Respiratory Syncytial Virus (RSV) 2023: Understanding Symptoms and Treatment

You've likely heard about respiratory syncytial virus (RSV), especially if you have little ones. As one of the leading causes of respiratory diseases, it's essential to understand RSV, especially with recent developments in 2023.

What is Respiratory Syncytial Virus?

RSV is a widespread virus responsible for respiratory infections. Historically, its peak activity happens between October and May. However, recent patterns have been disrupted, likely due to COVID-19 preventive measures. While kids are often the primary victims, older adults aren't spared, especially if they have underlying health conditions.

Respiratory syncytial virus is the most common cause of lower respiratory tract infections in children younger than five years old. Almost all children are infected with RSV by the time they are two years old.

How Does RSV Spread?

RSV transmission occurs when an infected person coughs or sneezes, releasing respiratory droplets. Direct contact with contaminated surfaces or inhaling these droplets can result in infection. Due to their developing immune systems and close contact with caregivers, infants are particularly vulnerable.

Is RSV Contagious?

Yes, RSV is contagious. It's most contagious within the first week of symptom appearance. On average, RSV is contagious from day two to day eight. However, there have been cases where it remains contagious for up to 4 weeks, which is more likely in young infants and individuals with weakened immune systems.

Many individuals may not present with symptoms, making it easier to transmit the virus. In one study, 42% of individuals with RSV were asymptomatic.(1)

Can Adults Get RSV?

Yes, adults can get RSV, although RSV in adults usually appears with milder cold-like symptoms. Although they may only have mild symptoms, adults with RSV can transmit the disease to other adults and children.

RSV can be confirmed with laboratory testing. Samples are taken from a nasal swab. We now offer at-home testing for the flu, COVID-19, and RSV. Speak to one of our doctors today to get a testing kit delivered to your home and get peace of mind.

RSV Risk Factors

While RSV can infect anyone, some groups are more at risk:

• Babies under 6 months

• Kids born during peak RSV season

• Children in daycare

• Babies with older siblings

• Kids with health conditions or those born early 

• Babies with a history of bronchopulmonary dysplasia (BPD)

• Kids born with certain types of heart disease

• Adults with certain respiratory conditions

• Seniors in care facilities

Keep your guard up by washing hands regularly, disinfecting surfaces, and avoiding contact with sick individuals.

RSV Symptoms and Differences Across Age Groups

RSV symptoms vary based on age:

• Infants and toddlers: RSV primarily affects the lower respiratory system. This often involves runny noses that progress into wheezing, leading to bronchiolitis and pneumonia. Sometimes it can affect the upper airways as well. For example, in toddlers aged between six months to three years old, RSV is one of the viruses that causes croup.

• RSV symptoms in adults and older children: RSV typically presents as an upper respiratory infection, with symptoms like coughing, a runny nose, and fever.

Other RSV symptoms can include:

• Apnea or trouble breathing

• Nasal congestion and discharge, sneezing

• Decreased appetite

• Irritation and inflammation of the mucus membranes inside the nose

• Conjunctivitis (pink eye)

• Sinus or ear infection

Emergency symptoms in children include unresponsiveness or altered mental status, nasal flaring (widening), cyanosis (blue-colored skin, mouth or fingers), decreased urine output, decreased ability to feed, increased rate of breathing, and worsening chest retractions. If any of these symptoms occur, seek emergency medical attention immediately.

RSV Treatment and New Advances in 2023

2023 has seen significant advancements in RSV prevention. The CDC has highlighted the introduction of nirsevimab (Beyfortus), a long-lasting monoclonal antibody for high-risk infants.(2) It was FDA-approved in July 2023 to prevent RSV lower respiratory tract disease in infants born entering their first RSV season or children up to 24 months of age who are at high risk of severe RSV disease. Beyfortus is expected to be available in early October 2023. While we are unable to prescribe this medication as it is an injection typically administered in a clinical setting, we are available and ready to help determine whether your child would be a good candidate for Beyfortus.(10) Additionally, two new vaccines, RSVPreF3 (Arexvy, GSK) and RSVpreF (AbrysvoTM, Pfizer), are now available for adults 60 years and older.  Pregnant individuals can also benefit from the RSVpreF vaccine, protecting their newborns.(2)  Speak to a physician to discuss if you would be a good candidate for these vaccines.  The American Academy of Pediatrics also suggests using Synagis (palivizumab), a medication that was FDA-approved in 1998 to help reduce the risk of RSV-related hospitalizations, for high-risk infants and children. Synagis (palivizumab)  is a monoclonal antibody used to protect against severe RSV infection in infants younger than 12 months at the start of RSV season with high-risk conditions.(3)* While we are unable to prescribe this medication as it is an injection typically administered in a clinical setting, we are able to help determine whether your child would benefit from this medication. Speak to a physician to discuss if palivizumab is recommended for your child. While there's no specific cure for RSV, treatments primarily target symptom relief. Over-the-counter pain relievers can alleviate fever and discomfort. It's important to note that antibiotics are ineffective against RSV since it's a virus. If you or your child have symptoms of RSV, make an appointment to speak with one of our expert physicians today to discuss treatment options and determine the severity of the illness.

With recent RSV seasons showing varying patterns, staying updated is essential. Book an appointment with our PlushCare doctors anytime to discuss RSV symptoms, treatment options, and the latest preventive measures. Protect yourself and your loved ones with the right information and care. *This includes patients born with less than 29 weeks of gestation, patients with chronic lung disease of prematurity, patients with significant congenital heart disease, airway abnormalities, or neuromuscular disease with impaired airway clearance, patients with cystic fibrosis with chronic lung disease or nutritional compromise, or patients undergoing cardiac transplantation during RSV season. This also includes patients aged 1-2 years old with chronic lung disease of prematurity requiring medical support within 6 months of the start of RSV season, who are severely immunocompromised, who have cystic fibrosis with manifestations of severe lung disease, or who are undergoing cardiac transplantation during RSV season.(3)

Read More About Respiratory Syncytial Virus

• Get Upper Respiratory Infection Treatment Online

• Lung Infection

• Newborn Congestion

Sources

1. Munywoki PK, Koech DC, Agoti CN, Bett A, Cane PA, Medley GF, Nokes DJ. Frequent Asymptomatic Respiratory Syncytial Virus Infections During an Epidemic in a Rural Kenyan Household Cohort. Journal of Infectious Disease. 2015 Dec 1;212(11):1711-8. Accessed on July 10, 2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633757/

2. Centers for Disease Control and Prevention (CDC). Increased Respiratory Syncytial Virus (RSV) Activity in Parts of the Southeastern United States: New Prevention Tools Available to Protect Patients. Accessed on September 11, 2023 at https://emergency.cdc.gov/han/2023/han00498.asp.

3. American Academy of Pediatrics. Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection. Accessed on September 11, 2023 at https://publications.aap.org/pediatrics/article/134/2/415/33013/Updated-Guidance-for-Palivizumab-Prophylaxis-Among.

4. Hall CB, Walsh EE, Long CE, Schnabel KC. Immunity to and frequency of reinfection with respiratory syncytial virus. Journal of Infectious Disease. 1991 Apr;163(4):693-8. Accessed on July 10, 2021 at https://pubmed.ncbi.nlm.nih.gov/2010624/ 

5. Centers for Disease Control and Prevention. Respiratory Syncytial Virus Infection (RSV). Accessed on July 20, 2021 at https://www.cdc.gov/rsv/index.html

6. Collins PL, Fearns R, Graham BS. Respiratory Syncytial Virus: Virology, Reverse Genetics, and Pathogenesis of Disease. Current topics in microbiology and immunology. U.S. National Library of Medicine. 2016 Mar 16. Accessed on July 20,2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794264/

7. Laham FR et al., Clinical Profiles of Respiratory Syncytial Virus Subtypes A and B among Children Hospitalized with Bronchiolitis. The Pediatric infectious disease journal. U.S. National Library of Medicine. 2018 Aug 1.Pediatr Infect Dis J. 2017 Aug; 36(8): 808–810. Accessed on July 20, 2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556381/

8. Cleveland Clinic. Respiratory Syncytial Virus in Children and Adults. Accessed on July 20, 2021 at https://my.clevelandclinic.org/health/diseases/rsv-respiratory-syncytial-virus

9. American Academy of Family Physicians. Respiratory Syncytial Virus Infection in Children. Accessed on July 20, 2021 at https://www.aafp.org/pubs/afp/issues/2011/0115/p141.html

10. U.S. Food and Drug Administration (FDA). FDA Approves New Drug to Prevent RSV in Babies and Toddlers. Accessed on October 10, 2023 at https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers.