus people can be infected multiple times. Sometimes an infant can become symptomatically infected more than once, even within a single HRSV season. Severe HRSV infections have increasingly been found among elderly patients. Young adults can be re-infected every five to seven years, with symptoms looking like a sinus infection or a cold (infections can also be asymptomatic).

==Signs and symptoms==
The incubation time (from infection until symptoms arrive) is 4–5 days.
For adults, HRSV produces mainly mild symptoms, often indistinguishable from [[Medicine:Common cold|common cold]]s and minor illnesses. The Centers for Disease Control consider HRSV to be the "most common cause of [[Medicine:Bronchiolitis|bronchiolitis]] (inflammation of the small airways in the lung) and [[Medicine:Pneumonia|pneumonia]] in children under 1 year of age in the United States".<ref>
{{cite web| url = https://www.cdc.gov/rsv/index.html| title = Respiratory Syncytial Virus| accessdate = October 2, 2009| date = October 17, 2008| publisher = Center for Disease Control, Respiratory and Enteric Viruses Branch}}</ref>
For some children, RSV can cause bronchiolitis, leading to severe respiratory illness requiring hospitalization and, rarely, causing death. This is more likely to occur in patients that are immunocompromised or infants born prematurely. Other HRSV symptoms common among infants include listlessness, poor or diminished appetite, and a possible fever.

Recurrent wheezing and [[Medicine:Asthma|asthma]] are more common among individuals who suffered severe HRSV infection during the first few months of life than among controls;<ref>{{cite journal |pages=1123–9 |doi=10.1164/rccm.200804-579OC |title=Evidence of a Causal Role of Winter Virus Infection during Infancy in Early Childhood Asthma |year=2008 |last1=Wu |first1=P. |last2=Dupont |first2=W. D. |last3=Griffin |first3=M. R. |last4=Carroll |first4=K. N. |last5=Mitchel |first5=E. F. |last6=Gebretsadik |first6=T. |last7=Hartert |first7=T. V. |journal=American Journal of Respiratory and Critical Care Medicine |volume=178 |issue=11 |pmid=18776151 |pmc=2588491}}</ref> whether HRSV infection sets up a process that leads to recurrent wheezing or whether those already predisposed to asthma are more likely to become severely ill with HRSV has yet to be determined.

Symptoms of pneumonia in immuno-compromised patients such as in transplant patients and especially bone marrow transplant patients should be evaluated to rule out HRSV infection. This can be done by means of [[Biology:Polymerase chain reaction|polymerase chain reaction (PCR)]] testing for HRSV nucleic acids in peripheral blood samples if all other infectious processes have been ruled out or if it is highly suspicious for RSV such as a recent exposure to a known source of HRSV infection. The incubation period is 2–8 days but is usually 4–6 days.

===Complications===
*bronchiolitis or pneumonia
*asthma
*recurring infections
*acute [[Medicine:Otitis media|otitis media]]

==Cause==
===Virology===
{{Virusbox
| image = Respiratory syncytial virus 01.jpg
| image_alt = Transmission electron micrograph of RSV
| image_caption = [[Engineering:Transmission electron microscopy|Transmission electron micrograph]] of RSV
| parent = Orthopneumovirus
| species = Human orthopneumovirus
| authority = 
| synonyms = 
*''Human respiratory syncytial virus''
*''Respiratory syncytial virus''
| synonyms_ref = <ref>{{cite web |title=ICTV Taxonomy history: ''Human orthopneumovirus'' |url=https://talk.ictvonline.org/taxonomy/p/taxonomy-history?taxnode_id=20181651 |website=International Committee on Taxonomy of Viruses (ICTV) |accessdate=27 December 2018 |language=en }}</ref>
| subdivision_ranks = 
| subdivision = 
}}

====Structure====
Human respiratory syncytial virus is a  medium-sized (120–200&nbsp;nm) enveloped virus that contains a linear negative-sense RNA genome (must be converted to a positive RNA prior to translation).  The former contains virally encoded F, G, and SH lipoproteins.  The F and G lipoproteins are the only two that target the cell membrane and are highly conserved among RSV isolates. HRSV is divided into two antigenic subgroups, A and B, on the basis of the reactivity of the virus with monoclonal antibodies against the attachment (G) and fusion (F)<ref name="Krarup_2017">{{cite journal |vauthors=Krarup A, Truan D, Furmanova-Hollenstein P, Bogaert L, Bouchier P, Bisschop IJ, Widjojoatmodjo MN, Zahn R, Schuitemaker H, McLellan JS, Langedijk JP | title = A highly stable prefusion RSV F vaccine derived from structural analysis of the fusion mechanism | journal = Nature Communications| year = 2015 | volume=6 | pages=8143 | pmid = 26333350 | doi = 10.1038/ncomms9143 | pmc=4569726| bibcode = 2015NatCo...6.8143K }}</ref> glycoproteins.  Subtype B is characterized as the asymptomatic strains of the virus that the majority of the population experiences.  The more severe clinical illnesses involve subtype A strains, which tend to predominate in most outbreaks.

Four of the viral genes code for intracellular proteins that are involved in genome transcription, replication, and particle budding, namely N (nucleoprotein), P (phosphoprotein), M (matrix protein), and L (“large” protein, containing the RNA polymerase catalytic motifs). The RSV genomic RNA forms a helical ribonucleoprotein (RNP) complex with the N protein, termed nucleocapsid, which is used as template for RNA synthesis by the viral polymerase complex. The three-dimensional crystal structure of a decameric, annular ribonucleoprotein complex of the RSV nucleoprotein (N) bound to RNA has been determined at 3.3 Å resolution. This complex mimics one turn of the viral helical nucleocapsid complex. Its crystal structure was combined with electron microscopy data to provide a detailed model for the RSV nucleocapsid.<ref>{{cite journal|last1=Tawar|first1=RG|last2=Duquerroy|first2=S|last3=Vonrhein|first3=C|last4=Varela|first4=PF|last5=Damier-Piolle|first5=L|last6=Castagné|first6=N|last7=MacLellan|first7=K|last8=Bedouelle|first8=Hugues|last9=Bricogne|first9=G|last10=Bhella|first10=D|last11=Eléouët|first11=JF|last12=Rey|first12=FA|title=Crystal structure of a nucleocapsid-like nucleoprotein-RNA complex of respiratory syncytial virus|journal=Science|date=November 2009|volume=326|issue=5957|pages=1279–83|doi=10.1126/science.1177634|pmid=19965480|bibcode=2009Sci...326.1279T}}</ref>

====Genome====
The genome is approximately 15,000 [[Biology:Nucleotide|nucleotide]]s in length and is composed of a single strand of [[Biology:RNA|RNA]] with negative polarity. It has 10 genes encoding 11 proteins.<ref name=Lee12>{{Cite journal |last=Lee |first=Wan-Ji |last2=Kim |first2=You-jin |last3=Kim |first3=Dae-Won |last4=Lee |first4=Han Saem |last5=Lee |first5=Ho Yeon |last6=Kim |first6=Kisoon |date=2012-12-15 |title=Complete Genome Sequence of Human Respiratory Syncytial Virus Genotype A with a 72-Nucleotide Duplication in the Attachment Protein G Gene |journal=Journal of Virology |volume=86 |issue=24 |pages=13810–13811 |doi=10.1128/JVI.02571-12 |pmc=3503102 |pmid=23166231}}</ref>

RSV, and the closely related Pneumonia Virus of Mice, are unique in the Paramyxoviridae family of RNA viruses for having two separate genes coding for nonstructural proteins (NS1, NS2) that suppress the host's innate immunity, mediated primarily by type I interferon (IFN).<ref>Barik S (2013) Respiratory syncytial virus mechanisms to interfere with type 1 interferons. Curr Top Microbiol Immunol. 372:173-91. doi: 10.1007/978-3-642-38919-1_9. {{PMID|24362690}}.</ref><ref>Ribaudo M, Barik S (2017) The nonstructural proteins of Pneumoviruses are remarkably distinct in substrate diversity and specificity. Virol J. ;14(1):215. doi: 10.1186/s12985-017-0881-7, {{PMID|29110727}}.</ref>

To date, 10 HRSV-A genotypes have been designated, GA1 to GA7, SAA1, NA1, and NA2. The HRSV-B genotypes include GB1 to GB4, SAB1 to SAB3, and BA1 to BA6.<ref name=Lee12/>

The genome of HRSV was completely sequenced in 1997.

====Evolution====
Bayesian estimates of the mutation rates in the subtype A genomes give a mutation rate of 6.47{{e|−4}} (credible interval: 5.56{{e|−4}} – 7.38{{e|−4}}) substitutions/site/year.<ref name=Tan2012>{{cite journal  |vauthors=Tan L, Lemey P, Houspie L, etal |title=Genetic Variability among Complete Human Respiratory Syncytial Virus Subgroup A Genomes: Bridging Molecular Evolutionary Dynamics and Epidemiology |journal=PLOS One |volume=7 |issue=12 |pages=e51439 |year=2012 |pmid=23236501 |pmc=3517519 |doi=10.1371/journal.pone.0051439 |editor1-last=Leung |editor1-first=Frederick C. C|bibcode=2012PLoSO...751439T }}</ref> This is similar to other RNA viruses. The population size has remained constant over the last 70 years and the G protein appears to be the main site of diversifying selection. The most recent common ancestor evolved ~1943 (credible interval: 1923–1954). The HRSV-B evolutionary rate (1.95{{e|−3}} nucleotide substitutions/site/year) is similar to that previously estimated for HRSV-A (1.83{{e|−3}} nucleotide substitutions/site/year). However, natural HRSV-B isolates appear to accommodate more drastic changes in their attachment G proteins. The most recent common ancestor of the currently circulating subgroup B strains was estimated to date back to around the year 1949. The divergence between the two major subgroups was calculated to have occurred approximately 350 years ago (mid-17th century).

====Taxonomy====
HRSV is a negative-sense, single-stranded [[Biology:RNA virus|RNA virus]] of the family ''[[Biology:Pneumoviridae|Pneumoviridae]]''.  Its name comes from the fact that [[Biology:Membrane fusion protein|F proteins]] on the surface of the virus cause the cell membranes on nearby cells to merge, forming syncytia.

===Transmission===
HRSV spreads easily by direct contact, and can remain viable for a half an hour or more on hands or for up to 5 hours on countertops.<ref>{{cite encyclopedia|title=Respiratory syncytial virus (RSV) |date=January 2011 |encyclopedia=A.D.A.M. Medical Encyclopedia, PubMed Health |publisher=National Center for Biotechnology Information, U.S. National Library of Medicine |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002531/ |url-status=dead |archiveurl=https://web.archive.org/web/20110204185922/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002531 |archivedate=February 4, 2011 }}</ref> Childcare facilities allow for rapid child-to-child transmission in a short period of time.<ref>{{Cite journal | last1 = Chu | first1 = H. Y. | last2 = Kuypers | first2 = J. | last3 = Renaud | first3 = C. | last4 = Wald | first4 = A. | last5 = Martin | first5 = E. | last6 = Fairchok | first6 = M. | last7 = Magaret | first7 = A. | last8 = Sarancino | first8 = M. | last9 = Englund | first9 = J. A. | doi = 10.1016/j.jcv.2013.04.011 | title = Molecular epidemiology of respiratory syncytial virus transmission in childcare | journal = Journal of Clinical Virology | volume = 57 | issue = 4 | pages = 343–350 | year = 2013 | pmid =  23684816| pmc = 3800193}}</ref>

The HRSV is virtually the same as chimpanzee coryza virus and can be transmitted from apes to humans, although transmission from humans to apes is more common.<ref>http://c.ymcdn.com/sites/www.aazv.org/resource/resmgr/IDM/IDM_Respiratory_Syncytial_Vi.pdf American Association of Zoo Veterinarians Infectious Disease Committee Manual 2013, CHIMPANZEE CORYZA/RESPIRATORY SYNCYTIAL VIRUS (RSV), Allison Wack, December 26, 2010, updated March 19, 2013.</ref> The virus has also been recovered from cattle, goats and sheep, but these are not regarded as major vectors of transmission and there is no animal reservoir of the virus.

HRSV infection can last 2–8 days, but symptoms may persist for up to three weeks.

==Diagnosis==
Human respiratory syncytial virus may be suspected based on the time of year of the infection; prevalence usually coincides
with the winter flu season.
* Physical exam: listening with a [[Engineering:Stethoscope|stethoscope]] for wheezing and other abnormal sounds in the chest
* Chest X-rays to check for typical bilateral perihilar fullness of [[Medicine:Bronchiolitis|bronchiolitis]] induced by the virus
* Skin monitoring to check for [[Medicine:Hypoxemia|hypoxemia]], a lower than usual level of oxygen in the bloodstream
* Blood tests to check white cell counts or to look for the presence of viruses, bacteria or other organisms
* Lab test of respiratory secretions

Several different types of laboratory tests are commercially available for diagnosis of RSV infection. Rapid diagnostic assays performed on respiratory specimens are available commercially. Most clinical laboratories currently use antigen detection tests. Compared with culture, the sensitivity of antigen detection tests generally ranges from 80% to 90%. Antigen detection tests and culture are generally reliable in young children but less useful in older children and adults.

Sensitivity of virus isolation from respiratory secretions in cell culture varies among laboratories. RT-PCR assays are now commercially available. The sensitivity of these assays is equal to or exceeds the sensitivity of virus isolation and antigen detection methods. Highly sensitive RT-PCR assays should be considered when testing adults, because they may have low viral loads in their respiratory specimens.

Serologic tests are less frequently used for diagnosis. Although useful for research, a diagnosis using a collection of paired acute and convalescent sera to demonstrate a significant rise in antibody titre to HRSV can not be made in time to guide care of the patient. On top of that, the antibody level does not always correlate with the acuteness or activity level of the infection.

RSV infection can be confirmed using tests for antigens or antibodies, or viral RNA by reverse transcription PCR.  Quantification of viral load can be determined by various assay tests.

==Prevention==
As the virus is ubiquitous in all parts of the world, avoidance of infection is not possible.{{citation needed|date=November 2015}}

However, [[Chemistry:Palivizumab|palivizumab]] (brand name Synagis manufactured by [[Company:MedImmune|MedImmune]]), a moderately effective prophylactic drug, is available for infants at high risk.  Palivizumab is a [[Biology:Monoclonal antibody|monoclonal antibody]] directed against RSV surface fusion [[Biology:Protein|protein]]. It is given by monthly injections, which are begun just prior to the RSV season and are usually continued for five months.  HRSV prophylaxis is indicated for infants that are premature or have either cardiac or lung disease, but the cost of prevention limits use in many parts of the world.<ref>{{cite journal |last1=Andabaka |first1=Tea |last2=Nickerson |first2=Jason W |last3=Rojas-Reyes |first3=Maria Ximena |last4=Rueda |first4=Juan David |last5=Bacic Vrca |first5=Vesna |last6=Barsic |first6=Bruno |title=Monoclonal antibody for reducing the risk of respiratory syncytial virus infection in children |journal=Cochrane Database of Systematic Reviews |issue=4 |pages=CD006602 |date=30 April 2013 |doi=10.1002/14651858.CD006602.pub4|pmid=23633336 }}</ref>

==Treatment==
To date, treatment has been limited to supportive measures. Adrenaline, bronchodilators, steroids, antibiotics, and ribavirin confer "no real benefit".<ref>Bourke TW, Shields MD. Bronchiolitis. BMJ Clinical Evidence. 2011;04:308</ref><ref>{{cite journal |pages=1026–7 |doi=10.1136/bmj.328.7447.1026 |title=Prevention of respiratory syncytial virus infection in infants |year=2004 |last1=Handforth |first1=J. |journal=BMJ |volume=328 |issue=7447 |pmid=15117767 |last2=Sharland |first2=M |last3=Friedland |first3=JS |pmc=403830}}</ref>

Studies of nebulized hypertonic saline have shown that the "use of nebulized 3% HS is a safe, inexpensive, and effective treatment for infants hospitalized with moderately severe viral bronchiolitis" where "respiratory syncytial virus (RSV) accounts for the majority of viral bronchiolitis cases".<ref name="kuzik">{{cite journal |pmid=17719935 |year=2007 |last1=Kuzik |first1=BA |last2=Al Qadhi |first2=SA |last3=Kent |first3=S |last4=Flavin |first4=MP |last5=Hopman |first5=W |last6=Hotte |first6=S |last7=Gander |first7=S |title=Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants |volume=151 |issue=3 |pages=266–70, 270.e1 |doi=10.1016/j.jpeds.2007.04.010 |journal=The Journal of Pediatrics}}</ref><ref>{{cite journal |pages=481–7 |doi=10.1378/chest.123.2.481 |title=Nebulized 3% Hypertonic Saline Solution Treatment in Hospitalized Infants With Viral Bronchiolitis |year=2003 |last1=Mandelberg |first1=A. |journal=Chest |volume=123 |issue=2 |pmid=12576370 |last2=Tal |first2=G |last3=Witzling |first3=M |last4=Someck |first4=E |last5=Houri |first5=S |last6=Balin |first6=A |last7=Priel |first7=IE|citeseerx=10.1.1.526.9223 }}</ref>
One study noted a 26% reduction in length of stay: {{nowrap|2.6 ± 1.9 days}}, compared with {{nowrap|3.5 ± 2.9 days}} in the normal-saline treated group (p=0.05).<ref name="kuzik"/>

Supportive care includes fluids and supplemental oxygen until the illness runs its course. [[Chemistry:Salbutamol|Salbutamol]] may be used in an attempt to relieve any bronchospasm if present. Increased airflow, humidified and delivered via [[Medicine:Nasal cannula|nasal cannula]], may be supplied in order to reduce the effort required for respiration.{{medical citation needed|date=November 2015}}

Presatovir, an experimental antiviral drug, has shown promising results in [[Engineering:Clinical trial|clinical trial]]s but has not yet been approved for medical use.<ref>Beigel JH, Nam HH, Adams PL, Krafft A, Ince WL, El-Kamary SS, Sims AC. Advances in respiratory virus therapeutics - A meeting report from the 6th isirv Antiviral Group conference. ''Antiviral Res''. 2019 Jul;167:45-67. {{pmid|30974127}} {{doi|10.1016/j.antiviral.2019.04.006}}</ref>

==Research==
As of 2017 there was no [[Medicine:Respiratory syncytial virus vaccine|respiratory syncytial virus vaccine]] despite many years of preclinical and clinical work.<ref>{{cite journal|last1=Schmidt|first1=ME|last2=Varga|first2=SM|title=Modulation of the host immune response by respiratory syncytial virus proteins.|journal=Journal of Microbiology (Seoul, Korea)|date=March 2017|volume=55|issue=3|pages=161–171|doi=10.1007/s12275-017-7045-8|pmid=28243940}}</ref>  A  formalin-inactivated candidate developed in the 1960s surprisingly increased infections, which came to be known as "immunopotentiation" or vaccine-enhanced disease.<ref>{{cite journal|last1=Melero|first1=JA|title=Influence of antigen conformation and mode of presentation on the antibody and protective responses against human respiratory syncytial virus: relevance for vaccine development.|journal=Expert Review of Vaccines|date=October 2016|volume=15|issue=10|pages=1319–25|doi=10.1080/14760584.2016.1175941|pmid=27055009}}</ref><ref>{{Cite journal|last=Schmidt|first=Megan E.|last2=Knudson|first2=Cory J.|last3=Hartwig|first3=Stacey M.|last4=Pewe|first4=Lecia L.|last5=Meyerholz|first5=David K. |last6=Langlois|first6=Ryan A.|last7=Harty|first7=John T.|last8=Varga|first8=Steven M.|date=January 2018|title=Memory CD8 T cells mediate severe immunopathology following respiratory syncytial virus infection|journal=PLOS Pathogens|volume=14|issue=1|pages=e1006810|doi=10.1371/journal.ppat.1006810|issn=1553-7374|pmc=5766251|pmid=29293660}}</ref>

As of 2017 several companies including [[Company:Novavax|Novavax]], [[Company:GlaxoSmithKline|GlaxoSmithKline]] and Bavarian Nordic were working on RSV vaccines.<ref>{{cite web|url=http://www.who.int/immunization/research/meetings_workshops/GSK_RSV_vaccdev_status_Dieussaert.pdf |title=GSK's RSV vaccine product development overview |publisher=[[Organization:World Health Organization|WHO]] |accessdate=2017-07-04}}</ref><ref>{{cite journal|last1=Esposito|first1=S|last2=Pietro|first2=GD|title=Respiratory syncytial virus vaccines: an update on those in the immediate pipeline.|journal=Future Microbiology|date=October 2016|volume=11|issue=11|pages=1479–1490|doi=10.2217/fmb-2016-0106|pmid=27750448}}</ref><ref>{{Cite web | url=http://novavax.com/page/11/clinical-stage-pipeline | title=Clinical Stage Pipeline – Novavax}}</ref>

==See also==
*Robert M. Chanock, discoverer of the human respiratory syncytial virus
*[[Biology:Metapneumovirus|Metapneumovirus]], another genus of closely related viruses
*[[Biology:Orthopneumovirus|Orthopneumovirus]], the genus of related syncytial viruses

==References==
{{Reflist}}

==External links==
{{Medical resources
|  DiseasesDB     = 11387
|  ICD10          = {{ICD10|B|97|4}}, {{ICD10|J|12|1}}, {{ICD10|J|20|5}}, {{ICD10|J|21|0}}
|  ICD9           = {{ICD9|079.6}}
|  ICDO           = 
|  OMIM           = 
|  MedlinePlus    = 001564
|  eMedicineSubj  = ped
|  eMedicineTopic = 2706
|  MeshID        = D018357
}}
*[http://www.discoverrsv.com/ discoverrsv.com] (registered to Novavax, manufacturer of RSV vaccines Prepare™ and Resolve™ for maternal/infant and elderly RSV immunizations)
*[http://www.preemiecare.org PreemieCare] information and support on premature infants including in-depth resources on RSV and our comprehensive NICU Glossary.
*[http://www.synagis.com Synagis] (registered to MedImmune, manufacturer of Synagis)
*[https://web.archive.org/web/20060209032622/http://www.rsvinfo.com/ Virazole] (registered to Valeant Pharmaceuticals, manufacturer of Virazole)
*[https://web.archive.org/web/20060211025311/http://www.kidshealth.org/PageManager.jsp?dn=familydoctor&lic=44&article_set=22938 The Family Doctor]
*[http://baby.lovetoknow.com/wiki/RSV_in_Infants RSV in Infants]: Information includes symptoms, treatment, and prevention
*[https://web.archive.org/web/20070911055656/http://www.biotrin.com/products.php?id=15&show=1&cat=1 Biotrin providers of RSV kits]
* Control of Communicable Diseases in Man.  American Public Health Association.
*[http://jvi.asm.org/content/86/24/13810.full]

{{Viral diseases}}
{{Common Cold}}
{{Taxonbar|from=Q1052913}}

{{DEFAULTSORT:Human Respiratory Syncytial Virus}}
[[Category:Paramyxoviridae]]

{{Sourceattribution|Human orthopneumovirus|1}}