• RSV
• Infections

Signs, Symptoms, and Treatment of RSV

Medically reviewed and edited by Dr. Anthony Puopolo

The Centers for Disease Control and Prevention (CDC) reports that each year in the United States, respiratory syncytial virus (RSV) leads to approximately:

• 2.1 million outpatient visits among children younger than 5 years old

• Up to 80,000 hospitalizations among children younger than 5 years old

• 120,000 hospitalizations of adults 65 years and older

• 6,000-10,000 deaths of adults 65 years and older

• Between 100-300 deaths in children younger than 5 years old

Respiratory syncytial virus is an endemic worldwide with cases being reported throughout the year.

Globally, RSV affects an estimated 64 million people and causes 160,000 deaths each year.

Although RSV infection rates typically peak during cold winter months, in the past year, infections have surged during the summer months, too.

What is RSV?

Respiratory syncytial virus is a common, contagious airborne virus that causes infection of the nose, throat, lungs, and breathing passages.

Respiratory illness and viruses are common in children under five, particularly those who are exposed to tobacco smoke.

Most cases are mild, but for some children a common cold or the flu can quickly turn into RSV, asthma, or pneumonia, and the child may need to go to the hospital.

Here’s what happens:

• Germs get into the child’s nose, mouth, or eyes either through the air or when they touch germ-laden objects.

• The germs settle in the upper respiratory tract — the nose, eyes, sinuses, mouth, and throat.

• When the immune system is working, the mucus in the nasal passages traps the germs, and tiny hairs (cilia) sweep them out of the airways.

• If the germs are not removed and infection sets in, the immune system sends extra blood cells to the nasal passages, causing them to become inflamed and congested.

• The nose produces extra mucus, resulting in a stuffy or runny nose.

From the nose, germs can spread and cause infection in the ears and sinuses, and/or move down into the large and small airways of the lungs and trigger asthma or lower respiratory tract infections.

An RSV infection is a common respiratory virus that affects the nose, throat, lungs, and breathing passages. The symptoms are mild, mimicking those of a cold.

Most children contract RSV before they turn two; it is the most common cause of more severe infections such as bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than one year in the U.S.

Although people recover from a respiratory syncytial virus infection within a week or two, it can be serious, especially in infants and the elderly. Severe RSV can be unpredictable and is the foremost cause of hospitalization in infants.

Certain groups of people are more susceptible to dangerous complications resulting from RSV, including:

• Infants younger than 6 months old

• Individuals with chronic lung disease

• Individuals with heart problems

• Immunocompromised individuals

• Adults over 65 years of age

How Do You Contract RSV?

An RSV infection spreads through contact when respiratory droplets (from coughing, sneezing, or kissing) travel from an infected person to someone else. It is a highly contagious virus.

It also spreads if you touch surfaces contaminated with the virus and then touch your eyes, nose, or mouth.

RSV can survive for many hours on hard surfaces such as tables, toys, and crib bars. The virus lives on soft surfaces, such as hands, for shorter periods of time.

Children are often exposed to RSV at daycare centers or at school. They can then infect other family members.

People who have an RSV infection are typically infectious for up to a week but sometimes, particularly in those with compromised immune systems, the virus can continue to spread for up to four weeks.

Unlike other viruses that infect the lungs and can be cured, an RSV infection can recur over and over again.

RSV Symptoms

In general, RSV symptoms include one or more of the following:

• Coughing

• Nasal congestion

• Fever

• Breathing faster than normal or having trouble breathing

• Thick mucus

• Vomiting

• Diarrhea

• Decreased food intake

For most healthy adults who get RSV, the virus causes symptoms resembling those of a cold or the flu, and may include:

• A runny nose

• Nasal congestion

• A sore throat

• Coughing

• Sneezing

Symptoms in children may include:

• A runny nose

• A decrease in appetite

• Coughing

• Sneezing

• Fever

• Wheezing

RSV typically lasts a week or two, and most children get better on their own. However, the virus can lead to more serious infections such as bronchiolitis or pneumonia.

In infants who are younger than six months, the only symptoms of RSV may be:

• Pauses in breathing

• A low fever

• Less mobility than usual

• A decreased appetite

• A cranky or irritable mood

Signs and symptoms of severe RSV infection in infants include:

• Short, shallow, and rapid breathing

• Struggling to breathe — chest muscles and skin pull inward with each breath

• Coughing

• A blue tinge to the skin

• A lack of appetite

• Extreme tiredness

Up to 2% of infants younger than six months with an RSV infection may develop worsening symptoms and will have to be hospitalized.

When they are hospitalized they may be given IV fluids, oxygen, and mechanical ventilation to help with breathing. With this type of supportive care, most babies can be discharged within a few days.

RSV infects the cells in the lungs and breathing passages, resulting in cold-like symptoms such as congestion, high fever, loss of appetite, a sore throat, and a runny nose.

Usually, symptoms clear up on their own in a few days.

If, however, you develop a barking cough it can be a sign of a more serious illness and may indicate that the infection has spread to the small airways in the lungs. This can lead to bronchiolitis or pneumonia.

Infants with severe RSV will have shallow and rapid breathing. This is usually accompanied by a hollowness of the chest area between and under the ribs.

Other symptoms you may notice are nasal flaring with each breath and a bluish tinge to the lips, mouth, and fingernails due to a lack of oxygen. Respiratory syncytial virus can sometimes worsen conditions such as:

• Asthma

• Chronic obstructive pulmonary disease (COPD)—a chronic lung disease that makes it difficult to breathe

• Congestive heart failure — when the heart does not pump an adequate supply of blood and oxygen throughout the body.

Older adults who get very sick from RSV may need to be hospitalized. For some, RSV may be fatal.

Older adults are at higher risk than young adults for serious complications from RSV because of a weakened immune system.

Healthy adults and older children usually don't require an RSV test, but infants, babies younger than six months, or adults over age 65 may need a test if they have symptoms that indicate an RSV infection.

How RSV is Diagnosed

Since the symptoms of RSV are typically mild, it is not usually necessary to test the patient in order to diagnose an infection.

However, if after a physical examination the doctor suspects that you have RSV, he or she may want to run a laboratory test to confirm the diagnosis.

The most common test administered for RSV is a blood or a swab test to check for viruses and white blood cell counts.

If you have a severe case of RSV that requires hospitalization, other tests may be carried out — such as a chest X-ray or CT scan — to see if there are lung problems.

When babies are very sick, blood and urine cultures may be taken to check for RSV-related bronchiolitis, as well as a urinary tract infection.

Who is at Risk for RSV?

Most children contract RSV before they turn two years old by being in close contact with other children. RSV can also be contracted by being in crowded places.

RSV may become severe or life-threatening in:

• All babies with congenital heart disease or lung disease, weakened immune systems, or neuromuscular disorders (which involves the muscles in the body and the nerves serving them).

• Older adults who have heart or lung disease, asthma, heart failure, or COPD.

• People with a weak immune system — including those with HIV/AIDS, chemotherapy patients, and those who have undergone an organ transplant.

• Premature infants. They are at an especially high risk for contracting severe RSV, because their lungs and respiratory system are undeveloped. They also have fewer antibodies than full-term babies, so they are less able to fight off infection.

Care of RSV

Mild RSV infections will go away in a week or two without treatment. You can use over-the-counter (OTC) fever reducers and pain relievers to manage symptoms.

Check with your doctor or healthcare provider if you are not sure whether an OTC product is safe to give to your child. Your doctor or healthcare provider may also suggest saline nose drops or a suction device (aspirator) to clear a stuffy nose.

It is important to stay hydrated, which you can do by drinking lots of water or herbal tea, and by keeping yourself comfortable and well rested.

Practicing good hygiene is the best way to avoid getting RSV and other viruses.

• Hand washing is essential. Wash your hands frequently with soap and water for at least 20 seconds to protect you from germs.

• To prevent spreading germs, avoid touching your eyes, nose, and mouth with unwashed hands.

• Avoid direct contact with people who are sick.

• Avoid activities such as kissing, and do not share drinking glasses, bottles, or eating utensils with people who have cold-like symptoms.

• Cover your mouth and nose with a tissue when coughing or sneezing. Discard the tissue immediately and wash your hands if possible.

• Clean and disinfect surfaces that are touched often — such as doorknobs, cell phones, and toys.

• Stay home from work, school, or public areas when you are sick. This will help protect others from catching your illness.

Home Treatments for Children Who Have RSV

Because it is a virus, antibiotics won’t help cure an RSV infection. But there are steps you can take to help your child feel more comfortable.

• A humidifier or cool mist vaporizer will help to break down mucus buildup (congestion) and will relieve coughing.

• If your child has a stuffy nose, use salt water nose drops to soften the mucus. The mucus can be suctioned out of the nose with a nasal aspirator.

• Give them lots of fluids. Younger children can be breastfed or bottle-fed in small amounts more often. Older children can drink liquids such as water, weak tea, diluted fruit juice, or chicken broth.

• Check your child’s temperature using a digital thermometer. -If the baby is under 3 months old, use a rectal thermometer. -For infants 4 months or older, you can take rectal, ear, or armpit temperatures. -When your child reaches age 4, a mouth temperature can be taken.

When to See the Doctor

You should seek medical attention if you:

• Have trouble breathing

• Have no appetite

• Have cold symptoms that become severe

• Have a shallow cough that continues throughout the day and night

Where Can I Learn More about RSV and Other Health Issues?

If you want to learn more about the causes and symptoms of RSV and other health issues, make a telehealth appointment at LifeMD today, and speak to a board-certified physician or nurse practitioner from the comfort of your home (or anywhere).

Dr. Anthony Puopolo

Dr. Puopolo holds a B.A. in Biology from Tufts University, M.A. in Biology from Boston University, and Doctor of Medicine from the Boston University School of Medicine. He also completed a Family Medicine and Psychiatry residency program in the U.S. Army.

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