Respiratory syncytial virus

Respiratory syncytial virus (RSV) affects individuals of all ages, but its impact is most severe in infants and older adults. Globally, RSV causes around 33 million episodes of lower respiratory tract infection in children under five each year, leading to over 3 million hospitalizations and more than 100,000 deaths.

RSV is increasingly recognized as a serious health threat in older adults, especially those with comorbidities. Its disease burden is considered comparable to that of influenza.

What are the key symptoms of RSV in adults and children?

In children, RSV symptoms vary by age:

• Neonates: Sepsis-like illness or apnea
• Infants under 2 years: Bronchiolitis
• Older children: Pneumonia

In severe cases, infants can progress to respiratory failure, which can be life-threatening.

In adults, the symptoms of RSV often resemble other respiratory infections and include cough, nasal congestion, dyspnea, and fatigue. In older adults, symptoms may be non-specific, such as collapse, delirium, or weakness. In those with chronic conditions (e.g., heart failure, chronic obstructive pulmonary disease [COPD]), RSV can trigger exacerbations with few or no upper respiratory signs, making diagnosis more challenging.

Who is most at risk of severe RSV disease?

Infants under 6 months and older adults – especially those with comorbidities (e.g., COPD, heart failure, diabetes) or compromised immune systems – are at highest risk of developing severe RSV infection. While many infants with life-threatening RSV are previously healthy, underlying conditions such as prematurity, congenital heart disease, or Down syndrome may contribute to severity.

Is RSV preventable?

Yes. RSV is now vaccine-preventable. Vaccines are approved for adults aged 60 years and older, and maternal vaccination during pregnancy can help protect infants. Long-acting monoclonal antibodies are also approved for infant prophylaxis, though global access remains variable.

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References

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