As a family medicine physician at UCHealth Primary Care – Estes Park, Dr. Richard Payden sees an increase in respiratory syncytial virus (RSV) cases each fall and into the following spring.

As a father, he’s dealt with this potentially serious virus firsthand.

“My two-and-a-half-year-old daughter got RSV first, then my wife, then my six-month-old son, then myself over the course of four days,” Payden said. “The three oldest did OK with fevers, body aches and cough. My 6-month-old son initially was doing well, but about four days into his illness he was having respiratory distress with increased work of breathing, retractions and rapid breathing rate.”

Payden took his son to the ER and after about four hours on oxygen, he and his son were able to go home, and his son is doing well now. But it was a stark reminder that this seasonal virus can affect the younger and older population just as seriously as COVID-19 and people need to be vigilant in protecting themselves.

What is RSV?

RSV stands for respiratory syncytial virus. RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Although most people recover within a week or two, it can be very serious in infants and older adults because it can lead to bronchiolitis and pneumonia.

Is RSV a coronavirus?

RSV and coronavirus are both respiratory illnesses with similar symptoms and transmission, but they are not in the same viral family.

Adults account for most cases of COVID-19 while most children contract an RSV infection by their second birthday, according to the Centers for Disease Control and Prevention. Older adults (65-plus), adults with weakened immune systems or heart or lung diseases have a high risk for severe RSV.

Is there an RSV season?

Cases of RSV usually increase in the fall, winter and spring months.

“We have been seeing a bit of an uptick in the number of cases of RSV that have been coming to our clinic,” Payden said. “And it is a little earlier this year compared to a normal year.”

What are the symptoms or signs of RSV?

Symptoms usually show within 4-6 days after getting infected and include:

• Coughing
• Sneezing
• Runny nose
• Fever
• Wheezing
• Decrease in appetite

Symptoms usually appear in stages. In infants, watch for irritability, a decrease in activity or appetite, and breathing difficulty (such as pausing while breathing). Fever isn’t always present with RSV.

Rashes are not common with RSV, but they are common with viruses such as measles, rubella, rubeola, chickenpox and fifth disease.

When should I take someone with RSV symptoms to see a health care professional?

RSV is the most common cause of bronchiolitis and pneumonia in children younger than one year old. If someone is having trouble breathing or is dehydrated as a result of RSV, that person should see a health care professional immediately. In severe cases of RSV, patients may need additional oxygen or need to be intubated for a few days.

Is RSV contagious and how does RSV spread? How long is its incubation period?

RSV is contagious as it is airborne. RSV spreads much like COVID-19, through virus droplets that enter the body through the eyes, nose or mouth. People can get RSV through direct contact, like kissing a child’s face who has RSV. The virus also can survive on hard surfaces for many hours. It survives on soft surfaces for a shorter amount of time.

People with RSV are usually contagious for three to eight days. People with weakened immune systems and some infants can continue to be contagious as long as they show symptoms, which could last up to four weeks.

What does RSV look like?

RSV can affect people of any age but infants and older adults are at increased risk of becoming seriously ill from RSV.

Each year, about 58,000 children younger than 5 years old are hospitalized for RSV, according to the CDC. Data also shows one to two children younger than 6 months with RSV out of every 100 children may need to be hospitalized.

Children who are at an even greater risk for severe illness from RSV include:

• Infants 6 months or younger.
• Premature infants.
• Children younger than 2 with chronic lung disease or congenital heart diseases.
• Children who are immunocompromised.
• Children with neuromuscular disorders, including those who have a hard time clearing mucus secretions or trouble swallowing.

Most adults who get RSV have mild or no symptoms. Symptoms are consistent with upper respiratory infections and include cough, headache, fatigue and fever, and symptoms usually last fewer than five days.

Adults at an even greater risk for severe illness from RSV include:

• Adults 65 years old and older.
• Those with chronic lung or heart diseases, including those with asthma, COPD (chronic obstructive pulmonary disease) or congestive heart failure.
• Those considered immunocompromised.

How long does RSV last?

People with mild RSV may have symptoms for 3-8 days, but the virus can linger for several weeks.

“A mild cough can linger for a long time, four to eight weeks at times, and can be normal,” Payden said. “However, if you are having severe cough, continued fevers, or are continually fatigued with symptoms, you should be evaluated.”

Can you get RSV more than once?

Most kids get an RSV infection by age two but you can get RSV at any age and more than once in your lifetime.

How is RSV different than coronavirus, croup, bronchiolitis or pneumonia? Can RSV cause other respiratory viruses?

Payden provides some insights into other viruses:

• RSV and coronaviruses are two different viruses that can present similarly.
• Croup is a condition that is characterized by inspiratory stridor (harsh vibrating noise when breathing), hoarseness and barking cough. It can be caused by several viruses, such as parainfluenza, RSV, coronaviruses, and influenza.
• Bronchiolitis is a syndrome usually present in children younger than two. Symptoms include fever, cough, respiratory distress and upper respiratory signs (runny nose, congestion, sore throat). It can be caused by several viruses including RSV, influenza, parainfluenza, and human metapneumovirus (HMPV).
• Pneumonia is a condition that is widely varying. Common pneumonia that people refer to is community-acquired pneumonia. Symptoms can vary widely from cough and mild shortness of breath to respiratory distress, fever and sepsis. This can be caused by viruses, bacteria and rarely, even some fungi in immunocompromised patients.

Are there RSV isolation precautions I should take?

Similar to precautions someone would take if they had the flu or COVID-19, people with RSV are contagious and should stay home and away from other people to avoid spreading the virus. Wash your hands often and avoid touching your eyes, nose or mouth with unwashed hands as this is how germs spread. Cover your cough or sneezes with your elbow or with a tissue, tossing it in the trash when you are done. Disinfect and clean frequently used surfaces to avoid spreading germs.

How should I treat RSV at home?

Although there is no specific treatment for RSV, you can take steps to relieve symptoms.

• Manage pain and fever with over-the-counter pain and fever reducers, such as acetaminophen or ibuprofen. Read doses instructions carefully and never administer aspirin to children.
• Drink lots of water to prevent dehydration.
• Ask your health care provider before giving your child any nonprescription cold medications as some ingredients are not safe for children.

Is there a test for RSV?

A health care provider may use one of several tests to determine an RSV infection. The most common are clinical laboratory tests:

• rRT-PCR test is more sensitive than a culture and antigen testing.
• antigen testing is highly sensitive (80-90%) for children but less so in adults.

Is there an RSV vaccine?

Three new vaccines for RSV have been approved since the beginning of May 2023. The RSV vaccine can prevent lower respiratory tract disease caused by RSV.

The CDC says that adults 60 years and older may receive a single dose of RSV vaccine based on discussions between the patient and their health care provider.

Health care providers sometimes administer nirsevimab and palivizumab to premature infants and young children with certain lung or heart conditions. This is given as a series of monthly shots during RSV seasons in the fall, winter and spring months. If you are concerned about a child’s risk for severe RSV, talk with your child’s doctor.