Medically Reviewed by Melinda Ratini, MS, DO on August 30, 2022
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When most people think of respiratory syncytial virus (RSV), they usually think of babies. But you can get it at any age. And if you’re older than 60, you’re at even greater risk for RSV. “The virus is increasingly recognized as a significant cause of respiratory illness in older adults in the U.S.,” says William Schaffner, MD, medical director of National Foundation of Infectious Diseases. The CDC estimates that 177,000 older adults are hospitalized every year and 14,000 die from RSV infections.

RSV can be easily dismissed as a cold in people who are healthy. Loved ones and caregivers should be aware of the possibility that RSV in older adults can cause serious sickness or may even be fatal. 

What Is RSV?

RSV is a highly contagious respiratory virus. That means it spreads very easily. RSV infects your nose, throat, lungs, and breathing passages. You’ll have symptoms like those of a common cold. It’s easy to confuse RSV with other viruses like the flu and COVID-19.

What Are the Symptoms of RSV?

Symptoms of RSV may look different depending on how old you are. Young infants may be irritable, not as active, and have a hard time breathing. In adults, symptoms can include: 

  • Runny nose
  • Cough
  • Not much of an appetite
  • Low-grade fever
  • Sneezing 

Serious infection in adults can happen and may cause pneumonia (an infection in one or both lungs) or bronchiolitis (an inflammation of the respiratory tract). You can watch for signs that RSV may be getting worse, such as:

  • High fever
  • Really bad cough
  • Wheezing – a loud whistling sound when breathing 
  • Fast breathing
  • Blue skin because of not enough oxygen 

If you’re having trouble breathing or your skin turns bluish, call 911 right away.

How Is RSV Diagnosed?

Since RSV often seems like a cold or the flu, your doctor will try to figure out exactly what you have. First, they’ll ask questions about your medical history. They’ll pay special attention to the symptoms you tell them about. Next, your doctor will give you a physical exam.  If they suspect RSV, they’ll likely do some follow-up lab tests, which may include:

  • Rapid RSV antigen test: This is the quickest way to diagnose RSV. A fluid sample is taken from your nose (with a nasal swab or gentle suction) to check for certain proteins called antigens. You can usually get results in about an hour.
  • Molecular test: Sometimes only small amounts of the virus are in your nose. For older adults, an RT-PCR test (which also uses a nasal swab) can find a smaller amount, compared to an antigen test. The samples are usually sent to a lab. In certain cases, your doctor might run a respiratory panel test to look for RSV as well as other viruses and bacteria. 

You don’t have to do anything to prepare for these tests. But you may feel some discomfort from the nasal swab. The best time to do these tests is within the first days of symptoms. 

How Does RSV Spread?

RSV often spreads quickly. Here are some common ways it can spread:

  • A person with RSV coughs or sneezes and virus droplets get into your nose, eyes, or mouth.
  • You touch a surface – like a kitchen counter or doorknob – that has RSV on it, then either rub your eyes or touch your face without washing your hands. RSV can live on hard surfaces for several hours.
  • You have close contact with someone who is infected with RSV, like an adult or child that you may kiss. 

If you have RSV, you can be contagious for at least 3-8 days. But if you have a weakened immune system, you can spread the disease for as long as 4 weeks, even if you don’t have symptoms anymore. RSV infections most often happen in the fall, winter, and spring (November to April). But you can get it in any season. 

How Does RSV Affect Adults Older Than 60?

For most adults, RSV will cause cold-like symptoms and will get better within 1 or 2 weeks. 

But some adults may have more serious complications like:

  • Pneumonia
  • Bronchiolitis
  • Congestive heart failure – when the heart can’t pump enough blood and oxygen throughout the body
  • Worsening of asthma or chronic obstructive pulmonary disease (COPD)

RSV’s symptoms can be much more serious in older adults who have asthma, COPD, and weakened immune systems. And almost everyone’s immune system gets weaker as we age, which puts older adults at greater risk. 

Sometimes RSV can be fatal. 

What Are the Treatments for RSV?

There isn’t a cure or a vaccine for RSV. Your doctor may suggest over-the-counter pain relievers or fever reducers. And saline drops or sprays can help with stuffy noses. While symptoms will go away for most adults, older adults with complications may have to go to the hospital. Generally, treatments involve supportive care like:  

  • IV fluids (in your vein) to make sure you’re hydrated
  • Oxygen
  • Ventilators to help you breathe
  • Breathing treatments

Early treatment with aerosol ribavirin that you inhale and immunoglobulin in your vein may improve survival if you have a very weak immune system.

How Can RSV in Older People Be Prevented?

If you’re at high risk for RSV – or you’re a caregiver or loved one of an adult over 60 who may be more prone to getting it – there are things you can do to keep yourself and them healthy:
 

  • Avoid close contact with sick people. This includes touching, kissing, or hugging someone who has cold-like symptoms. Don’t drink from the same glass or share eating utensils. If you can’t avoid close contact, think about using a mask or gloves.
  • Wash your hands often. Use soap and water for at least 20 seconds. If washing your hands isn’t an option, use an alcohol-based sanitizer to keep germs off fingers and palms. 
  • Avoid putting your hands on your face. Germs can be spread by touching your nose, eyes, and mouth. 
  • Clean and disinfect surfaces. Regularly cleaning counters, doorknobs, mobile devices, or other surfaces you constantly touch is a good practice to help stop illness. RSV can stay on surfaces for several hours. That is true whether someone with RSV coughs or sneezes droplets onto the surfaces or just touches them.
  • Cover your mouth when you sneeze or cough. If you are around an older loved one a lot, make sure you are covering your mouth and nose when you cough or sneeze. Use a tissue, then throw it away afterward (and wash your hands). If you feel a sneeze coming on and don’t have a tissue, sneeze into your upper shirt sleeve. 

What Is the Outlook for People Over 60 Who Get RSV?

Adults over 60 are more likely to get serious illness with RSV. Not all adults will necessarily have to go to the hospital. But some may face serious complications, especially if they already have weakened immune systems or long-term lung and heart problems.

Right now, researchers are working to find ways to stop and treat RSV. Those include vaccines and monoclonal antibodies targeted for infants and young children, older adults, pregnant people, and people who have weak immune systems. One vaccine has shown promise in clinical trials for protecting people 60 and older against serious illness from RSV. Other clinical trials show positive results, too.

Schaffner says: “There is a need for rapid, inexpensive, highly accurate, and easy-to-use RSV” tests at places where people go for health care.  That’s especially true for “primary care practices, which can help increase awareness of RSV infection in vulnerable populations,” Schaffner says.

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SOURCES:

William Schaffner, MD, medical director, National Foundation of Infectious Diseases.

CDC: “RSV in Older Adults and Adults with Chronic Medical Conditions,” “Respiratory Syncytial Virus.”

National Foundation for Infectious Disease: “Facts about Respiratory Syncytial Virus.”

American Lung Association; “RSV Treatment and Prevention.”

MedlinePlus: “Respiratory Syncytial Virus,” “Respiratory Syncytial Tests.”

Norton Healthcare: “RSV Can Be Deadly in Adults Age 65+.”

Clinical Microbiology Reviews: “Respiratory Syncytial Virus Infection in Adults.”

UpToDate: “Respiratory syncytial virus infection: Treatment.”

Pfizer: “Pfizer Announces Positive Top-Line Data from Phase 3 Trial of Older Adults for its Bivalent Respiratory Syncytial Virus (RSV) Vaccine Candidate.”