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Respiratory Syncytial Virus (RSV)

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This information was reviewed and approved by Carrie A. Horn, MD, Nathan Rabinovitch, MD, MPH (11/2/2022).

What is RSV?

Respiratory syncytial (pronounced sin-sish-uhl) virus is highly contagious. The RSV virus causes sudden, cold-like symptoms, severe breathing problems and respiratory tract illness. This virus can affect all ages. RSV in babies and children born prematurely can be especially serious. RSV in adults over age 65 and anyone with underlying heart, lung or immune system diseases, carries an increased risk of a severe infection.

The time between exposure to this virus and the beginning of RSV symptoms is four to six days. RSV in adults and most children lasts less than two weeks. Most children have had the RSV virus at least once by the time they are 2 years old. It is possible to get the virus more than once during the same RSV season.

RSV season is usually in the fall through late spring. RSV is the most common cause of lower respiratory tract infections in children under 1 year of age. An upper respiratory tract infection affects the sinuses and throat. A lower respiratory tract infection affects the lungs and the airways in the lungs. Infections in the lower respiratory tract last longer and are more serious.
RSV Risk Factors

These people have an increased risk of developing severe RSV infection:

  • Adults over age 65

  • Adults with heart or lung disease

  • Children and adults with weakened immune systems

  • Children with Down syndrome

  • Children with neuromuscular disorders that have difficulty swallowing or clearing mucus

  • Children with persistent asthma, bronchopulmonary dysplasia, cystic fibrosis and other chronic lung diseases

  • Infants and children born with heart or lung disease

  • Infants born before 35 weeks (8 months)

  • Infants exposed to HIV

  • Infants exposed to secondhand smoke

  • Infants less than 6 months old, especially those born during the first half of RSV season

  • Infants who attend daycare

  • People who live at or above 8,200 feet elevation

RSV Causes

RSV is primarily spread through infected droplets from coughs and sneezes. The virus can live for several hours on hands, clothes, utensils, furniture and other objects. It can be spread from touching a contaminated surface.

RSV Symptoms

RSV is a respiratory virus like the common cold, the flu and COVID-19. Symptoms common to respiratory virus infections are cough, runny nose and fever. Wheezing is a unique symptom of RSV even in people without asthma. New loss of taste or smell seems to be a symptom unique to COVID, although a lot of sinus congestion can decrease the sense of smell. RSV can also cause ear infections, bronchiolitis, pneumonia, pink eye and sleep apnea. In adults, it also can lead to an exacerbation of heart failure, COPD or interstitial lung disease. The cough from RSV can last for over two weeks even when the rest of the symptoms get better.

Symptoms of RSV are generally worse days three through five. RSV symptoms may include:

  • Runny or stuffy nose

  • Coughing

  • Sneezing

  • Fever

  • Wheezing

  • Sore throat

  • Mild headache

  • Decreased appetite

  • General ill feeling

RSV symptoms in babies and toddlers can include:

  • Irritability

  • Decreased activity

  • Decreased appetite

  • Apnea (pause while breathing)

  • Short, shallow and rapid breathing

  • Difficulty breathing (using muscles around the ribs, stomach or collarbone to breathe)

  • Dehydration (dry mouth or lips, less frequent wet diapers or lack of tears when crying)

Call the doctor if your child, or anyone who is at risk of developing RSV, has these symptoms:

  • High fever

  • Cough

  • Wheezing

  • Signs of dehydration (less frequent urination or wet diapers)

  • Difficulty breathing

  • Refused to eat or drink

Get immediate medical help if you or your child:

  • Has trouble breathing or is breathing very fast

  • Has blue lips or fingernails

RSV Diagnosis

RSV acts like the common cold, so most children and adults won’t need to see a doctor. Children and adults who are at risk will need to be diagnosed by a doctor. The RSV virus is diagnosed through testing nasal fluids either by a nasal swab or nasal wash. New tests can look for RSV, flu and COVID all at the same time.
RSV Treatment

RSV in adults and children generally does not need medical treatment. The RSV infection lasts about a week or two. Home treatments can manage RSV symptoms and include:

  • Plenty of fluids to prevent dehydration

  • Cleaning the nose by blowing, using a saline nose spray, nasal aspirator or nasal wash

  • Treating fever with acetaminophen or ibuprofen (children 6 months and older)

Do not give your child aspirin because it can cause Reye syndrome, which is life-threatening.
Do not use over-the-counter cold and flu medicines in children unless instructed by your doctor.

For adults and children who develop a serious infection, RSV treatment may include medication. Some people with RSV may be hospitalized for monitoring and to receive supportive care such as oxygen, IV fluids, breathing treatments and ventilation.
Prevent an RSV infection

Currently, there is no RSV vaccine but several are in development. For those who have an increased risk of developing serious complications from RSV, palivizumab may be prescribed. Talk with your doctor to learn if this medication is right for you or your child.

The best way to avoid getting RSV is to:

  • Wash hands thoroughly and frequently, or use hand sanitizer if soap and water are not available

  • Cover coughs and sneezes with a tissue, upper sleeve or elbow

  • Avoid exposure to tobacco and other types of smoke (including secondhand smoke)

  • Reduce time high-risk children are in childcare centers during RSV season

  • Clean frequently touched surfaces often during cold, flu and RSV seasons

  • Don’t touch your face with unwashed hands

  • Wear a mask in public if you or your child are at high risk of severe illness

At National Jewish Health, we have doctors with expertise in diagnosing and treating RSV in both children and adults.

Adults make an appointment with one of our pulmonary experts.

Parents, sometimes multiple visits are needed to diagnose and treat all related issues. Make an appointment for your child to be seen in our Day Program to consolidate those visits.