About Respiratory Syncytial Virus (RSV) in Older Adults

Overview

Respiratory Syncytial Virus (RSV) is a virus that can cause a cold-like respiratory illness. RSV is very contagious and is most often seen during “flu season”, which is generally between November and February. For many people, RSV causes a mild illness that goes away in 1-2 weeks with self-care and over-the-counter medication remedies for symptoms. Some people, however, may develop lower respiratory tract disease from RSV that may lead to hospitalization. People at risk for developing severe RSV include infants, older adults, and people who have certain chronic conditions (like lung or heart disease) or conditions that weaken the immune system. It is important that people at risk take measures to reduce their chances of RSV infection.

Symptoms of RSV infection can vary and may include a mild cold-like illness or more severe respiratory complications such as bronchiolitis and pneumonia. Illness from RSV cannot be easily distinguished from other respiratory viruses, so laboratory diagnosis is necessary through viral detection tests. Severe RSV can lead to pneumonia, worsening of respiratory conditions, hospitalizations, intensive care unit admission, and even death within one year of admission. It is important for to be aware of the risks for severe RSV for prevention and treatment strategies.

Causes and Risk Factors

RSV illness is causes by infection with RSV.

RSV is a viral infection that affects the respiratory system, specifically the lungs and airways.
RSV is spread through respiratory droplets when an infected person coughs or sneezes, or by touching contaminated surfaces and then touching the face.
The virus enters the body through the nose or mouth and infects the cells lining the airways, leading to inflammation and damage.

RSV Risk Factors: RSV is highly contagious and easily spread. Risk factors for developing RSV infection include

Being around people who are infected with RSV:
- Being around young children during respiratory season is a particular risk. Researchers estimate that 90% of children will have RSV respiratory infection before the age of 2 years. Hence, being at childcare centers, preschools, or other places where groups of young children may be encountered increases the risk of getting RSV.
- Close contact with infected individuals, such as family members or healthcare workers.
Living conditions: Crowded living environments, such as nursing homes or assisted living facilities, can facilitate the spread of RSV.
Poor hand hygiene: Not practicing proper hand hygiene, including regular handwashing or using hand sanitizers, can increase the risk of RSV transmission.

Severe RSV Risk Factors: In addition to general risk factors for RSV infection and respiratory illness, it is important to recognize risk factors for developing severe RSV infection that could lead to hospitalization.

Risk factors for developing severe RSV include:

Older age: Adults > 65 years old are more susceptible to severe RSV infections due to age-related changes in the immune system.
Certain chronic conditions: People with chronic lung conditions (such as asthma and chronic obstructive pulmonary disease), heart disease, including congenital heart conditions and congestive heart failure, severe obesity, and severe diabetes
Compromised (weakened) immune systems: People with conditions that weaken the immune system such as HIV and cancer, or taking medications that suppress the immune system
Prematurity
Children under 2 years old

It is important to note that risk factors increase a person’s chance of getting RSV infection or developing severe RSV but doesn’t not mean that everyone with risk factors will get RSV illness. Taking preventive measures, such as practicing good hygiene, avoiding close contact with infected individuals, and for high-risk adults, RSV vaccination, can help reduce the risk.

Symptoms

The most common early symptoms of RSV include:

Runny nose
Sore throat
Sneezing
Cough
Mild cold-like symptoms

As the infection progresses or becomes more severe, the following symptoms may occur:

Difficulty breathing: This may require emergency care.
Fatigue: Feeling tired or weak.
Shortness of breath: Difficulty taking deep breaths.
Fever: A high body temperature.
Wheezing: A whistling sound when breathing.

Babies may not always have typical cold symptoms. In infants less than 6 months old, symptoms may include:

Fussiness or irritability
Lack of interest in playing
Decreased appetite
Changes in breathing patterns (for example, rapid breathing)

It's important to note that RSV can cause more severe infections in older adults, especially those with chronic heart or lung diseases or weakened immune systems. In these cases, hospitalization may be necessary. Symptoms of severe RSV for which immediate medical attention is needed include:

Blue or gray skin color
Wheezing or other noises when breathing
Short, shallow or fast breathing
Flaring (spreading out) of nostrils while breathing
Difficulty breathing; feeling unable to catch your breath or get in enough air

If you experience any severe symptoms or are at high risk for severe RSV and suspect that you have RSV, it's essential to seek medical attention. Your healthcare provider can provide a proper diagnosis and recommend appropriate treatment options.

Diagnosis

To diagnose RSV in adults, the following examinations, tests, and procedures are commonly performed:

Medical history: The healthcare professional will ask about your symptoms and medical history. They will want to know about your medical conditions and medications.
Physical exam: The healthcare professional will listen to your lungs with a stethoscope and check your blood oxygen level. Checking blood oxygen level is often done with pulse oximetry, which is a non-invasive test where a monitor is placed on a finger to measure the level of oxygen in the blood. This gives the doctor information about how well you are breathing.
Nasopharyngeal swab: A sample is taken from the back of the nose and throat to test for the presence of RSV.

Based on initial findings, severity of symptoms, and individual factors, additional examinations, tests or procedures may be performed, including:

Chest X-ray: This imaging test can help evaluate the extent of lung involvement and identify complications such as pneumonia.
Blood tests: These can include a complete blood count (CBC) to assess white blood cell count and inflammation markers, as well as respiratory viral panel testing to detect other respiratory viruses that may be present.
Arterial blood gas analysis: In severe cases, a sample of arterial blood may be taken to measure oxygen and carbon dioxide levels, providing information about respiratory function.

It's important to note that other examinations, tests, and procedures may performed based upon the individual situation.

Treatment Options

Prevention

The best treatment for RSV is preventing an RSV infection. In addition to avoiding exposure to people already infected with RSV, there are RSV vaccines and monoclonal antibodies available.

Vaccines and Immunizations

There are currently three RSV vaccines available in the US:

Arexvy is a vaccine indicated for active immunization for the prevention of lower respiratory tract disease (LRTD) caused by respiratory syncytial virus (RSV) in

Individuals 60 years of age and older.
Individuals age 50 through 59 years who are at increased risk for (LRTD) from RSV.

mResvia is a vaccine indicated for active immunization for the prevention of lower respiratory tract disease (LRTD) caused by respiratory synctyial virus (RSV) in

Individuals 60 years of age and older.
Individuals 18 through 59 years of age who are at increased risk of LRTD caused by RSV.

Abrysvo is a vaccine indicated for

Pregnant individuals at 32 through 36 weeks gestational age for the prevention of lower respiratory tract disease (LRTD) and sever LRTD caused by respiratory syncytial virus (RSV) in infants from birth through 6 months of age
The prevention of LRTD caused by RSV in individuals 60 years of age and older
The prevention of LRTD caused by RSV in individuals 18 through 59 years of age who are at increased risk of LRTD caused by RSV

Monoclonal antibodies
There are currently two monoclonal antibody injections for RSV prevention in infants and children:

Clesrovimab: Clesrovimab is an antibody that is given as an injection to prevent RSV lower respiratory tract disease in neonates and infants who are born or entering their first RSV season.

Nirsevimab: Nirsevimab is also an antibody that is given as an injection to neonates and infants who are born or entering their first RSV season and children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.

Treatment

There currently are no treatments specifically for RSV. The goal of treatment for RSV is primarily to alleviate symptoms until the illness resolves on its own in 1-2 weeks. It is also important to detect severe illness or complications as early as possible for additional supportive treatment. The recommended treatments include:

For people with mild-to-moderate RSV:
- Over-the-counter fever and pain relievers, like acetaminophen or ibuprofen. For children or people with chronic conditions or taking prescription medications, it is important to check with a healthcare provider before starting new medications for guidance regarding the proper dose to take. Note that aspirin should not be given to children.
- Cool-mist humidifiers to make breathing more comfortable.
- Nasal saline sprays and nasal suctioning for infants to help relieve congestion
- Hydration: Drink plenty of fluids
- It is important to note that antibiotics are not effective for treating RSV infection.
For severe RSV, additional supportive therapies may be needed, including
- Oxygen therapy
- Intravenous hydration
- Help to remove mucus from the airways (suctioning)

Early detection, prevention strategies (such as vaccination), and supportive care play crucial roles in managing RSV. Always consult with your healthcare professional for personalized advice regarding treatment options.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.