RSV in Adults: Signs, Symptoms & Treatments

Respiratory Syncytial Virus (RSV) is a common virus that affects the respiratory tract. Often associated with young children, RSV can also significantly impact adults, especially those with compromised immune systems. Each year in the United States, an estimated 60,000 to 120,000 older adults are hospitalized, and 6,000 to 10,000 die from RSV infection.

The signs and symptoms of RSV can vary, but within some groups this can be an extremely high-risk virus. Clinical trials have, and continue to play a critical role in developing treatments and prevention strategies to protect such groups.

What is RSV in adults?

​​RSV is a common virus that usually causes mild illness that can lead to an upper respiratory infection. You might not even realize you have RSV, and without the correct laboratory testing, it is often grouped with other respiratory infections that cause cold-like symptoms.

RSV can be dangerous for certain high-risk adults, such as the immunocompromised or the elderly, as the respiratory infections are harder to fight off. In some cases, the infection can become so severe that hospitalization is required.

How common is RSV in adults?

RSV is considered common as it is very contagious and easily spread. A lot of people may never know they have even had RSV since it usually feels like a common cold. However, RSV is the leading cause of lower respiratory tract infections, and it is usually at the time of infection that RSV is tested for.

For high-risk adults, such as the elderly and those with COPD or heart failure, RSV may be the cause of around 10% of winter hospitalizations for pneumonia. Within these groups specifically, studies have indicated that RSV could cause 0.6%-0.8% of acute flare-ups in chronic obstructive pulmonary disease (COPD) patients, with some studies reporting even higher rates in specific populations.

What causes RSV?

RSV is spread from person to person by inhaling infected respiratory secretions from the nose or throat. It’s possible to catch RSV through close contact with an infected person, such as shaking hands or hugging, or by touching contaminated objects like doorknobs, keyboards, or toys, and then touching your eyes, nose, or mouth. The virus can survive on surfaces for several hours, which makes it easy to spread.

When is peak season for RSV infection?

Winter is typically the peak season for RSV. During colder months people tend to gather indoors, increasing the risk of transmission. Sometimes this can extend into early spring, when the “common cold” is circulating, disguising transmission of RSV and reducing the likelihood of testing.

What are the symptoms of RSV in adults?

Adults with RSV usually exhibit typical cold symptoms. These symptoms can be mild and often include congestion, such as a stuffy or runny nose.

A persistent cough, sometimes producing mucus, is common, as well as a mild to moderate fever. People with RSV also commonly feel tired or fatigued, with mild headaches and nasal congestion.

Severe RSV symptoms in adults

In some cases, especially among high-risk groups, RSV can lead to more severe symptoms that significantly impact daily life and may require medical attention.

These symptoms can include extreme tiredness or weakness and a low appetite that can lead to weight loss. Patients may also experience a persistent or severe cough, wheezing, and shortness of breath, making even minimal exertion difficult.

Breathing difficulties can manifest as short, shallow, or rapid breathing, which can be exhausting. In severe cases, difficulty breathing may occur, sometimes accompanied by bluish skin, lips, or nails, indicating low oxygen levels in the blood.

Other symptoms include a high fever (above 38°C/100°F), irritability, and a sore throat, which can make swallowing painful. Sudden changes in mental state, such as confusion or disorientation, may also arise.

Who is at risk for severe RSV?

Several groups are at higher risk of RSV and its complications, including premature babies, children under 2 years old, children with underlying health conditions, and adults over the age of 60.

In adults, certain factors increase the risk of severe RSV infection. Those with chronic respiratory conditions such as COPD, asthma, or interstitial lung disease. Cardiovascular diseases, including congestive heart failure and coronary artery disease, can also increase the severity of RSV.

Immunocompromised individuals such as those with HIV/AIDS, organ transplant recipients - particularly those with kidney, liver, or lung transplants - or people on immunosuppressants are especially vulnerable.

Additionally, poorly controlled diabetes, kidney disease, and liver disorders all increase the risk associated with RSV.

As well as the individuals themselves, those living with them, working with them, or those in close-contact settings also face higher exposure and transmission risk.

Possible complications of severe RSV

RSV infection can spread to the lower respiratory tract, causing more severe symptoms and potentially leading to other conditions or problems, including:

• Pneumonia
• Acute bronchitis
• Bronchiolitis
• Worsening of existing conditions such as asthma, congestive heart failure, or chronic obstructive pulmonary disease (COPD)
• Respiratory failure

How is RSV diagnosed?

Since RSV often resembles a cold or the flu, your doctor will need to run specific tests to determine whether you have RSV. Starting with a medical history they may then conduct a physical exam and listen to your lungs to check for wheezing or other abnormal sounds.

If they suspect you have RSV they will order follow-up lab tests. These may include imaging tests to help diagnose RSV, such as a chest X-ray to check for lung inflammation. Blood tests might also be necessary to check white cell counts or to look for viruses, bacteria, and other germs. A swab of secretions from inside the mouth or nose may be used to test for the RSV virus. In some cases, pulse oximetry (a painless skin monitor) might be used to detect lower-than-normal levels of oxygen in the blood.

How long does RSV last in adults?

After exposure to RSV, symptoms typically appear within four to six days. Most infections resolve on their own within a week or two. However, if you experience more severe symptoms or are in a high-risk group, recovery could take much longer.

What are the treatment options for RSV in adults?

There isn’t a specific treatment for RSV. Mild cases typically resolve on their own within a week or two. Since RSV is a virus, it cannot be treated with antibiotics. You can use nasal saline spray and a cool-mist humidifier to relieve congestion and aid breathing, or over-the-counter medication to reduce fever.

For more severe cases or high-risk individuals, other steps can be taken to help relieve symptoms and support bodily functions while their body fights the virus. IV fluids can be given to ensure hydration, as well as oxygen therapy to maintain adequate oxygen levels.

In some cases, antiviral medication like ribavirin may be used. Ventilators may also be used to assist with breathing, while mucus removal techniques can be used to help clear the airways.

In rare but life-threatening cases, a patient may need to be placed on a ventilator. If you are at higher risk or develop severe symptoms, you should see your physician or possibly go to the emergency room, depending on the severity.

Is there an RSV vaccine?

In May 2023, the U.S. Food and Drug Administration (FDA) approved a vaccine for RSV. Some groups are eligible to receive an RSV vaccine to prevent the virus from causing severe symptoms and lower respiratory tract disease.

• Adults aged 60 and above: Eligible to receive one of the two licensed RSV vaccines. The American Academy of Family Physicians (AAFP) recommends a single dose for adults 60 years and older. Discuss with your healthcare provider whether the RSV vaccine is recommended for you, considering your overall health and any chronic conditions or risk factors.
• Pregnant individuals: Eligible to receive the RSV vaccine between weeks 32 and 36 of pregnancy to protect their infants during the first six months of life.
• Babies up to 8 months old: Can receive a monoclonal antibody immunization against RSV (nirsevimab), administered as a single dose during or before their first RSV season.

RSV in transplant patients

RSV is associated with high morbidity and mortality among solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Transplant patients are at higher risk because medications used to prevent organ rejection also suppress the immune system. This makes it harder to fight off infections like RSV.

Additionally, conditions that necessitate the transplant, such as chronic lung disease before a lung transplant, may continue to leave patients vulnerable to respiratory viruses. Management options are currently limited or lack strong clinical evidence. This makes clinical research in this area particularly important.

Common complications of RSV in transplant patients

Transplant patients with RSV may experience several complications, including:

• Increased Severity of Infections: RSV can progress to more severe conditions such as bronchiolitis or pneumonia more frequently in transplant patients.
• Impact on Transplanted Organ: RSV can affect the function of transplanted organs, particularly in the case of lung transplants.
• Risk of Graft Rejection: Severe RSV infection can trigger an immune response that could lead to graft rejection.

Prevention and monitoring of RSV in transplant patients

There are four main categories of prevention and monitoring, that range from vaccines to protocols.

• Vaccination: Transplant patients, because of their weakened immune systems, need careful review when considering vaccinations and there is limited information specifically about transplant patients and other highly immunocompromised people. The Advisory Committee on Immunization Practices (ACIP) recommends RSV vaccines for transplant patients over 60 with clinical trials showing these vaccines are very effective in preventing serious RSV-related lung infections. Decisions on whether to vaccinate should ultimately involve detailed talks between the patient and their doctor, considering the risks and benefits of their unique situation.
• Infection Control Practices: as transplant patients are a high-risk group, the best course of action is to prevent them from ever getting RSV in the first place. This is where infection control comes in. Remember to wash your hands regularly, wear masks when you're in crowded places or around people who are sick, and stay away from anyone who has symptoms like a cough or a runny nose.
• Regular Medical Review: Regular check-ups are essential for transplant recipients to keep an eye on their overall health and lung function. During these visits, healthcare providers can check if vaccinations are needed, take steps to prevent infections like RSV, and adjust medications as necessary.
• Early Intervention Protocols: Recognizing the early signs of RSV is crucial for transplant patients. Early intervention protocols should ensure that patients consult with their healthcare providers as soon as symptoms develop. Treatment might include antiviral medications and supportive care at home.

How to prevent RSV

Washing your hands frequently is a key and simple step in preventing RSV. Make sure to wash your hands after using the bathroom and before handling food. It's also wise to clean your hands after touching objects that many people use (as previously mentioned, RSV can live on surfaces for several hours). To reduce your exposure to germs, especially if you're at high risk for RSV, avoid crowded places and close contact with others, particularly during the peak of respiratory virus season.

When you sneeze or cough, cover your mouth and nose with a tissue, your elbow, or your clothes instead of your hands to help stop the spread of germs. Avoid sharing food, drinks, or utensils with others, and regularly clean surfaces that are frequently touched like doorknobs and tables.

Keeping up to date with vaccinations is also important in developing a strong immune system; discuss with your healthcare provider about the recommended vaccines and the best times to receive them, including your annual flu and COVID-19 shots.

RSV and clinical research

Currently, there are only two vaccines approved by the FDA to date, which highlights that more clinical research into RSV is necessary. Scientists are actively conducting vaccine clinical trials aimed at developing both preventive vaccines and treatment options for RSV. This research is crucial for high-risk groups, including the elderly and those with weakened immune systems, who are particularly vulnerable to the virus.

Among the ongoing studies, some are exploring the potential of presatovir, an antiviral drug initially developed to combat RSV. Researchers are specifically looking into how effective this drug can be in transplant patients, a group that faces a high risk of severe illness from RSV.

How to get involved in a clinical trial for RSV

If you're interested in participating in a clinical trial for RSV, the first step is to discuss it with your healthcare provider. They can help determine if you are a suitable candidate for a clinical trial and inform you about any ongoing trials that are recruiting participants. This is particularly important for those in high-risk groups, such as organ transplant recipients, who are often prioritized in these studies.

You can also look for trials by searching online databases or by connecting with local groups in your area that focus on health and medical research. Participating in a clinical trial not only gives you access to new treatments but also allows you to contribute to advancements in medical research.

Why get involved in a clinical trial for RSV?

Participating in a clinical trial for RSV is important because it supports vital research on a virus that is both common and severe. By joining a clinical trial, you can help scientists learn more about RSV and develop better ways to prevent and treat it.

If you are part of a high-risk group, joining a clinical trial could give you access to new, potentially beneficial treatments that are not yet widely available. Your participation not only has the potential to improve your own health but also helps enhance care for others facing similar health challenges in the future.

Conclusion

In conclusion, RSV is a serious health issue, especially for the elderly and transplant recipients. Knowing the signs and symptoms can help with early detection and management. While treatment options are currently limited, ongoing clinical research is crucial for developing better treatments and vaccines. By participating in clinical trials, individuals can access new treatments and help advance medical research, benefiting everyone.

FAQs

Can antibiotics treat RSV?

No, antibiotics cannot treat RSV because it is a virus. Antibiotics are only effective against bacterial infections, so they do not work on viral infections like RSV.

Is RSV deadly?

RSV can be deadly, particularly for certain high-risk groups. While most people with RSV experience only mild, cold-like symptoms, the virus can lead to severe respiratory illnesses such as bronchiolitis and pneumonia, which can be life-threatening. This is especially true for the elderly, infants, and individuals with weakened immune systems.

Can you get RSV twice?

Yes, it is possible to get RSV multiple times throughout your life. According to a 2021 review of studies, the risk of getting RSV again after an initial infection is about 70% lower within the first six months. Research suggests that your body begins to develop an immune response to RSV within 5 to 10 days, but immunity may wane over time, allowing for reinfection.