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Respiratory Syncytial Virus (RSV)

Respiratory syncytial [sin-SISH-uhl] virus, called RSV, is a virus that affects your lungs. It is a common virus with cold-like symptoms that can affect people of all ages. RSV is the most common cause of pneumonia and airway swelling in children under 1 year of age in the United States.
RSV usually causes mild symptoms. Most people get better in a week or two. But RSV can be serious, especially for infants and older adults.
What Are the Symptoms of RSV?

It can take as long as four to six days after being exposed to RSV before someone has symptoms. Symptoms include:

  • Runny nose
  • Eating less or not interested in eating
  • Coughing
  • Sneezing
  • Red, inflamed eyes (conjunctivitis)
  • Fever
  • Wheezing

Symptoms in very young infants may be different. They can include:

  • Being irritable or cranky
  • Eating or drinking less or not interested in eating
  • Decreased activity
  • Trouble breathing, increased breathing rate
  • Pauses in breathing that last more than 10 seconds

Call your child’s doctor right away if your child is having trouble breathing, not drinking enough fluids, not responding well, or their symptoms are getting worse.

If you or your child have any of the above symptoms, ask your doctor to test for COVID-19, flu, and RSV. It is possible to have any of these illnesses at the same time.

RSV may have symptoms similar to other respiratory illnesses, asthma, and allergies. Our chart below lists the different symptoms for RSV, the flu, COVID-19, the common cold (caused by other viruses), asthma, and seasonal allergies.

Chart showing COVID-19 symptoms

How Does RSV Spread?

RSV spreads when someone with the virus coughs or sneezes. The virus droplets get into the air, and then you breathe them in. The droplets can also land on surfaces, like a doorknob or toys. You can catch the infection by touching the doorknob with the virus on it and then touching your face. The virus can live on hard surfaces, such as a table or crib rail, for many hours.

You can also get RSV from direct contact, like kissing someone with RSV. Children often come in contact with RSV at day care centers or in schools.

People of any age can get RSV, but it typically affects infants and toddlers. If you have a certain medical condition, the infection may be more severe. For example, people with lung diseases – such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis – congenital heart disease, and immune disorders are at higher risk.

Who Is at High Risk From RSV?
Adults who have the highest risk of RSV infection include:

  • Older adults, especially those 65 and older
  • Adults with chronic heart or lung disease, such as asthma, COPD, emphysema
  • Adults with weakened immune systems or immune deficiencies
  • Adults living at high altitudes (8,500 feet or 2,500 meters or higher)

Infants and young children are also at high risk. Children at greatest risk for severe illness from RSV include:

  • Premature infants
  • Very young infants, especially ages 6 months and younger
  • Children younger than 2 years old with chronic lung disease like asthma or heart disease (present from birth)
  • Children with neuromuscular disorders – this includes children who have trouble swallowing or clearing mucus
  • Children with Down syndrome
Can RSV Cause or Affect Asthma?
Like the flu, RSV is a lung infection that can trigger asthma. You may not feel or see symptoms of RSV the first two days you are sick. By day three, you may start to feel congested, have a runny nose, fever, or may start to wheeze. People with asthma may have more severe asthma symptoms when they have RSV. If you or your child have asthma and get sick with RSV, be sure to follow your Asthma Action Plan. If your doctor changes your Asthma Action Plan when you are sick, follow this plan as soon as you start having symptoms. Know your asthma warning signs and symptoms. Call your health care provider if you have trouble breathing, wheezing, or a cough that gets worse or if your symptoms don’t get better or get worse.

RSV is the leading cause of hospital stays in young children and infants. Babies who get sick with RSV are more likely to have asthma later in childhood.1

What Is the Treatment for RSV?
If you have asthma, contact your doctor right away if you have symptoms of RSV. Or if your infant has RSV symptoms – whether they have asthma or not – contact their doctor.

Most RSV infections will go away on their own in about seven to 10 days. RSV is caused by a virus, so antibiotics will not help. Talk with your doctor about taking over-the-counter medicines to help with symptoms, like pain relievers or cough and cold medicine. Ask about nasal suction and lubrication which may help ease congestion. Drink plenty of fluids and rest. Limit your time around other people to prevent spreading RSV.

How Can I Protect Myself and Others From RSV?

There are steps to protect yourself and others from RSV:

  • Get the flu and COVID-19 vaccines to help avoid having more than one infection at the same time.
  • If you have RSV or cold-like symptoms, stay home to reduce your chance of spreading it.
  • Wear a face mask in crowded indoor spaces when respiratory infections are spreading, which is usually during the fall and winter.
  • 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, drinking after someone, shaking hands, and sharing utensils with others who are sick.
  • Clean frequently touched surfaces, such as doorknobs and cell phones, often.

Parents and caregivers can protect children from getting RSV by following these steps:

  • Get your child the flu vaccine to reduce the chance that they will get the flu and RSV at the same time or reduce their risk of severe illness.
  • Get your child the COVID-19 shot if they are 6 months or older to reduce the chance they will get COVID-19 and RSV at the same time or reduce their risk of severe illness.
  • Avoid close contact with sick people and stay home when you are sick.
  • Wash hands often with soap and water for at least 20 seconds.
  • Avoid touching faces with unwashed hands.
  • Talk with your child’s care center or school about what steps they take to reduce RSV spread.
  • Have a backup child care plan in case it is needed.
  • When possible, limit the time you spend in highly contagious settings during RSV season (fall, winter, spring).

There is a medicine that is available to prevent severe RSV illness called palivizumab [pah-lih-VIH-zu-mahb]. It is a monoclonal antibody treatment. This medicine is only for certain infants and children who are at high risk. This can include infants born prematurely(less than 29 weeks), premature infants with chronic lung disease, and people with congenital heart disease (present from birth). The medicine cannot help treating children who already have RSV disease or prevent an RSV infection.

If your child is at high risk for severe RSV disease, talk with your child’s doctor to see if palivizumab is a good option.

Right now, there are no RSV vaccines for humans. Scientists are working on several vaccines, monoclonal antibodies, and antiviral treatments to help protect people who are pregnant (and their fetuses), infants and young children, and older adults from severe RSV infection.

Medical Review: January 2023 by John James, MD

1. CDC. (2019). RSV in Infants and Young Children. Centers for Disease Control and Prevention.

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