A man wearing a mask holds a baby while looking out of a window.

5 Things Older Adults Need to Know About RSV

Along with SARS-CoV-2 and influenza, this virus has contributed to a brutal season for respiratory illness.

By Amy Dusto

Human respiratory syncytial virus (RSV) is more than a pediatric problem. The CDC estimates that 60,000–120,000 adults 65 and older are hospitalized annually with the virus and 6,000–10,000 die in the U.S., outpacing the rates experienced by young children.

Along with influenza, RSV surged in fall and winter with the return to more normal social interactions. Although this season’s RSV cases seem to have peaked, older adults should continue to be aware of the virus—and also have hope.

Older adults are at high risk for severe RSV infection

“For most adults, RSV will cause a mild cold. However, older adults, especially adults 65 and older and those with underlying conditions, are at increased risk for severe RSV,” says Laura Hammitt, MD, director of the Infectious Disease Program at the Center for Indigenous Health, where she works on an RSV surveillance program among Native Americans, who have historically experienced higher-than-average rates of infection. Hammitt notes that conditions that can increase the risk of severe RSV among adults include chronic heart or lung disease, or a weakened immune system.

Severe RSV infection also increases the risk for secondary bacterial infections. One study by the Center for Indigenous Health found that RSV was associated with approximately 6% of pneumonia hospitalizations among Native American adults.

RSV is in your community

“RSV has been off the charts in many parts of the U.S. this year,” Hammitt says. In mid-November, total RSV infections hit nearly twice their previous highest peak in the last five years, which occurred in 2019, according to CDC data. Reinfection is possible, even within the same year.

Although RSV cases for 2022–23 seem to have peaked, doctors are cautioning everyone—especially the more vulnerable—to remain vigilant: The risk for multiple or more severe infections is compounded by rising cases of influenza and COVID, which have not yet peaked this season.

An RSV vaccine is on the way

Multiple drug companies, including Moderna, Pfizer, Janssen, and GSK, are now in the late stages of clinical trials for RSV vaccines for older adults, with the FDA expected to begin reviewing them as early as spring 2023.

“The data are very encouraging, showing that these RSV vaccines elicit a strong antibody response and prevent severe RSV disease in adults who are 60 and older,” Hammitt says, adding that she expects more vaccine candidates to follow quickly. “In addition to the vaccines for older adults, the FDA is also expected to review RSV vaccines for pregnant women and monoclonal antibodies for infants, both of which have been proven highly efficacious for prevention of severe RSV disease in young infants.”

Given RSV’s severity and global presence, researchers have been seeking vaccine candidates for decades. But only recently have they discovered how to stabilize and target a protein on the surface of the virus before it enters cells and starts replicating.

There are no RSV-specific treatments

Unlike influenza and COVID, for which there are antiviral treatments, there is no specific treatment for RSV. Instead, patients are advised to take the same measures as with any other respiratory ailment: over-the-counter cold medicine, rest, and hydration. Hospitalized patients may receive oxygen or additional supports.

Together with spiking rates of infection, this “makes the prospect of effective RSV [vaccines] all the more exciting,” Hammitt says. In the meantime, we can help prevent the spread of infection with good hand-washing and staying home when sick.

Protecting yourself from RSV helps protect your loved ones

“You may not feel susceptible, but [RSV] is really dangerous for kids,” says Rupali Limaye, PhD ’12, MPH, MA, an associate professor in International Health and deputy director of the International Vaccine Access Center who is studying ways to encourage patients to get an RSV vaccine when it becomes available.

When the COVID vaccines rolled out, one messaging tactic was to encourage younger, lower-risk groups to inoculate to protect the elderly; for the RSV vaccine, older adults will need to be encouraged to vaccinate to protect themselves as well as babies and young children. “Especially now with RSV plus COVID circulating—both are attacking the lungs,” she says. “Pediatricians are worried about children getting both, or RSV, COVID, and the flu. The worry is that all three together could have devastating effects on small babies.”

The CDC reports 2.1 million outpatient visits, 58,000–80,000 hospitalizations, and 100–300 deaths annually among children under 5 infected with RSV in the U.S. In fall 2022, the rate of hospitalization for children under 4 was nearly 2.5 times the peak rate for all of 2019–20.

“If you have questions about RSV, talk to your provider,” Limaye says. “We want people to please reach out to a scientifically credible source—someone you trust, someone who understands the science behind the vaccine development.”