Most of the time an RSV infection is merely uncomfortable, but in some cases it can be life-threatening. It is a particular danger to babies younger than 6 months, for whom an infection in the lungs and breathing passages can lead to serious illness, hospitalization, and even death. Other high-risk groups include people who are immunocompromised and adults ages 65 and up. In fact the NFID has called RSV in older adults “a hidden annual epidemic.” In a typical year about 177,000 older adults are hospitalized because of RSV, and roughly 14,000 die, according to the Centers for Disease Control and Prevention (CDC).
A Seasonal Shift and Increase in RSV Cases
Peak season for RSV infection in the United States is fall, winter, and spring. But some doctors have been seeing infections in warmer months as well. During the height of the COVID-19 pandemic in 2020 and 2021, health agencies reported a steep drop in cases of RSV and flu in the United States and around the world, according to research published in September 2021 in Pediatrics. Infectious disease experts credit the decrease to COVID-19 safety measures like masking and social distancing. They believe that easing these precautions likely led to the rebound of cases in warm weather and is contributing to a wave of respiratory infections this fall, including a spike in pediatric RSV and an unusually early start to flu season. The combined threat of RSV, COVID-19, and flu has led public health experts to coin a new term: “tripledemic.” A barking or wheezing cough, however, may signal the infection is getting worse and has spread to the lower respiratory tract, causing bronchiolitis (an inflammation of the small airways in the lung) or pneumonia (an infection of the lungs).
How Do Adults Get RSV?
Like other respiratory infections, RSV is highly contagious and spreads via sneezing, coughing — even kissing. The airborne virus can enter the body through the eyes, nose, or mouth, says the Cleveland Clinic. The virus can also spread to people who touch contaminated surfaces or objects and then touch their face. RSV is usually contagious for three to eight days, but some infected infants and people with weakened immune systems can continue to spread the virus for as long as four weeks, according to the CDC.
Who Is Most at Risk From RSV as an Adult?
Adults 65 and over with a weakened immune system or underlying heart or lung disease are at the highest risk of having severe complications from RSV. “This is due to older adults having a lower respiratory reserve and less lung capacity,” says Inessa Gendlina, MD, PhD, an infectious diseases physician at Montefiore Health System and an assistant professor in the department of medicine at the Albert Einstein College of Medicine in New York City. Severe disease from RSV infection can also worsen existing symptoms of heart disease, asthma, or chronic obstructive pulmonary disease (COPD). The virus, Dr. Gendlina notes, is now known to have a high mortality rate for people with these conditions, particularly the frail elderly. Aditya Shah, MBBS, an infectious disease expert at Mayo Clinic in Rochester, Minnesota, says the impact of RSV infections on older adults will also depend on other underlying conditions, including diabetes, obesity, or kidney disease. “Outcomes are better in those patients that do not have these risk factors,” he says.
What to Do if You Have Symptoms of RSV?
If you’re sick with some type of respiratory infection and don’t know which kind, Dr. Shah says it’s best to get tested. While the symptoms of RSV can overlap with those of COVID-19 and the flu, there are several laboratory tests available to help with diagnosis. Your doctor can administer an antigen or PCR (polymerase chain reaction) test to identify or rule out RSV as the cause of your symptoms. If you can’t get to your doctor or another healthcare facility, you have a new option: The U.S. Food and Drug Administration (FDA) recently authorized emergency use of a direct-to-consumer three-in-one home test by Labcorp that can determine whether you have the flu, COVID-19, or an RSV infection. You swab your nose to collect a sample, then FedEx it to a lab for PCR analysis. The Labcorp kits can be purchased online or in stores, without a prescription. Test results are delivered in around one to two days through an online portal. You can then follow up with a healthcare provider.
How to Treat RSV in Adults
There is no treatment for a mild or moderate RSV. In most cases, doctors simply recommend drinking plenty of fluids, taking over-the-counter pain or fever medication, and resting. Symptoms should go away on their own in a week or two. The FDA had approved one drug to treat severe lung infections caused by RSV, an antiviral drug called ribavirin. The downside is it’s known to have several adverse side effects, including rash and chest pain. Gendlina says people who are severely immunocompromised — a blood stem-cell transplant recipient, for example — may be given oral or inhaled ribavirin, possibly in combination with intravenous immunoglobulin (antibodies from healthy people), to fight off the infection.
How to Prevent RSV Infection
If you are virus-free and want to stay that way, or are sick and want to avoid infecting others, the CDC suggests the following:
Wash your hands often. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.Avoid touching your eyes, nose, and mouth to prevent the spread of viruses from your hands.Cover your mouth and nose with a tissue when sneezing and coughing, or sneeze and cough into your elbow.Avoid close contact (within six feet) with others who have coughs, colds, or are sick with a known RSV infection.Stay home if you are sick.Don’t share cups, bottles, or any objects. RSV can live on such surfaces for hours (and be transmitted to your hands).If you are prone to sickness or have a weakened immune system, stay away from large crowds of people.Clean frequently used surfaces (such as door knobs and countertops) with a virus-killing disinfectant.
RSV Vaccines for Older Adults May Be on the Way
Despite 50 years of research, there are currently no licensed vaccines to protect high-risk individuals from RSV infection. But dozens of RSV vaccine candidates are in development, and at least four for older adults are showing promising results in late-stage clinical trials. “Multiple clinical trials now appear to be eliciting the long-sought high-titer neutralization of RSV,” says Peter Kwong, PhD, chief of the structural biology section of the vaccine research center at the NIH’s National Institute of Allergy and Infectious Diseases (NIAID). In October 2022 GlaxoSmithKline (GSK) announced phase 3 clinical trial results of an investigation involving adults 60 and over. Their vaccine candidate, the company said in a statement, showed about 94 percent efficacy against severe RSV disease and overall efficacy of over 82 percent. The FDA is reviewing the clinical trial data and is expected to make a decision about approval in spring 2023, according to GSK. Kwong’s research colleague Barney Graham, MD, the former director of the NIH’s Vaccine Research Center, shared on Twitter his excitement over the positive GSK results nearly a decade after he helped design the vaccine “Having a safe and effective vaccine for RSV has been a career-long dream.” Also underway is Pfizer’s RENOIR phase 3 clinical trial, which has enrolled adults 60 and older to test its RSV vaccine candidate. In August 2022 the company announced an interim analysis of the study results, which found the shot to be about 67 percent effective at preventing moderate RSV disease and 86 percent effective against severe disease. The vaccine appears to be well-tolerated and safe, Pfizer added. Moderna is studying an investigational messenger RNA (mRNA) vaccine — using the same technology as its COVID-19 vaccine — to understand whether it can help protect against RSV. The phase 3 trial is currently recruiting healthy adults 60 and older. The global phase 3 EVERGREEN study from Janssen (a subsidiary of Johnson & Johnson) is evaluating its RSV vaccine when compared with placebo in approximately 23,000 adults aged 60 years and older. To learn more about joining an RSV clinical trial go to ClinicalTrials.gov.
