Respiratory Syncytial Virus or RSV is one of the most common respiratory viruses circulating today. Often thought of as only being dangerous to babies and toddlers due to how often child-related RSV spikes are in the news, the virus is actually just as worrisome in older adults.
In fact, while more than 2 million children under age 5 make an RSV-related outpatient visit each year with some 58,000 to 80,000 of them ending up in the hospital, far more older adults infected with the viral disease are hospitalized, per surveillance data from the U.S. Centers for Disease Control and Prevention. The organization notes that between 100,000 and 150,000 adults age 60 and older end up being hospitalized because of RSV each year.
Here's what RSV is, why it especially impacts the youngest and oldest members of society and how it is usually treated.
RSV is a respiratory virus that infects the nose, throat and lungs. While people with larger airways and strong immune systems aren't as adversely affected by the infection, young children and older adults often are. The main reason infants and toddlers struggle is "due to the size of their airways," says Dr. David Hill, a North Carolina-based pediatrician and a spokesperson of the American Academy of Pediatrics. "RSV clogs up the smallest breathing tubes (known as bronchioles) in the child's lungs - and the smaller the lungs, the more severe the effects." He adds that older adults are similarly affected "due to age-related loss of lung tissue and diminished immune function and chest muscle strength." The same can be said for people with certain lung conditions such as asthma or COPD.
Airway blockage and reduced lung function can diminish a vulnerable person's ability to eat, drink or even breathe, which is why nutrients and fluids may need to be administered intravenously with oxygen assistance often also becoming necessary.
RSV is spread from person to person, with the virus "often hitching a ride on a sneeze, a kiss or a shared toy," says Hill. Once germs are inhaled either directly from expelled respiratory droplets or by touching an infected surface, then touching one's eyes, nose or mouth, it usually takes between four to six days for symptoms to appear.
Common RSV symptoms in many people include "a runny nose, cough, sneezing and fever - basically mild cold-like symptoms that are mostly contained to the upper respiratory tract," says Dr. Alison Mitzner, a board-certified pediatrician in New York City and the author of "Calm and Confident Parenting." In this stage, RSV can be hard to distinguish from the common cold or other respiratory viruses like COVID-19 or influenza.
But things change when the virus moves from the upper respiratory system to the lower respiratory tract. Once in the trachea, bronchioles and lungs, "RSV can wreak havoc and cause symptoms like wheezing and difficulty breathing and lead to infections like bronchiolitis or pneumonia," Mitzner says.
In toddlers, some of the earliest signs that RSV has infected the lower respiratory system are a diminished interest in eating and decreased vocalizations such as crying, cooing or speaking, says Hill. "You may also see the skin pulling between their ribs, under their rib cage, or over the collarbones and the base of the neck as they struggle to breathe," he adds. "And you may notice a grunting sound with each breath, the nose flaring when they inhale or the head bobbing up and down with breathing." As oxygen and nutrient intake diminish, energy levels quickly follow and infected children often become sleepy or unresponsive. "Children with any of these symptoms should be seen immediately by a medical provider," advises Hill.
Ditto for older adults or immunocompromised people who have recently had cold-like symptoms and are now struggling to breathe, experiencing dizziness or confusion or are eating/drinking less.
RSV that has moved from the upper to lower respiratory tract in vulnerable people is often treated in hospital settings with the primary goal being to help with oxygen assistance and nutrient intake until the body kills the virus. Professional care also sometimes includes "airway clearance with the help of respiratory therapists," says Hill. "Albuterol or saline nebulizer treatments are also sometimes recommended, but few patients respond to them."
When RSV symptoms remain mild, symptoms can be treated at home. "Common at-home treatments and remedies include nasal saline with suctioning, using a cool-mist humidifier, frequent fluids and feedings to ensure hydration and taking acetaminophen or ibuprofen (if older than 6 months) for fever," says Mitzner.
For most people, RSV symptoms "tend to peak between days three to five of the illness," she adds, "but may last up to two weeks."