RSV in Children and Adults

What is RSV?

RSV (respiratory syncytial virus) is a common respiratory virus. It targets your lungs, especially small air pathways (bronchioles). RSV is one of the most frequent causes of childhood illness. Most children get the virus by 2 years of age. RSV can also infect adults.

Most healthy children and adults who get RSV will have a mild case with regular cold symptoms. The condition usually resolves itself in about a week.

Premature infants, babies younger than 6 months old, people above age 65 and people who have a compromised immune system, chronic lung disease or congenital heart condition can get a more severe case of RSV. A severe RSV infection can lead to pneumonia and bronchiolitis, which may require hospital care. RSV can also make existing heart and lung conditions worse.

Is RSV contagious?

Yes, RSV is very contagious. It’s easiest to spread the illness in the first few days or week of symptoms. Some babies and people with weakened immune systems may remain contagious for as long as four weeks after their symptoms start.

How does RSV spread?

RSV spreads through close contact with a person who has the virus. When an infected person sneezes or coughs, the virus goes into the air around them and can get into your body through your eyes, nose or mouth. RSV can live on hard surfaces, like counters or door knobs. If you touch something that the virus landed on, then touch your face or mouth, you can get sick with RSV.

How long does it take for symptoms of RSV to show up?

After RSV exposure, it can be two to eight days before you’ll start to have symptoms. Then, the illness generally last for three to seven days. Most children and adults recover fully in one to two weeks.

Who does RSV affect?

RSV infects almost all children by the time they’re 2 years old. Most of the time, this virus only causes cold symptoms. However, for some babies and certain adults, the infection can be dangerous.

Infants and adults who are at a higher risk of developing severe RSV include:

• Premature infants.
• Infants under 6 months of age.
• Infants born with heart or lung conditions.
• Children and adults with weakened immune systems (like after organ transplant or chemotherapy).
• Children who have difficulty swallowing or can’t clear mucus.
• Adults above age 65.

• Adults with congestive heart failure, chronic obstructive pulmonary disease (COPD) or asthma.

How common is RSV?

Most children get RSV before their second birthday. The virus spreads easily among young children, in daycare or school settings. This happens because children are in close contact with each other and may share toys with another contagious child.

In the U.S., RSV sends an estimated 58,000 children under the age of 5 to hospitals for treatment each year. There are nearly 177,000 adults hospitalized each year for RSV, and 14,000 adults over age 65 die from this infection.

Around the world, RSV affects an estimated 64 million people and causes 160,000 deaths annually.

Is RSV seasonal?

Yes, RSV is a seasonal illness like the influenza virus, which causes the flu. In most areas of the United States, the virus causes most infections in the late fall through early spring.

What are the symptoms of RSV?

Symptoms of RSV can take two to eight days after the virus enters your body to appear. They can show up in stages rather than all at once. The main symptoms of RSV include:

• Coughing.
• Runny nose.
• Sneezing.
• Wheezing.
• Fever.

Symptoms of RSV can affect age groups differently.

Symptoms of RSV in babies

Not all babies experience common symptoms of RSV like coughing and a runny nose. Babies younger than 6 months who get RSV may have the following symptoms only:

• Fussiness or irritability.
• Decreased appetite.
• Minimal interest in activities.
• Changes in their breathing pattern.

Babies younger than 6 months may require a hospital stay to monitor their breathing and oxygen levels if they get RSV, especially if they have other chronic health issues.

Symptoms of RSV in toddlers

Toddlers, or children between the ages of 1 and 3 years, may experience the following symptoms of RSV:

• Runny nose.
• Coughing and sneezing.
• Decreased eating or drinking.
• Less interest in playing.
• Trouble swallowing.
• Breathing faster than normal.

Severe symptoms of RSV in babies and toddlers

If your baby or toddler has any of the following symptoms, visit the emergency room or call 911 immediately:

• Noisy breathing.
• Flaring (spreading out) of nostrils with every breath.
• Blue or gray color to their lips, mouth and fingernails.
• Belly breathing or “caving in” of the chest in the form of an upside-down “V” starting under the neck.
• Short, shallow, slow or rapid breathing.
• Pauses while breathing.

Symptoms of RSV in children and adults

Children older than 5 years and adults may not have any symptoms of RSV, or they’ll have very mild symptoms. If a child or adult does get symptoms of RSV, they’re similar to symptoms of the common cold and include:

• Runny nose.
• Congestion.
• Mild headache.
• Sore throat.
• Cough.
• Fatigue.
• Fever.

Visit the emergency room if you or your child has trouble breathing. Call your healthcare provider if you have RSV symptoms and you’re over the age of 65 or if you have a compromised immune system or a heart or lung condition. RSV can turn into a severe infection and may require treatment from a healthcare provider.

What causes RSV?

The respiratory illness we know as RSV (respiratory syncytial virus) is a viral infection. Respiratory syncytial virus targets your respiratory tract. It enters your lungs through your nose and throat. The infection damages or destroys cells in your lower respiratory tract, which leads to symptoms of the condition.

How do babies get RSV?

RSV is very contagious and spreads quickly through close contact with an infected person. Particles of the virus spread via fluid from a person’s nose or mouth. Common ways that a baby can get RSV include:

• Receiving affectionate kisses from someone who has the virus.
• Touching an object or toy with an infected person’s saliva or mucus on it, followed by the baby touching their mouth or nose.
• An infected person coughing or sneezing near a baby.

RSV can be life-threatening, especially in premature infants, babies younger than 6 months old or children with a weakened immune system.

How is RSV diagnosed?

A healthcare provider will diagnose RSV after reviewing your medical history and learning more about your symptoms. Your provider will examine you using a stethoscope to listen to your lungs and they may check your oxygen level with a finger monitoring test called a pulse oximeter (pulse ox).

A swab test can detect the virus. During this test, your provider will use a cotton swab to collect mucus from your nose or mouth. They may also take a blood sample to look for signs of an infection (like an abnormal white blood cell count).

If your provider suspects a more severe illness, they’ll order additional blood or urine tests or imaging tests (X-rays, CT scans) to check your lungs.

How is RSV treated?

Mild RSV symptoms are similar to the common cold and don’t require treatment from a healthcare provider. RSV usually goes away on its own within one to two weeks.

To help you feel better, at-home treatment for mild RSV could include:

• Taking over-the-counter (OTC) medications like acetaminophen (TYLENOL®) or ibuprofen (Advil®) to treat fever or pain. Don’t give your child aspirin to treat a fever. Talk to your provider before taking any over-the-counter cold medications, especially medications you plan on giving a child, to make sure it’s safe.
• Drinking fluids to stay hydrated and eating regularly even if you have a low appetite.
• Not smoking tobacco products or vaping.
• Using a cool mist vaporizer to soothe dry breathing passages if recommended by your doctor.
• Applying saline nasal drops to loosen mucus in your nose.
• Blowing your nose in a tissue to keep your airways open or gently suctioning excess mucus out of your infant’s nose.
• Getting plenty of rest.

Treatment for severe RSV

Severe RSV requires immediate treatment by a healthcare provider. You may require emergency treatment if you:

• Have trouble breathing.
• Develop pneumonia or bronchiolitis.
• Have a compromised immune system.

Treatment for severe RSV could include:

• Getting oxygen using a mask, nasal prongs or a breathing machine (ventilator).
• Getting fluids into your body by an IV that goes into a vein in your arm.
• Removing mucus from your airway using a thin tube that goes into your lungs to clean them out.
• Taking medications like antivirals to help your body fight the virus.

Only about 3% of children with RSV require a hospital stay, and most children can go home from the hospital in a few days.

Do antibiotics treat RSV?

Antibiotics aren’t a treatment option for viral infections like RSV. Your healthcare provider may prescribe antibiotics if testing shows that you have bacterial pneumonia or another infection.

Is there a vaccine for RSV?

Yes, there's an RSV vaccine available for older adults, and an RSV immunization for babies.

How soon after treatment will I feel better?

Mild cases of RSV can clear up in one to two weeks. More severe cases of RSV may last longer.

How can I prevent RSV?

You can help prevent the spread of RSV by:

• Covering your cough. Don’t use your hands, but instead use a tissue or cough into the fabric of your shirt.
• Wash your hands frequently with soap and water.
• Avoid close contact with others, especially people who have the virus.
• Clean and sanitize frequently touched surfaces, objects and toys.
• Keep your children home from school or daycare when they or other children become ill.
• If you have a child at high risk of developing severe RSV, try to limit their time in large social settings during the RSV season.

Can I get RSV twice?

It’s possible to get RSV more than once in your lifetime and even more than once during a single RSV season. Repeated infections tend to be less severe than the first infection. However, if you’re an adult above age 65, an adult with a weakened immune system or you have a long-term heart or lung condition, RSV infection may be more serious if you get it again.

How does Palivizumab (SYNAGIS®) prevent severe RSV?

A healthcare provider may prescribe Palivizumab (SYNAGIS®) as a preventative drug during RSV season.

Palivizumab is a drug approved to prevent severe RSV in infants and children at high risk for complications. The drug doesn’t cure RSV. It’s not used to treat children who already have RSV. Your child can still get RSV, but this drug can prevent severe infections from the virus. It’s given as monthly injections during the RSV season. Ask your healthcare provider if palivizumab is recommended for your child.

What can I expect if I have RSV?

Most cases of RSV are mild and cause cold symptoms. Almost all children under 2 years of age will get RSV. Many adults and healthy children who get it don’t need treatment.

Infants, especially premature, and adults above age 65 are at the greatest risk of severe RSV. This can lead to pneumonia or bronchiolitis. It can also worsen other heart and lung conditions and may require hospitalization.

You can help prevent the spread of RSV by following good hygiene.

Always contact your healthcare provider or go to the emergency room if you have breathing problems, a high fever or are concerned about any of your or your child’s symptoms.

Is there a cure for RSV?

Currently, there’s no cure for RSV. However, scientists continue to learn about the virus and look for ways to prevent the infection or better manage severe illness.

Can RSV lead to serious illnesses?

It’s possible that RSV can lead to serious medical conditions that can be life-threatening if left untreated. These conditions could include:

• Pneumonia.
• Bronchiolitis.
• Worsening heart and lung conditions like chronic obstructive pulmonary disease (COPD) or asthma.
• Congestive heart failure.

When should I see a healthcare provider?

Call your healthcare provider if you have the following symptoms:

• Fever (temperature above 100.4 degrees Fahrenheit or 38 degrees Celsius) or a fever lasting more than a few days.
• Changes to your pattern of breathing.
• Cold symptoms become severe.

Visit your healthcare provider if your baby has the following symptoms:

• Unexpected fussiness.
• Dehydration or less than one wet diaper every eight hours, dry mouth or crying without tears.
• Coughing continues day and night and makes it hard to feed.
• Poor appetite.

When should I go to the ER?

Visit the emergency room if you or your child experience the following symptoms:

• Difficulty breathing, pauses while breathing, or short, shallow and rapid breathing.
• Noisy breathing.
• Blue or gray color to your skin.

What questions should I ask my doctor?

• What over-the-counter medicines should I give my child?
• How often should I give my child medicine?
• Is my child’s oxygen level OK?
• Does my child need to stay in the hospital?
• How do I prevent the rest of my family from getting RSV?

A note from Cleveland Clinic

RSV can be a scary illness for new parents with young babies. If you notice your child is sick and shows signs of RSV, especially if they’re under the age of 6 months, contact your provider or visit the emergency room. Even if your child has a mild case, it’s best to talk to your healthcare provider to make sure their symptoms aren’t serious. During RSV season, try to avoid large events or social gatherings where contagious illnesses can easily spread. You can help prevent the spread of RSV by washing your hands frequently, asking others around your baby to wash their hands and by cleaning and sanitizing frequently touched surfaces, objects and toys.