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Respiratory Syncytial Virus in Adults of Color

Respiratory syncytial virus (RSV) is a common germ that can settle into your lungs and airways. It's the top cause of upper respiratory infection in babies and toddlers, but anyone can get it. While RSV isn't new to the medical community, you might've noticed it making headlines more often this season.

According to Khalilah Gates, MD, a pulmonary and critical care specialist at Northwestern Medicine in Chicago, there are a few reasons why we're talking about RSV a little bit more now. One is that there's been a post-pandemic uptick in all respiratory viruses, she says, because we're around each other more often and no longer taking extreme measures to stop the spread of COVID-19.

"When we first started coming out of the mask mandate, particularly for little kids, we saw a huge spike in RSV," Gates says. "And that's because we'd gone about 2 or 3 years as a community without experiencing RSV like we normally had before [the pandemic]."


With less routine exposure to the virus, Gates says, people may get a little sicker from RSV for a little while. This immunity-building period won't be a big problem for most adults, who usually get only cold-like symptoms from an infection.

RSV can be more of a threat to people over 60 especially those who already have heart and lung problems or a weakened immune system. "We do know that people in communities of color are groups that are disproportionately affected by many of those conditions," says Robert H. Hopkins Jr., MD, medical director of the National Foundation for Infectious Diseases.

Much more testing is needed to know how RSV affects different racial and ethnic groups. But there are steps you can take now to protect yourself from the virus and get care if you do get sick.

RSV: Not Just a Danger for Kids

Most people, especially parents and grandparents, are familiar with RSV as a childhood illness. That's because almost all kids get sick with it before they turn 2. But RSV causes the most severe disease for folks at both ends of the age spectrum.

Here's how RSV affects adults ages 65 and older each year:

  • Up to 1.9 million doctor visits
  • 60,000 to 160,000 hospitalizations
  • 6,000 to 10,000 deaths

Most adults who get RSV won't die from it or need supportive treatment at the hospital. But it's hard to predict how an aging immune system will react to the virus, so it's important to know what signs and symptoms to watch for and what to do in case of emergency.

"Don't wait it out. You need to seek care so we can get the appropriate diagnosis."

Khalilah L. Gates, MD

Typically, RSV causes a mild cough, fever, and sore throat for around 3 to 5 days up to 2 weeks. You should go to the doctor right away if during that time period you get shortness of breath, Gates says, or your symptoms get worse in a way that seems out of the ordinary for you.

Since RSV causes symptoms that are similar to those of other upper respiratory illnesses, like cold, flu, and COVID-19, you may not be able to tell what kind of infection you have based on symptoms alone. You'll need a medical provider to test you for it.

"Don't wait it out," Gates says. "You need to seek care so we can get the appropriate diagnosis. There are many things we can do to support you through it, even in the case of severe disease."


The Dangers of RSV in Older Adults

You can still fight germs as you age, but everyone's immunity weakens with time. The medical term for this is immunosenescence, and it makes you more prone to getting severe disease from RSV (or any infection) simply because your immune system doesn't work as well as it used to.

Compared to younger adults, older people with RSV are more likely to get lower respiratory tract diseases such as:

  • Bronchiolitis - inflammation and swelling of the small airways of the lungs
  • Pneumonia - a lung infection
  • Acute respiratory distress syndrome - when fluid leaks into your lungs, making it hard to breathe

There are more White people in the U.S. than people of color, so most people diagnosed with RSV are White. But older adults who are Black, Hispanic or Latino/Latina, and Native American or Alaska Native are more likely to be hospitalized for RSV at a younger age.

From July 2022 to June 2023, among adults 60 or older who were hospitalized and tested positive for RSV:

  • 67.2% were non-Hispanic White
  • 15.4% were Black
  • 7.1% were Asian or Pacific Islander
  • 6.9% were Hispanic or Latino/Latina
  • 0.4% were Native American or Alaska Native

This is the breakdown of hospitalizations for RSV by average age for certain racial and ethnic groups:

  • 59 years old: Native American/Alaska Native
  • 60 years old: Black
  • 62 years old: Hispanic
  • 72 years old: Non-Hispanic White
  • 73 years old: Asian/Pacific Islander

There isn't an exact age where RSV becomes more dangerous. Your risk starts to go up as you enter your 60s and increases from there. But how sick you'll get depends on several things, Hopkins says, including your genes, overall health, and whether you have other medical conditions.

If you're 65 or older, you're more likely to get hospital-worthy RSV symptoms if you have:

Why Do Certain Health Conditions Boost the Odds of Severe Disease From RSV?

According to Hopkins, if you have heart disease, particularly heart failure (when the heart doesn't pump enough blood and oxygen through the body), you tend to have excess moisture or water in your lungs. That makes it harder to clear out mucus and other secretions when a virus gets into your upper respiratory tract.

RSV can add to breathing problems already caused by asthma, COPD, or other lung diseases. If you have diabetes, high blood sugar can affect the ability of some of your white blood cells to kill bacteria and viruses. And anyone with a weakened immune system is more vulnerable to all kinds of infections.

"That might be somebody who's got cancer or is on chemotherapy," Hopkins says. "Or somebody who's on medications for inflammatory bowel disease or rheumatologic conditions like rheumatoid arthritis or lupus."

Disparities in RSV in Older Adults of Color

Skin color alone doesn't boost your chances of catching a respiratory virus or getting seriously sick from an RSV infection. But people in the U.S. who are Black, Hispanic or Latino/Latina, or Native American or Alaska Native are more likely to face social and economic disadvantages or have medical conditions that raise the risk of RSV complications.

Racial inequities result largely from social factors that determine health. Those are nonmedical things like the environment you live in, lack of access to health care, and whether or not you know about or feel comfortable getting vaccines or medical treatment. There's no evidence that disparities in RSV among older adults of color are the result of the virus itself or genetic differences, Gates says.

"As a health care community, we need to slow down and have shared decision-making conversations with our patients. The days of, 'Do it because I say so' are over." Khalilah L. Gates, MD

"What is different about those communities is how they experience the world and society in which we exist that then leads to higher rates of hypertension, heart disease, diabetes," Gates says. "Then you get something else on top of that [like RSV], and that can make health outcomes a little bit different."


Here are some other things to think about when it comes to how RSV may impact communities of color:

What part of the country you live in. RSV season tends to last longer in warmer areas. This includes Southern states that are home to large Black communities, including Alabama, Georgia, Mississippi, North Carolina, and South Carolina.

You live around lots of other people. Older folks who live in long-term care facilities or multigenerational households may be exposed to germs more often than some other adults. And RSV rates are high among Black and Hispanic kids. Children who are Native American or Alaska Native also get the infection a lot.

You have multiple medical conditions. Health issues like diabetes, high blood pressure, obesity, asthma, and heart disease all take a greater toll on racial and ethnic minority groups. And older adults who have more than one health problem are more likely to have poorer outcomes from an RSV infection.

RSV Vaccine for Older Adults

In May 2023, the FDA approved two RSV vaccines (each a single shot) recommended for people age 60 or older. Studies show that both protect against serious illness from RSV for about two viral seasons.

They are:

  • Arexvy (RSVPreF3)
  • Abrysvo (RSVpreF), the same shot recommended for pregnant people

The RSV vaccines work a lot like the flu shot. They contain a part of the actual virus. This harmless protein triggers an immune response. This priming process helps your body fight RSV if or when you're exposed to it later on.

COVID-19 vaccines work a different way. They contain messenger RNA (mRNA). Unlike traditional vaccines, mRNA vaccines give your cells instructions for how to make a virus-like protein. This teaches your body how to spot the virus and mount an immune response if you're infected in the future.

One key thing to remember is that you can still catch RSV if you get vaccinated. It's just that you're a lot less likely to get so sick from an infection that you need to go to the hospital, or worse. "Like all of our other vaccines, we're trying to minimize severe complications," Gates says.

You may benefit the most from the RSV vaccine if you have one or more of the following medical conditions:

  • COPD
  • Congestive heart failure
  • Any heart and lung disease
  • Kidney disease
  • Liver disease
  • Neurological or neuromuscular conditions
  • Blood disorders
  • Diabetes
  • A weakened immune system (from a health problem or medication)

Your doctor may also strongly urge you get the RSV vaccine if you:

  • Are frail
  • Are older than 75
  • Live in an aging or long-term care facility
  • Have other medical conditions
  • Spend a lot of time around young children

Private health insurance should cover the cost of recommended vaccines, including RSV. Call your insurer to find out for sure. If you have government-run insurance like Medicaid or Medicare drug coverage (Part D), you should be able to get the RSV shot for free.

If you don't have health insurance, check with your state or local health department about low- or no-cost vaccine options. There may be a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) in your area where you can get the vaccine.

Talk to your doctor about the pros and cons of the RSV vaccine. Let them know if you have any concerns about how the shot might affect your health or questions about why you need it in the first place. Make an appointment to talk about vaccines later on if you feel overwhelmed during your visit.

"As a health care community, we need to slow down and have shared decision-making conversations with our patients so they can understand why we recommend what we recommend," Gates says. "The days of, 'Do it because I say so' are over."

Raising RSV Awareness in Older Adults

If you're 60 or older, it's very important to know how to protect yourself and your loved ones against all respiratory viruses. But awareness and access to RSV vaccines may be particularly important for adults who are Black, Hispanic or Latino/Latina, or Native American or Alaska Native - groups that are more likely to be hospitalized for RSV at younger ages.

It's important to note that RSV doesn't infect underserved minority groups differently than people of other races. "It's our society and health care system that allow health disparities to persist," Gates says. "But while the system is working on changing, what are the things that you can do to help yourself in that environment?"

"If I can reduce your risk for ending up in the hospital or having severe disease in order to get that protection, it's a lot better to do that safely with a vaccine."

Robert H. Hopkins Jr., MD

Gates discusses preventive measures and the RSV vaccine with older adults "every single day at every single clinic." She goes over the advantages of getting the shot and helps people understand their risk of catching the virus. For example, if you take care of grandchildren who go to day care, "the chances they'll bring home RSV are pretty high," she says.

Until recently, you couldn't build immunity against RSV without fighting it off naturally. But by staying up to date on recommended vaccines, you can give your body's defense system a boost without taking the same health risks.

That's why Hopkins, who's in his 60s, recently got his RSV vaccine. And it's something he's urging both his patients and his parents, who are in their 80s, to get.

"I tell people, I want to give you the same level of protection that I want my family members to have," he says. "And if I can reduce your risk for ending up in the hospital or having severe disease in order to get that protection, it's a lot better to do that safely with a vaccine."

How to Protect Yourself from RSV

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