Respiratory syncytial virus (RSV): Symptoms, treatments, and vaccination

Today, more children and older adults are getting severe RSV infections. In the winter of late 2020 into early 2021, there were almost no cases of RSV.

Some children and babies have little natural protection. That’s because their immunity has lessened, or they weren’t exposed to respiratory viruses before the pandemic.

For older adults, the population of people over 60 is larger now than it has ever been before, and more people are immunocompromised than before the pandemic.¹

RSV infections can be dangerous for certain adults, babies, and children. Those at highest risk for severe RSV infection include:

• Adults 60 and over 
• Adults with heart or lung disease 
• Adults with weakened immune systems
• Adults with certain other underlying health conditions
• Adults living in nursing homes or long-term care facilities
• Premature infants
• Young children with congenital (from birth) heart or chronic lung disease
• Young children with weakened immune systems 

Most of the time, RSV is a mild, cold-like illness that lasts 1 to 2 weeks. However, according to the Centers for Disease Control and Prevention (CDC), 1% to 2% of babies younger than 6 months may need to be hospitalized. Those who are hospitalized may need oxygen or help breathing. Most children can leave the hospital within a few days.

No. Almost all children get an RSV infection by their second birthday.

Symptoms of RSV usually appear within 4 to 6 days after infection. Mild, cold-like symptoms typically include:

• Congested or runny nose
• Decreased appetite
• Coughing
• Sneezing
• Fever
• Moderate wheezing

Severe symptoms to look out for in children include: 

• Severe wheezing
• Rapid breathing or respiratory distress 
• Bluish skin or fingernails
• Refusal to drink liquids
• Decreased number of wet diapers
• Extreme tiredness

Some people with an RSV infection, especially older adults and infants under 6 months, may develop a lung infection, get dehydrated, or have trouble breathing. In the most severe cases, a person may need to be hospitalized so they can be treated with IV fluids (if they can’t eat or drink enough), additional oxygen, or a machine to help them breathe. In most of these cases, hospitalization lasts only a few days.

RSV also can worsen existing health conditions, such as:

• Asthma
• Chronic obstructive pulmonary disease (COPD) (a 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 are at greater risk than young adults for serious complications from RSV because their immune systems are weaker. Some older adults who get very sick from RSV may need to be hospitalized, and some may even die.

RSV spreads through the air from droplets from coughing or sneezing. It can spread quickly in schools, child care centers, nursing homes, and other places where people are in close contact.

RSV can also survive for many hours on hard surfaces, such as toys or furniture. That’s why washing your hands regularly is important for preventing the spread of the virus.

If you or your child is at high risk, make sure to:

• Avoid close contact with sick people 
• Wash your hands and your child’s hands often with soap and water for at least 20 seconds
• Avoid touching your face or your child’s face with unwashed hands
• Limit the time children spend in child care or other crowded places
• Stay home when sick
• Clean frequently touched surfaces
• Avoid exposure to people who are smoking 

Also, all eligible family members should get a flu shot and COVID-19 vaccination to help protect against complications from RSV.

• Drink plenty of fluids to prevent dehydration.
• Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Never give aspirin to children.)
• Talk to your doctor or a clinician before giving your child over-the-counter cold medicines. Some medicines contain ingredients that aren’t good for children.
• Use nasal saline and a nasal aspirator or bulb syringe if your child is too young to blow their nose. This removes sticky nasal fluid and can help your child breathe more comfortably.

Yes, for certain populations:

• People 75 and older: The CDC recommends a single RSV vaccination for anyone age 75 and older.
• People 60 to 74: The CDC recommends that people in this age group who are at increased risk for severe RSV disease get vaccinated once. Ongoing health conditions that increase RSV risk include cardiovascular disease, lung disease, liver disorders, advanced chronic kidney disease, moderate or severe immunocompromise, diabetes with organ damage or for patients taking certain diabetes medications, severe obesity, and neurologic or neuromuscular conditions.
• People who are pregnant: The CDC recommends the RSV vaccine for pregnant people to protect their babies from severe RSV disease during the respiratory illness season. Pregnant people should get a single dose of Pfizer’s bivalent vaccine (Abrysvo) during weeks 32 through 36 of pregnancy during September through January.
• All infants under 8 months and some older babies: The FDA has approved an RSV immunization treatment that will help protect all infants under 8 months during their first RSV season, as well as some older babies 8 to 19 months who are at increased risk of severe illness. This isn’t a vaccine, but it’s recommended as part of routine childhood immunizations. Infants generally do not need this RSV immunization treatment if maternal RSV was received during pregnancy.

People ages 75 and older, pregnant people (from September through January), and people ages 60-74 who are at increased risk of severe RSV should get the RSV vaccine.

People ages 60-74 are at increased risk of severe RSV if they have at least one of the following conditions:

• Advanced chronic kidney disease
• Blood disorder
• Cardiovascular disease
• Diabetes with organ damage or for patients taking certain diabetes medications
• Liver disorders
• Lung disease
• Moderate or severe immunocompromise
• Neurologic or neuromuscular conditions
• Severe obesity

Older adults or those who live in a nursing home or other long-term care facility are also at higher risk for severe RSV infection. 

Yes, the RSV vaccine is safe and effective. The most common side effects include pain at the injection site, fatigue, headache, and muscle or joint pain. During clinical trials, the vaccine reduced the risk of lower respiratory tract disease (an infection like pneumonia) by about 80%.

Serious conditions, including Guillain-Barré syndrome (GBS), were reported in a few people during clinical trials. GBS is a rare condition that occurs when your immune system attacks your nerves, causing muscle weakness. Also, a few people developed atrial fibrillation (abnormal heartbeat). The number of people affected was too small to know if these conditions were caused by the RSV vaccine. For most higher-risk eligible people, the benefits of protecting yourself or your infant from a severe RSV infection are greater than the risks.

People with a history of severe allergic reaction to any component of the RSV vaccine shouldn’t get the vaccine.

No. The RSV vaccine is not an annual vaccine and is currently recommended as a single-lifetime dose for older adults. If you have received an RSV vaccine in the past, you do not need another one.

Nirsevimab (also known as Beyfortus) is a type of medicine known as an antibody.³ It provides immediate, short-term protection from RSV disease.

Nirsevimab blocks RSV from entering healthy cells, especially cells in the lungs. One dose helps to prevent RSV infection for 5 months, which is the length of a typical RSV season.

The CDC recommends nirsevimab for:

• Infants under 8 months during their first RSV season
• Infants and children 8 to 19 months old who are at increased risk of severe RSV disease

Nirsevimab isn’t technically a vaccine. It’s an injection that provides protection against RSV. Infants generally don’t need nirsevimab if their mother received a maternal RSV vaccination during pregnancy.

The CDC recommends a maternal vaccine called Abrysvo for people 32 to 36 weeks pregnant. It can help protect babies from birth to 6 months from the risk of severe lung disease caused by RSV. The vaccine works by helping the pregnant person’s immune system recognize and target RSV. This immune response to RSV is passed on to the baby before birth. This helps protect babies against severe lung disease for up to 6 months after they’re born, when they’re at highest risk. If a pregnant person receives the maternal RSV vaccine 14 or more days before delivery, their baby won’t need nirsevimab, except in very rare situations.

According to the CDC, nirsevimab reduces the risk of severe RSV disease by about 75%. One dose of nirsevimab protects infants for at least 5 months. That’s the length of an average RSV season. Nirsevimab doesn’t actually activate the immune system. This means protection is most effective in the weeks right after nirsevimab is given and lessens over time. Nirsevimab doesn’t provide long-term protection against RSV disease. But it does protect infants when they’re most at risk of getting very sick from RSV. As children get older, they’re less likely to get very sick from RSV.