By David Herman, MD
Typically known as a virus that is especially dangerous for babies, respiratory syncytial virus — commonly known as RSV — can also have serious consequences for older adults.
In fact, the Centers for Disease Control and Prevention (CDC) estimates that each year between 60,000 and 160,000 older adults in the United States are hospitalized and 6,000 to 10,000 die due to RSV infection.
However, there is help on the way in the form of new vaccines recently approved by the U.S. Food and Drug Administration (FDA).
Additionally, the FDA is reviewing the use of the vaccine in pregnant women and is considering approval of a monoclonal antibody shot to prevent RSV in infants and vulnerable toddlers.
What is RSV?
RSV is a highly contagious common respiratory virus that usually causes mild, cold-like symptoms.
While most people recover from RSV in a week or two, the virus can be serious for infants and some young children as well as older adults.
RSV circulation is seasonal, typically starting during the fall and peaking in winter.
The virus can spread when:
- An infected person sneezes or coughs.
- You get virus droplets from a cough or sneeze in your eyes, nose or mouth.
- You have direct contact with the virus, like kissing the face of a child who has RSV.
- You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands.
People infected with RSV are usually contagious for three to eight days and may become contagious a day or two before they start showing signs of illness.
People are typically infected with RSV for the first time as an infant or toddler and nearly all children are infected before their second birthday.
What are the Signs and Symptoms?
In most cases, symptoms of RSV are mild and include:
- Runny nose.
- Decrease in appetite.
- Coughing.
- Sneezing.
- Fever.
- Wheezing.
In very young infants with RSV, the only symptoms may be irritability, decreased activity, decreased appetite and apnea (pauses in breathing more than 10 seconds).
When RSV infection is severe, both children and older adults are at greater risk for pneumonia and bronchiolitis (swelling of the small airway passages in the lungs).
If you or your child are having difficulty breathing or experiencing worsening symptoms, call your healthcare provider right away.
Who is at Risk?
Though anybody can get RSV, those most at risk for complications are:
- Premature infants.
- Infants, especially those 6 months and younger.
- Children younger than 2 years old with chronic lung disease or congenital heart disease
- Children who have neuromuscular disorders, including those who have difficulty
swallowing or clearing mucus secretions. - Older adults, especially those 65 years and older.
- Adults with chronic heart or lung disease.
- Children and adults with weakened immune systems.
How is RSV Treated?
At present, there is no specific treatment for RSV though antiviral medication is under development. If you or your child develop RSV, talk to your healthcare provider about steps you can take to relieve symptoms.
In cases of severe RSV, hospitalization may be necessary.
How Can RSV Be Prevented?
You can help prevent RSV by:
- Washing your hands often with soap and water for at least 20 seconds.
- Keeping your hands off your face.
- Avoiding close contact with sick people.
- Covering your cough and sneezes.
- Cleaning and disinfecting surfaces.
- Staying home when you’re sick.
What About the Vaccine?
To date, the FDA has approved two different RSV vaccines for use in older adults. One is called Arexvy and is produced by GlaxoSmithKline. The other is called Abrysvo and is produced by Pfizer.
Both have been proven safe and effective for adults aged 60 and older.
The vaccines still require review by the CDC, which will establish recommendations for use, and it is anticipated that both will be available this coming fall.
Like other vaccines, side effects could include pain at the injection site, fatigue, muscle pain, headache and joint stiffness and pain.
In addition, this month an FDA advisory panel also recommended approval of a monoclonal antibody shot to protect infants against RSV.
Monoclonal antibodies are man-made antibodies that are similar to the ones your body would naturally make in response to an infection — or a vaccine. A similar treatment is already in use for high-risk infants. If the FDA approves the shot, it too will likely be available this fall.
The FDA is also reviewing the use of Abrysvo in pregnant women to help prevent RSV in infants.
Talk With Your Doctor
If you are concerned about your risk for complications from RSV or how to prevent RSV in your infant or toddler, talk with your doctor. Vaccines and other measures can offer protection to those most vulnerable when RSV season starts this fall.
To find a physician with Penn Medicine Princeton Health, call (888) 742-7496 or visit
www.princetonhcs.org.
David J. Herman, M.D., is board certified in infectious disease and internal medicine. He is the Hospital Epidemiologist and chairman of the Infection Control Committee at Penn Medicine Princeton Health.