RSV Infection Across All Ages: Symptoms, Risks, and Prevention
Respiratory Syncytial Virus (RSV)
Everything you need to know about symptoms, prevention, and treatment of this common respiratory virus.
What is Respiratory Syncytial Virus (RSV)?
Respiratory Syncytial Virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms but can be serious for infants and older adults.
First discovered in 1956, RSV infects the lungs and breathing passages. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia in children younger than 1 year of age in the United States.
Nearly all children will have been infected with RSV by their second birthday. However, infection doesn't provide lifelong immunity, so people can be infected multiple times throughout their lives.
Symptoms of RSV Infection
Symptoms of RSV infection usually appear 4-6 days after exposure and typically include:
Infants (0-12 months)
- Runny nose
- Decreased appetite
- Coughing and sneezing
- Fever (not always present)
- Wheezing or difficulty breathing
- Irritability or decreased activity
- Pauses in breathing (apnea)
Warning signs requiring immediate medical attention: Rapid breathing, chest wall retractions, nasal flaring, grunting, blue color around lips/fingernails.
Children (1-12 years)
- Runny or stuffy nose
- Cough (may be severe)
- Sneezing
- Fever
- Decreased appetite
- Wheezing (in some cases)
- Ear infections (common complication)
Most healthy children experience mild symptoms similar to a common cold and recover within 1-2 weeks.
Adults (13-64 years)
- Congested or runny nose
- Dry cough
- Sore throat
- Mild headache
- Low-grade fever
- Fatigue
- Wheezing (if asthmatic)
In healthy adults, RSV symptoms are usually mild and similar to the common cold. Recovery typically occurs within 1-2 weeks.
Older Adults (65+ years)
- Congestion
- Cough (often persistent)
- Shortness of breath
- Fever
- Sore throat
- Wheezing
- Fatigue and weakness
- Worsening of chronic conditions
Older adults are at higher risk for severe RSV infection, including pneumonia and hospitalization.
How RSV Spreads
RSV spreads through direct contact with respiratory droplets from an infected person. Understanding transmission helps in prevention.
Primary Transmission Routes
- Airborne droplets: When an infected person coughs or sneezes
- Direct contact: Kissing a child with RSV
- Indirect contact: Touching surfaces contaminated with RSV then touching face
- Close personal contact: Sharing cups or utensils
People infected with RSV are usually contagious for 3-8 days but may spread the virus for up to 4 weeks, especially infants and immunocompromised individuals.
Seasonal Patterns
In the United States, RSV infections typically occur during fall, winter, and spring. The timing and severity of RSV season can vary by location.
Diagnosing RSV
Healthcare providers use several methods to diagnose RSV, especially when symptoms are severe or in high-risk individuals.
Laboratory Diagnostic Methods
| Test Method | Turnaround Time | Sensitivity | Common Use |
|---|---|---|---|
| Rapid Antigen Test | 15-30 minutes | 80-90% | Point-of-care, outpatient |
| RT-PCR | 1-6 hours | 95%+ | Hospitals, reference labs |
| Viral Culture | 3-7 days | Moderate | Research, surveillance |
| DFA Test | 2-4 hours | 85-95% | Hospital laboratories |
| Serology | 1-3 days | Variable | Epidemiological studies |
Nasopharyngeal swabs or aspirates are the preferred specimens for RSV testing. Rapid antigen tests may yield false negatives if insufficient material is collected, so follow-up testing may be needed if clinical suspicion remains high.
Treatment Options
Most RSV infections resolve on their own. Treatment focuses on relieving symptoms and supporting respiratory function.
Supportive Care at Home
- Hydration: Drink plenty of fluids to prevent dehydration
- Fever management: Acetaminophen or ibuprofen as directed
- Nasal saline drops: For congestion, especially in infants
- Humidifier: Cool mist humidifier to ease breathing
- Rest: Adequate rest to support recovery
- Positioning: Keep infants upright to ease breathing
Medical Treatment
For severe cases requiring hospitalization, treatment may include:
- Supplemental oxygen
- Intravenous (IV) fluids
- Bronchodilators (in some cases)
- Mechanical ventilation for respiratory failure
- Suction of mucus from airways
Antibiotics are not effective against viral infections like RSV. They may be prescribed only if there's a bacterial complication such as pneumonia or ear infection. Do not give aspirin to children with viral infections due to the risk of Reye's syndrome.
Prevention Strategies
Preventing RSV infection is especially important for high-risk individuals. Multiple strategies work best together.
General Prevention Measures
- Hand hygiene: Wash hands frequently with soap and water for at least 20 seconds
- Avoid touching face: Especially eyes, nose, and mouth with unwashed hands
- Clean surfaces: Regularly disinfect frequently touched surfaces
- Avoid close contact: Stay away from people who are sick
- Stay home when sick: Prevent spreading illness to others
- Cover coughs/sneezes: Use a tissue or your elbow, not your hands
Medical Prevention
In 2023, the FDA approved new RSV vaccines for older adults and a maternal vaccine to protect infants. Additionally, nirsevimab (Beyfortus), a long-acting monoclonal antibody, provides protection for infants entering their first RSV season.
High-Risk Infant Protection
- Palivizumab: Monthly injections during RSV season for eligible high-risk infants
- Breastfeeding: Provides antibodies that may offer some protection
- Avoid smoke exposure: Secondhand smoke increases RSV risk and severity
- Limit daycare exposure: Especially during RSV season for infants under 6 months
High-Risk Groups
Certain populations are more vulnerable to severe RSV infection and require special attention.
Infants born prematurely (especially before 29 weeks) have underdeveloped lungs and immune systems. Their airways are smaller and more easily obstructed by inflammation and mucus. Hospitalization rates are 10 times higher than full-term infants.
Children with congenital heart disease, chronic lung disease, neuromuscular disorders, or weakened immune systems are at increased risk. RSV can exacerbate underlying conditions and lead to severe respiratory distress.
Age-related decline in immune function (immunosenescence) and higher rates of chronic cardiopulmonary conditions make older adults vulnerable. RSV causes approximately 177,000 hospitalizations and 14,000 deaths annually in US adults over 65.
People with weakened immune systems (organ transplant recipients, chemotherapy patients, HIV/AIDS) can develop prolonged, severe RSV infections with higher mortality rates. They may shed the virus for weeks and are at risk for pneumonia.
Frequently Asked Questions
While RSV, cold, and flu viruses cause similar respiratory symptoms, RSV particularly affects the lower respiratory tract in vulnerable populations. It's the leading cause of bronchiolitis and pneumonia in infants. Unlike flu, RSV doesn't typically cause high fever or body aches in adults.
Yes. RSV infection doesn't provide complete or long-lasting immunity. Reinfection is common throughout life, though subsequent infections are usually less severe than the first. There are two main subtypes (A and B) that can both cause infection.
Seek immediate medical care if you or your child has: difficulty breathing, rapid breathing, bluish color around lips or nails, high fever (over 100.4°F in infants under 3 months), dehydration (fewer wet diapers, no tears when crying), or worsening symptoms. Infants with pauses in breathing (apnea) need emergency care.
Yes. In 2023, the FDA approved RSV vaccines for adults 60+ (Arexvy and Abrysvo) and a maternal vaccine (Abrysvo) given during pregnancy to protect infants. For infants, nirsevimab (Beyfortus) is a monoclonal antibody injection that provides protection through an RSV season. Talk to your healthcare provider about eligibility.
In most healthy children and adults, RSV symptoms resolve within 1-2 weeks. The cough may linger for 3-4 weeks. Infants, older adults, and people with weakened immune systems may experience longer recovery periods. Severe cases requiring hospitalization typically improve within 3-7 days with proper medical care.
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