This common respiratory illness typically causes a runny nose and mild cough, but for infants and older adults, it can lead to a serious lung infection.
With the ongoing COVID-19 pandemic, you may feel like you have enough viruses to worry about. But if you’re an older adult or are taking care of young children, there’s another viral menace you’ll also want to watch out for: respiratory syncytial virus (RSV).
Though many people have never heard of it, “RSV is so common that pretty much everyone gets it by the time they are 2 years old,” says Denise McCulloch, MD, MPH, an infectious disease physician-scientist at the University of Washington School of Medicine in Seattle.
For most healthy children and adults, RSV causes a week or so of coldlike symptoms. But it can be very serious and even life-threatening for the very young, the old, and people with weakened immune systems or underlying lung or heart disease.
In a typical year in the United States, RSV leads to approximately 58,000 hospitalizations and as many as 500 deaths among children younger than 5 years old. For individuals age 65 and over, RSV causes some 177,000 hospitalizations and 14,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC).
RSV circulates in most parts of the country from November to April — the so-called “RSV season.” But the arrival of COVID-19 (and subsequent masking and social distancing) in 2020 upended RSV’s usual pattern.
“We saw almost no RSV [in 2020 and the first half of 2021],” says Marian Michaels, MD, MPH, a professor in the division of pediatric infectious diseases at the University of Pittsburgh School of Medicine. “Then all of these children started coming into the hospital with RSV in different parts of the country last July and August.”
While Dr. Michaels anticipates that RSV will eventually return to its typical late fall-winter pattern, it may continue to be off-kilter for the next year or two. “At this point, we really need to be on the lookout for RSV at any time of year,” she adds.
RSV spreads easily from one person to another. When someone who is infected coughs or sneezes, virus-containing droplets become airborne. “If you’re standing within 6 feet of that person, the virus can enter your body through your eyes, nose, or mouth,” Michaels explains.
You can also get RSV by touching something an infected person touched, like a doorknob or a toy, then touching your eyes, nose, or mouth. The virus can last on hard surfaces for many hours.
People infected with RSV are usually contagious for the three to eight days they are having symptoms, but some babies and individuals with weakened immune systems can continue to spread the virus even after they seem to have recovered, for as long as four weeks, the CDC says.
Virtually everyone gets RSV at least once and sometimes more than once. “Because you don’t develop a perfect immune response, you can get reinfected,” Michaels notes. “The first infection, however, is usually the worst.”
Young children who attend childcare centers or who have siblings in school are at a higher risk of exposure and infection. When kids bring RSV home, parents often get it, too. “For adults, it’s usually no big deal,” says Michaels. “You have a cold, and you don’t really know it’s different from any other rival infection. That’s because one, our airways are bigger, and two, we’ve seen it before.”
For some babies, children, and adults, however, RSV can lead to serious lung infection, breathing problems, and hospitalization. “Infants are particularly vulnerable to severe RSV infection in the first two months of life,” Dr. McCulloch notes. Other people who are at risk for developing severe or life-threatening RSV include:
Symptoms of RSV tend to show up four to six days after getting infected, notes the Mayo Clinic. For most children past 6 months old and adults who get RSV, symptoms are similar to the common cold:
Symptoms generally last three to seven days, though a cough can linger for a couple of weeks.
Infants don’t always show these symptoms, notes the CDC. In babies less than 6 months old, the only symptoms of RSV infection might be irritability, decreased activity and appetite, and apnea (pauses while breathing).
Contact your doctor right away if your baby or child:
Most healthy adults and children handle RSV well, but complications can occur if the virus spreads to the lower respiratory tract.
This can result in bronchiolitis (inflammation of the small airways of the lungs) and pneumonia (infection of the lungs). In fact, RSV is the most common cause of bronchiolitis and pneumonia in children younger than age 1, says the CDC.
For both children and adults, RSV can also make chronic health problems worse. For example, those with asthma may experience asthma attacks as a result of RSV infection, notes McCulloch.
Adults with congestive heart failure or chronic obstructive pulmonary disease may experience more severe symptoms, or exacerbations, triggered by RSV, she adds.
While some research suggests that having severe RSV as a baby can increase a child’s risk of developing asthma, it’s not clear if the connection is cause and effect. “We don’t know if kids get asthma because they had severe RSV or if it’s because this child, who was going to have asthma, was more at risk of having RSV cause lung disease,” Michaels explains.
Your doctor may suspect RSV based on symptoms and the amount of RSV currently circulating in your community.
The process of making a diagnosis begins with a physical exam that typically includes listening to the lungs with a stethoscope to check for wheezing or other abnormal sounds, as well as a simple test to check blood oxygen levels that uses a small device called a pulse oximeter that clips to a finger, says the Mayo Clinic.
To make a definitive diagnosis and rule out other respiratory illnesses like the flu or COVID-19, your doctor may do a PCR (polymerase chain reaction) test for RSV. “Some doctors and hospitals now do a triple PCR test that checks for RSV, flu, and COVID-19 with a single nasal swab,” says McCulloch.
If more severe illness is suspected, your doctor may order imaging tests (such as a chest X-ray or CT scan) to check the lungs for signs of infection.
There is no specific treatment for RSV or medicine that shortens the course of the infection. RSV usually goes away on its own in one to two weeks, the CDC says.
In the meantime, if you have RSV or are caring for another adult or a child who is infected, there are some steps you can take to ease discomfort:
One or two out of every 100 children younger than 6 months with RSV infection may need to be hospitalized, says the CDC. Those who are hospitalized may require IV fluids, oxygen, and rarely, mechanical ventilation.
While there’s currently no vaccine for RSV, there are steps you can take to reduce your risk of getting it and spreading it.
During RSV season (or whenever RSV is circulating at especially high levels in your community), be sure to:
For infants at high risk of severe RSV, including babies born very prematurely or who have congenital lung disease or heart defects, doctors will use a protective medication called Synagis (palivizumab), which is a monoclonal antibody (an immune system protein that is created in the lab). The drug, which is given as a monthly injection for five months, can help prevent severe RSV infection.
On the horizon: A monoclonal antibody drug called nirsevimab, recently developed by Sanofi and AstraZeneca, could protect infants against severe RSV for an entire season with just one shot.
After decades of research, with numerous setbacks, several RSV vaccine contenders are finally getting close to the finish line. While COVID-19 slowed and complicated the RSV vaccine trials, it also opened up some new avenues of investigation.
Moderna, for example, is currently testing an RSV vaccine for people over age 60 based on the same mRNA technology it used to develop its COVID-19 shots. On February 22, the company announced that its RSV shot will enter phase 3 testing (the final test a vaccine or drug must pass before it can be sold). It will join three other phase 3 candidates for older adults from Pfizer, GlaxoSmithKline, and Johnson & Johnson.
Researchers are also homing in on a vaccine for babies — either through direct inoculation or maternal vaccination. “Newborns are highly vulnerable to RSV, but vaccines don’t tend to be effective until a baby is at least 2 months old,” McCulloch explains. Vaccinating mothers, who can pass the antibodies on to their babies, is a strategy already used with flu and pertussis (whooping cough), she notes.
On March 2, Pfizer's maternal vaccine candidate received a breakthrough designation from the U.S. Food and Drug Administration, which means it will be able to move more quickly through the next phases of testing, as well as the vaccine approval process.
It’s exciting that things are moving forward, nevertheless, we are likely still several years away from having a widely available vaccine for babies, older adults, or pregnant women, says McCulloch. But when that day comes, it will be a game changer. “The burden of RSV is huge,” she adds. “If we can prevent people from getting a severe infection, it will be an enormous improvement.”
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