Respiratory Syncytial Virus Infection (RSV)
Overview
Respiratory syncytial virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. 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 (infection of the lungs) in children younger than 1 year of age in the United States.
Transmission
RSV can spread when
- An infected person coughs or sneezes
- You get virus droplets from a cough or sneeze in your eyes, nose, or mouth
- You have direct contact with the virus, like kissing the face of a child with RSV
- You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands
People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks. Children are often exposed to and infected with RSV outside the home, such as in school or childcare centers. They can then transmit the virus to other members of the family.
RSV can survive for many hours on hard surfaces such as tables and crib rails. It typically lives on soft surfaces such as tissues and hands for shorter amounts of time.
People are typically infected with RSV for the first time as an infant or toddler and nearly all children are infected before their second birthday. However, repeat infections may occur throughout life, and people of any age can be infected. Infections in healthy children and adults are generally less severe than among infants and older adults with certain medical conditions. People at highest risk for severe disease include
- Premature infants
- Young children with congenital (from birth) heart or chronic lung disease
- Young children with compromised (weakened) immune systems due to a medical condition or medical treatment
- Children with neuromuscular disorders
- Adults with compromised immune systems
- Older adults, especially those with underlying heart or lung disease
In the United States and other areas with similar climates, RSV circulation generally starts during fall and peaks in the winter. The timing and severity of RSV circulation in a given community can vary from year to year.
Treatment
Most RSV infections go away on their own in a week or two.
There is no specific treatment for RSV infection, though researchers are working to develop antivirals (medicines that fight viruses).
Take steps to relieve symptoms
- Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Never give aspirin to children.)
- Drink enough fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration (loss of body fluids).
- Talk to your healthcare provider before giving your child nonprescription cold medicines. Some medicines contain ingredients that are not good for children.
RSV Vaccine
RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization. Vaccines are available to protect older adults from severe RSV. Monoclonal antibody products are available to protect infants and young children from severe RSV.
CDC Recommends:
Adults 60 years old and over:
- Adults 60 years of age and older may receive a single dose of RSV vaccine using shared clinical decision-making.
Infants and young children:
- 1 dose of nirsevimab for all infants younger than 8 months born during or entering their first RSV season.
- 1 dose of nirsevimab for infants and children 8–19 months old who are at increased risk for severe RSV disease and entering their second RSV season.
- Note: A different monoclonal antibody, palivizumab, is limited to children under 24 months of age with certain conditions that place them at high risk for severe RSV disease. It must be given once a month during RSV season. Please see AAP guidelines for palivizumab.
If you have any questions about RSV or the products above, talk to your healthcare provider.
Prevention
In the summer of 2023, a new RSV vaccine was approved for adults 60 years and older. CDC recommends adults 60 years and older may receive a single dose of RSV vaccine, based on discussions between the patient and health care provider.
See the RSV Vaccine section of this website for more information about the RSV vaccine.
There are steps you can take to help prevent the spread of RSV. Specifically, if you have cold-like symptoms you should
- Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands
- Wash your hands often with soap and water for at least 20 seconds
- Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
- Clean frequently touched surfaces such as doorknobs and mobile devices
Ideally, people with cold-like symptoms should not interact with children at high risk for severe RSV disease, including premature infants, children younger than 2 years of age with chronic lung or heart conditions, children with weakened immune systems, or children with neuromuscular disorders. If this is not possible, they should carefully follow the prevention steps mentioned above and wash their hands before interacting with such children. They should also refrain from kissing high-risk children while they have cold-like symptoms.
Parents of children at high risk for developing severe RSV disease should help their child, when possible, do the following
- Avoid close contact with sick people
- Wash their hands often with soap and water for at least 20 seconds
- Avoid touching their face with unwashed hands
- Limit the time they spend in childcare centers or other potentially contagious settings during periods of high RSV activity. This may help prevent infection and spread of the virus during the RSV season
Dashboard: Hospitalized RSV Cases in Denver County, 2019 to Present
*Data is updated on a monthly basis.
RSV in Infants or Young Children
Overview
RSV can be dangerous for some infants and young children. Each year in the United States, an estimated 58,000-80,000 children younger than 5 years old are hospitalized due to RSV infection. Those at greatest risk for severe illness from RSV include
- Premature infants
- Infants, especially those 6 months and younger
- Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
- Children with weakened immune systems
- Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions
Severe RSV Infection
Virtually all children get an RSV infection by the time they are 2 years old. Most of the time RSV will cause a mild, cold-like illness, but it can also cause severe illness such as
- Bronchiolitis (inflammation of the small airways in the lung)
- Pneumonia (infection of the lungs)
One to two out of every 100 children younger than 6 months of age with RSV infection may need to be hospitalized. Those who are hospitalized may require oxygen, IV fluids (if they aren’t eating and drinking), and/or mechanical ventilation (a machine to help with breathing). Most improve with this type of supportive care and are discharged in a few days.
Early Symptoms of RSV
RSV may not be severe when it first starts. However, it can become more severe a few days into the illness. Early symptoms of RSV may include
- Runny nose
- Decrease in appetite
- Cough, which may progress to wheezing or difficulty breathing
RSV in Very Young Infants
Infants who get an RSV infection almost always show symptoms. This is different from adults who can sometimes get RSV infections and not have symptoms. In very young infants (less than 6 months old), the only symptoms of RSV infection may be
- Irritability
- Decreased activity
- Decreased appetite
- Apnea (pauses in breathing more than 10 seconds)
Fever may not always occur with RSV infections.
What you should do if your child is at high risk for severe RSV infection
RSV season in most regions of the U.S. starts in the fall and peaks in the winter. If you have contact with an infant or young child, especially those who were born prematurely, have chronic lung or heart disease or a weakened immune system, you should take extra care to keep the infant healthy by doing the following:
- Wash your hands often: Wash your hands often with soap and water for at least 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer. Washing your hands will help protect you from germs.
- Keep your hands off your face: Avoid touching your eyes, nose, and mouth with unwashed hands. Germs spread this way.
- Avoid close contact with sick people: Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms.
- Cover your coughs and sneezes: Cover your mouth and nose with a tissue or your upper shirt sleeve when coughing or sneezing. Throw the tissue in the trash afterward.
- Clean and disinfect surfaces: Clean and disinfect surfaces and objects that people frequently touch, such as toys, doorknobs, and mobile devices. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, when they cough or sneeze, droplets containing germs can land on surfaces and objects.
- Stay home when you are sick: If possible, stay home from work, school, and public areas when you are sick. This will help protect others from catching your illness.
RSV in Older Adults and Adults with Chronic Medical Conditions
RSV infections can be dangerous for certain adults. Each year, it is estimated that between 60,000-120,000 older adults in the United States are hospitalized and 6,000-10,000 of them die due to RSV infection. Adults at highest risk for severe RSV infection include:
- Older adults, especially those 65 years and older
- Adults with chronic heart or lung disease
- Adults with weakened immune systems
-
Severe RSV Infection
When an adult gets RSV infection, they typically have mild cold-like symptoms, but some may develop a lung infection or pneumonia.
RSV can sometimes also lead to worsening of serious conditions such as:
- Asthma
- Chronic obstructive pulmonary disease (COPD) – a chronic disease of the lungs that makes it hard to breathe
- Congestive heart failure – when the heart can’t pump enough blood and oxygen through the body
Older adults who get very sick from RSV may need to be hospitalized. Some may even die. Older adults are at greater risk than young adults for serious complications from RSV because our immune systems weaken when we are older.
What you should do if you or a loved one is at high risk for severe RSV disease
RSV circulation starts in the fall and peaks in the winter. If you are at high risk for severe RSV infection, or if you interact with an older adult, you should take extra care to keep them healthy:
- Wash your hands often: Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer. Washing your hands will help protect you from germs.
- Keep your hands off your face: Avoid touching your eyes, nose, and mouth with unwashed hands. Germs spread this way.
- Avoid close contact with sick people: Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms.
- Cover your coughs and sneezes: Cover your mouth and nose with a tissue or your upper shirt sleeve when coughing or sneezing. Throw the tissue in the trash afterward.
- Clean and disinfect surfaces: Clean and disinfect surfaces and objects that people frequently touch, such as toys, doorknobs, and mobile devices. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, when they cough or sneeze, droplets containing germs can land on surfaces and objects.
- Stay home when you are sick: If possible, stay home from work, school, and public areas when you are sick. This will help protect others from catching your illness.
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