Respiratory Syncytial Virus in Children and Adults

Overview

What is respiratory syncytial virus (RSV)?

Respiratory syncytial virus (RSV) is a common respiratory virus. It affects the lungs and its bronchioles (smaller passageways that carry air to the lung). RSV is one of the most common causes of childhood illness, infecting most children by two years of age. RSV can also infect adults.

Most healthy children and older adults who get RSV will get a mild case with cold-like symptoms. Only self-care or “comfort care” is usually needed.

Severe infection with RSV can lead to pneumonia (an infection in the lungs) and bronchiolitis (inflammation of the small airways in the lungs) and may require hospital care. People at greatest risk of severe infection are the very young (those less than six months old), those over the age of 65 and those of any age who have heart or lung conditions or a weakened immune system. RSV can also make existing heart and lung problems worse.

Is respiratory syncytial virus (RSV) contagious? How is it spread? How long does it last?

Yes, RSV is highly contagious — particularly during the three- to seven-day period a person has symptoms. Some infants and people with weakened immune systems may remain contagious for as long as four weeks.

The virus is spread through close contact, when an infected person sneezes or coughs and the virus becomes airborne and gets into your body through your eyes, nose or mouth. It’s also spread by touching objects that the virus has landed on and then touching your face. RSV can live on hard surfaces for many hours.

It takes between two to eight days from the time a person is exposed to the RSV to show symptoms. Symptoms generally last three to seven days. Most children and adults recover fully in one to two weeks.

How common is respiratory syncytial virus (RSV)?

Most children get RSV before two years of age. Infection is easily spread in young children because of their close contact with other children who may be infected, through the sharing of their toys and constant touching of objects that may be contaminated with the virus. Some 57,000 children under age five require hospital care due to RSV each year in the U.S.

Among adults, about 177,000 older adults are hospitalized each year for RSV. Some 14,000 adults die due to this infection each year.

Is respiratory syncytial virus (RSV) a seasonal illness?

Yes, like the flu, RSV is a seasonal illness. It occurs in most areas of the U.S., starting in late fall and lasting through early spring.

Who gets respiratory syncytial virus (RSV) infection?

RSV infects almost all children at least once before they are two years old. Most of the time, this virus only causes minor cold-like symptoms. However, for some babies and certain adults, the infection can be more dangerous.

Infants and adults at highest risk of severe or life-threatening RSV infection are:

  • Premature infants (because their lungs are underdeveloped).
  • Infants under 6 months of age.
  • Infants born with heart or lung disease.
  • Children and adults with weakened immune systems, including those who have received an organ transplant or those undergoing chemotherapy.
  • Children who have difficulty swallowing or can’t clear mucous.
  • Adults 65 years of age and older.
  • Adults with heart and lung diseases, such as congestive heart failure, chronic obstructive pulmonary disease or asthma.

Symptoms and Causes

What are the signs and symptoms of respiratory syncytial virus (RSV) in infants?

Common symptoms of RSV in infants include:

  • Runny nose.
  • Decrease in appetite.
  • Sneezing and coughing.
  • Fever (temperature above 100 degrees Fahrenheit). Fever may not always be present.

Symptoms in the youngest infants include:

  • Fussiness/irritability.
  • Decreased activity/more tired than usual.
  • Decreased appetite.
  • Pauses in breathing.

Symptoms of severe RSV in infants include:

  • Short, shallow and rapid breathing.
  • Flaring (spreading out) of nostrils with every breath.
  • Belly breathing (look for a “caving in” of the chest in the form of an upside-down “V” starting under the neck).
  • Bluish coloring of lips, mouth and fingernails.
  • Wheezing (This can be a sign of pneumonia or bronchiolitis.)
  • Poor appetite.

What are the symptoms of respiratory syncytial virus (RSV) in older children and adults?

Many older children and adults have no symptoms or very mild symptoms. Common symptoms of RSV in those who do get symptoms are similar to the common cold and include:

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

What serious conditions can respiratory syncytial virus (RSV) lead to?

Serious conditions that can arise from RSV include:

  • Pneumonia or bronchiolitis.
  • Worsening symptoms in people with such conditions as chronic obstructive pulmonary disease, asthma and congestive heart failure.

Diagnosis and Tests

How is respiratory syncytial virus (RSV) diagnosed?

Your healthcare provider will take your or your child’s medical history and ask about symptoms. The physical exam will include listening to your or your child’s lungs and checking oxygen level in a simple finger monitoring test (pulse oximetry). They may order blood testing to check for signs of infection (such as a higher than normal white blood cell count) or take a nose swab to test for viruses.

If more severe illness is suspected, your healthcare provider will order imaging tests (X-rays, CT scan) to check your or your child’s lungs.

Management and Treatment

How is respiratory syncytial virus (RSV) treated?

If you or your child has mild symptoms, prescription treatment is usually not needed. RSV goes away on its own in one to two weeks. Antibiotics are not used to treat viral infections, including those caused by RSV. (Antibiotics may be prescribed, however, if testing shows you or your child has bacterial pneumonia or other infection.)

Some young children who develop bronchiolitis may have to be hospitalized to receive oxygen treatment. If your child is unable to drink because of rapid breathing, he or she may need to receive intravenous fluids to stay hydrated. On rare occasions, infected babies will need a respirator to help them breathe. Only about 3% of children with RSV require a hospital stay. Most children are able to go home from the hospital in two or three days.

If you are an older adult and especially if you have a weakened immune system, you may need to be hospitalized if the RSV is severe. While in the hospital, you may receive oxygen or be put on a breathing machine (ventilator) to help your breathe or receive IV fluids to help with dehydration.

Is a vaccine available to prevent respiratory syncytial virus (RSV)?

No vaccine is available to treat RSV yet. Scientists are working on developing one.

Is there a cure for respiratory syncytial virus (RSV)?

Currently, there is 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.

What is palivizumab (Synagis®)?

Pavlivimab is a drug approved to prevent severe RSV in certain infants and children at high risk for severe disease. The drug doesn’t cure RSV, is not used to treat children who already have severe RSV and can’t prevent RSV infection. It is given as monthly injections during the RSV season. Ask your healthcare provider if pavlivimab is an appropriate drug to prevent RSV infection in your child.

If I or my child gets respiratory syncytial virus (RSV) once, can we get it again?

People who contract certain viruses can sometimes build an immunity to a virus. This means that they will not become infected again for some length of time or even forever. This is not the case for RSV. It’s possible for you or your child to get RSV more than once over your life and even more than once during a single RSV season.

The good news is that repeated infections tend to be less severe than the original infection. However, if you are an older adult or an adult with a weakened immune system or long-term heart or lung disease, RSV infection may be more serious if you are infected again.

Prevention

What can I do to prevent getting respiratory syncytial virus (RSV) or prevent spreading RSV if infected?

You can follow the same precautions that one follows if they have the cold, flu or any other contagious disease:

  • Wash your hands often. Wash for 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. (Alcohol-based rubs work well for young children who don’t have the coordination or attention span for proper hand washing technique.)
  • Avoid touching your eyes, nose and mouth to prevent the spread of viruses from your hands.
  • Cover your mouth and nose with a tissue when sneezing and coughing or sneeze and cough into your elbow. Throw the tissue in the trash. Wash your hands afterward. Never cough or sneeze into your hands!
  • Avoid close contact (within 6 feet) with those who have known RSV, coughs, colds or are sick. Stay home if you are sick.
  • Don’t share cups, toys or bottles, or any objects. Viruses may be able to live on such surfaces for hours (and be transmitted to your hands).
  • If you are prone to sickness or have a weakened immune system, stay away from large crowds of people.
  • Clean frequently used surfaces (such as doorknobs and counter tops) with a virus-killing disinfectant.

Additional tips for children:

  • Keeping your children home from day care when they or other children become ill.
  • If you have a child at high risk of developing severe RSV, try to limit time at child care centers or gatherings of large number of children during the RSV season.
  • Wash toys frequently.

How can I make my child with respiratory syncytial virus (RSV) feel better at home?

  • Do not allow anyone to smoke around your child or in the home. This can complicate breathing.
  • Try using a cool mist vaporizer to soothe dry breathing passages if recommended by your doctor. Hot-air vaporizers should be avoided because of the risk for scald burns.
  • Make sure your child gets plenty of fluids, such as breast milk or formula for infants, or milk, juices, and water for older children. Breast milk contains antibodies that can help fight infections.
  • For fever, give your child (older than 6 months) medicine such as acetaminophen (Children’s Tylenol®) or ibuprofen. Never give your child aspirin, as aspirin could cause Reye’s syndrome.
  • Apply saline nasal drops to help loosen mucus in the nose.
  • Blow little noses frequently (or gently suction your infants’ nose).
  • Allow your child plenty of rest, as needed.
  • Give all medicines as instructed by your child’s doctor.

Outlook / Prognosis

What can be expected if I or my child develop respiratory syncytial virus (RSV)?

Most cases of RSV are mild and cause cold-like symptoms. Almost all children under two years of age will be infected with RSV.

Most cases of RSV in adults and healthy children will not require treatment. Infants and older adults at greatest risk of severe RSV can develop pneumonia or bronchiolitis or experience a worsening of their existing heart and lung conditions and may require hospitalization.

You can help prevent the spread of RSV by following good common sense hygiene / cleanliness tips.

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

Living With

When should I call my healthcare provider?

Call your healthcare provider if you or your child has these symptoms:

  • Fever (temperature above 100 degrees Fahrenheit).
  • Fever lasting more than two days.
  • Grey or blue tint to tongue, lips or skin.
  • Difficulty breathing.
  • Cold symptoms that have become severe.

Additional symptoms to watch for in young children include:

  • Extreme fussiness, decreased alertness.
  • Dehydration (Signs include less than one wet diaper every 8 hours, dry mouth and crying without tears).
  • Coughing continues day and night.
  • Poor appetite.

Last reviewed by a Cleveland Clinic medical professional on 04/02/2020.

References

  • Centers for Disease Control and Prevention. Accessed 3/25/2020.Respiratory Syncytial Virus Infection. Older Adults Are at High Risk of Severe RSV Infection. (https://www.cdc.gov/rsv/factsheet-older-adults.html)
  • Centers for Disease Control and Prevention. Accessed 3/25/2020.Respiratory Syncytial Virus Infection. Older Adults. (https://www.cdc.gov/rsv/high-risk/older-adults.html)
  • American Lung Association. Accessed 3/25/2020.RSV Symptoms and Diagnosis. (https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/rsv/rsv-symptoms-causes-risk.html)
  • National Foundation for Infectious Diseases. Accessed 3/25/2020.Respiratory Syncytial Virus in Older Adults: A Hidden Annual Epidemic. (https://www.nfid.org/wp-content/uploads/2019/08/rsv-report.pdf)
  • MedImmune. Pavlivimab (Synagis). Accessed 3/25/2020.What is Synagis? (https://www.synagis.com/what-is-synagis.html)
  • Centers for Disease Control and Prevention. . Accessed 3/25/2020.Respiratory Syncytial Virus Infection (RSV) (https://www.cdc.gov/rsv/index.html)
  • Piedimonte G. Cleve Clinic J Med 2015;82 (11 suppl1):S-13-18. Accessed 3/25/2020.RSV infections: State of the art. (https://www.ccjm.org/content/82/11_suppl_1/S13)
  • Piedimonte G, Perez MK. Respiratory Syncytial Virus Infection and Bronchiolitis. Peds Review 2014;35(12):519-530. Accessed 3/25/2020.
  • American Academy of Pediatrics. (healthychildren.org.) Accessed 3/25/2020.RSV: When It’s More Than Just a Cold. (https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/RSV-When-Its-More-Than-Just-a-Cold.aspx)

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