RSV Risk to Infants and Older Adults

In most people, RSV usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.

People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Symptoms of RSV infection usually include:

• Runny nose
• Decrease in appetite
• Coughing
• Sneezing
• Fever
• Wheezing

These symptoms usually appear in stages and not all at once. RSV symptoms are typically at their worst on days 3 through 5 of illness. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties.

RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States. Almost all children will have had an RSV infection by their second birthday.

RSV can spread when:

• An infected person coughs or sneezes.
• You get virus droplets from a cough or sneeze in your eyes, nose, or mouth.
• You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands.
• You have direct contact with the virus, like kissing the face of a child with RSV.

People infected with RSV are usually contagious for 3 to 8 days. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks. Children are often exposed to and infected with RSV outside the home, such as in school or child-care centers. They can then transmit the virus to other members of the family.

RSV can survive for many hours on hard surfaces such as tables and crib rails. It typically lives on soft surfaces such as tissues and hands for shorter amounts of time.

There are steps you can take to help prevent the spread of RSV. Specifically, if you have cold-like symptoms you should:

• 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, shaking hands, and sharing cups and eating utensils, with others.
• Clean frequently touched surfaces such as doorknobs and mobile devices. 

Ideally, people with cold-like symptoms should not interact with children at high risk for severe RSV disease, including premature infants, children younger than 2 years of age with chronic lung or heart conditions, and children with weakened immune systems. If this is not possible, they should carefully follow the prevention steps mentioned above and wash their hands before interacting with such children. They should also refrain from kissing high-risk children while they have cold-like symptoms.

Parents of children at high risk for developing severe RSV disease should help their child, when possible, do the following:

• Avoid close contact with sick people.
• Wash their hands often with soap and water for at least 20 seconds.
• Avoid touching their face with unwashed hands.
• Limit the time they spend in child-care centers or other potentially contagious settings, especially during fall, winter, and spring. This may help prevent infection and spread of the virus during the RSV season.

Currently, CDC surveillance has shown an increase in RSV infections and RSV-associated emergency department visits and hospitalizations in multiple U.S. regions, with some regions nearing seasonal peak levels. This is unusual, since RSV usually peaks from late December to mid-February.

RSV is a respiratory illness, like influenza (flu) and SARS-CoV-2, the virus that causes COVID-19. All three viruses cause infection of the respiratory tract, including the lungs, and all three may be more common during colder months. Unlike the flu and COVID, there is no vaccine or treatment currently available for RSV.

People of any age can get another RSV infection, but infections later in life are generally less severe. People at highest risk for severe disease include:

• Premature infants.
• Young children with congenital (from birth) heart or chronic lung disease.
• Young children with compromised (weakened) immune systems due to a medical condition or medical treatment.
• Adults with compromised immune systems.
• Older adults, especially those with underlying heart or lung disease.

Healthy adults and infants infected with RSV do not usually need to be hospitalized. But some people with RSV infection, especially older adults and infants younger than 6 months of age, may need to be hospitalized if they are having trouble breathing or are dehydrated. In the most severe cases, a person may require additional oxygen or intubation (have a breathing tube inserted through the mouth and down to the airway) with mechanical ventilation (a machine to help a person breathe). In most of these cases, hospitalization only lasts a few days.

Each year, RSV causes about 14,000 deaths among adults 65 and older and up to 300 deaths among children under 5. 

There is no specific treatment for RSV infection.

No vaccine is available, but at least two candidates are currently being studied and appear to be highly effective in older adults. One drug manufacturer is also developing an antiviral drug to treat RSV.

RSV causes mild cold-like symptoms in most people. While there is no specific treatment, you can take steps to relieve symptoms:

• Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. Never give aspirin to children.
• Drink enough fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration (loss of body fluids).
• Talk to your health care provider before giving your child nonprescription cold medicines. Some medicines contain ingredients that are not good for children.

A drug called palivizumab is available to prevent severe RSV illness in certain infants and children who are at high risk for severe disease. This could include, for example, infants born prematurely or with congenital (present from birth) heart disease or chronic lung disease. The drug can help prevent serious RSV disease, but it cannot help cure or treat children already suffering from serious RSV disease, and it cannot prevent infection with RSV. If your child is at high risk for severe RSV disease, talk to your health care provider to see if palivizumab can be used as a preventive measure.

You can take the steps above to relieve symptoms and prevent spread. Call your health care professional if you or your child are having difficulty breathing, not drinking enough fluids, or experiencing worsening symptoms.

IHS is committed to ensuring that the patients and tribal communities that we serve have the information that they need to reduce the impact of respiratory viral illness in Indian Country, including from RSV, flu, and COVID-19. In addition to taking precautions to prevent respiratory viral infection, IHS strongly recommends that everyone stays up to date with their COVID-19 and flu vaccinations.

At-risk persons and those experiencing serious symptoms from a respiratory infection should call their IHS health care professional for advice and care.

For more information about RSV, visit the CDC website Exit Disclaimer: You Are Leaving www.ihs.gov .