When most people hear "RSV," they think of infants in hospital with breathing tubes. But respiratory syncytial virus does not discriminate by age. It infects adults every year. For certain populations, it can be just as dangerous as influenza or COVID-19. In fact, RSV is now a leading cause of respiratory hospitalization and death among older adults in the United States.
This article explains what RSV looks like in adults, who is most at risk, how it is treated, and when symptoms require medical attention.
RSV in Adults: By the Numbers
- 60,000-120,000 hospitalizations among US adults 65+ annually
- 6,000-10,000 deaths among US adults 65+ annually
- 177,000 hospitalizations among all US adults annually
- 14,000 deaths among all US adults annually
- Season: Typically October through March (overlapping with flu season)
What Is RSV?
Respiratory syncytial virus (RSV) is an RNA virus belonging to the family Pneumoviridae. It is one of the most common respiratory viruses, with virtually all children infected by age two. Unlike some viruses, RSV infection does not confer lasting immunity—people are reinfected throughout their lives, often multiple times.
In healthy younger adults, these reinfections usually show up as mild upper respiratory symptoms that look like a common cold. RSV behaves differently in older adults and those with compromised immune or cardiopulmonary systems. The virus can descend into the lower respiratory tract. This causes bronchiolitis, pneumonia, and flare-ups of underlying conditions like COPD and heart failure.
RSV Symptoms in Adults
Mild Disease (Most Healthy Adults)
- Runny nose and nasal congestion
- Dry cough
- Low-grade fever (100-101°F)
- Sore throat
- Headache
- Fatigue and malaise
- Body aches
- Sneezing
In this presentation, RSV is virtually indistinguishable from rhinovirus (common cold), mild influenza, or early COVID-19. Symptoms typically resolve within one to two weeks.
Moderate to Severe Disease (High-Risk Adults)
- Progressive cough becoming productive
- Wheezing and audible chest sounds
- Shortness of breath, initially with exertion, then at rest
- Rapid breathing (respiratory rate above 20 breaths/minute)
- Higher fevers (above 101°F)
- Decreased appetite and dehydration
- Worsening of baseline COPD, asthma, or heart failure symptoms
- Oxygen desaturation (below 94% on pulse oximetry)
Who Is at Higher Risk?
While any adult can contract RSV, certain groups face significantly elevated risk for severe disease and complications:
- Adults aged 65 and older: Age-related immune decline (immunosenescence) impairs the ability to mount an effective immune response
- Chronic obstructive pulmonary disease (COPD): RSV triggers acute exacerbations and can cause rapid decompensation
- Congestive heart failure: Respiratory infection increases cardiac workload and can precipitate fluid overload
- Asthma: RSV is a potent trigger for asthma exacerbations in adults
- Immunocompromised individuals: Organ transplant recipients, those on chemotherapy, HIV/AIDS, and patients on immunosuppressive therapy
- Residents of nursing homes and long-term care facilities: Close-quarters living facilitates transmission
- Adults with diabetes: Impaired immune function increases susceptibility
- Smokers and former smokers: Compromised mucociliary clearance and airway inflammation
How RSV Differs from Cold, Flu, and COVID
Distinguishing RSV from other respiratory infections based on symptoms alone is challenging, as there is significant overlap. However, some patterns may help:
- RSV vs. common cold: RSV tends to produce more prominent lower respiratory symptoms (wheezing, chest tightness) in at-risk adults than typical rhinovirus colds
- RSV vs. influenza: Flu typically has more abrupt onset with higher fevers, more severe myalgia, and prominent headache. RSV tends to have more gradual onset with prominent nasal congestion
- RSV vs. COVID-19: COVID may include loss of taste/smell (less common with newer variants), and tends to have a different time course of illness. Both can cause significant lower respiratory disease in vulnerable populations
Definitive diagnosis requires testing—PCR-based respiratory panels can identify RSV alongside influenza and SARS-CoV-2 from a single nasal swab.
Treatment for RSV in Adults
There is currently no widely approved antiviral specifically for RSV in the general adult population. This is unlike influenza, which has oseltamivir, or COVID-19, which has nirmatrelvir/ritonavir. Treatment is mainly supportive:
Mild Disease Management
- Rest: Allow your immune system to fight the infection
- Hydration: Adequate fluid intake to thin secretions and prevent dehydration
- Acetaminophen or ibuprofen: For fever and body aches
- Nasal saline irrigation: To manage congestion
- Honey (for adults): May soothe cough, particularly at bedtime
- Humidified air: Can ease breathing and reduce cough irritation
Moderate to Severe Disease
- Supplemental oxygen: For patients with oxygen saturation below 92-94%
- Bronchodilators: Inhaled albuterol may provide some relief for wheezing, though evidence for benefit in RSV bronchiolitis is mixed
- Systemic corticosteroids: May be used for COPD or asthma exacerbations triggered by RSV
- IV fluids: For dehydration in hospitalized patients
- Ribavirin: An antiviral sometimes used in severely immunocompromised patients (transplant recipients), though data supporting its use is limited
- Mechanical ventilation: In severe cases requiring ICU-level care
RSV Vaccination for Adults
A major advance in RSV prevention came in 2023. The FDA approved two RSV vaccines for adults aged 60 and older: Arexvy (GSK) and Abrysvo (Pfizer). Both target the RSV prefusion F protein. Both have shown strong efficacy in clinical trials.
Current CDC recommendations (updated 2024) include:
- Adults 75 and older: Recommended to receive a single dose of RSV vaccine
- Adults 60-74 at increased risk: Recommended if they have any of the following conditions: chronic heart disease, chronic lung disease (including COPD and asthma), diabetes with complications, moderate or severe immunocompromise, or residence in a nursing home or long-term care facility
- Shared clinical decision-making: For other adults 60-74 who may benefit based on individual risk factors
The vaccines are given as a single intramuscular injection. Clinical trials showed about 83% efficacy against RSV-associated lower respiratory tract disease in the first season. Protection continued into the second season, though somewhat reduced. Ongoing research is evaluating whether booster doses will be needed.
When to Seek Medical Attention
Contact a healthcare provider if you experience:
- Shortness of breath or difficulty breathing
- Wheezing or chest tightness that does not improve with rest
- Fever above 103°F (39.4°C)
- Symptoms that worsen after initial improvement (suggesting secondary infection)
- Inability to keep fluids down
- Symptoms lasting beyond 10 days without improvement
- Any worsening of underlying heart or lung condition
Seek emergency care immediately for any of these signs: severe breathing difficulty (using accessory muscles or unable to speak in full sentences), bluish lips or fingernails (cyanosis), confusion or altered mental status, or chest pain.
Prevention Strategies
Beyond vaccination, these measures help reduce RSV transmission:
- Hand hygiene: Frequent hand washing with soap for at least 20 seconds
- Avoid touching face: RSV enters through eyes, nose, and mouth
- Clean high-touch surfaces: RSV can survive on hard surfaces for several hours
- Avoid close contact with sick individuals: Stay at least 3-6 feet away when possible
- Stay home when sick: To prevent spreading to vulnerable individuals
- Mask wearing: Consider wearing a mask in crowded indoor spaces during peak RSV season if you are high-risk
How Long Are You Contagious?
Adults with RSV are typically contagious for 3 to 8 days after symptoms begin, though viral shedding may start 1-2 days before symptoms appear. Immunocompromised individuals may shed the virus for up to 4 weeks. During the contagious period, practice respiratory hygiene and avoid contact with high-risk individuals, particularly young infants and elderly family members.
Yes, adults can and do get RSV. While RSV is most well-known as a childhood illness, it infects people of all ages throughout life. Most healthy adults experience RSV as a mild cold, but older adults (65+) and those with chronic heart or lung disease or weakened immune systems can develop serious lower respiratory tract infections requiring hospitalization. RSV causes approximately 60,000-120,000 hospitalizations and 6,000-10,000 deaths a
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Frequently Asked Questions
Can adults get RSV?
Yes, adults can and do get RSV. While RSV is most well-known as a childhood illness, it infects people of all ages throughout life. Most healthy adults experience RSV as a mild cold, but older adults (65+) and those with chronic heart or lung disease or weakened immune systems can develop serious lower respiratory tract infections requiring hospitalization. RSV causes approximately 60,000-120,000 hospitalizations and 6,000-10,000 deaths among US adults aged 65+ annually.
What are the symptoms of RSV in adults?
RSV symptoms in adults typically include runny nose and nasal congestion, dry cough that may progress to productive cough, low-grade fever, sore throat, headache, fatigue, and body aches. In healthy adults, these symptoms resemble a common cold and resolve in 1-2 weeks. In high-risk adults, RSV can progress to wheezing, shortness of breath, rapid breathing, and signs of pneumonia or bronchiolitis.
How long does RSV last in adults?
In healthy adults, RSV symptoms typically last 1 to 2 weeks. The cough may persist for 2-3 weeks after other symptoms resolve. In older adults or those with underlying conditions, illness may be prolonged (3-4 weeks) and may require medical intervention. Adults remain contagious for approximately 3-8 days after symptoms begin, though immunocompromised individuals may shed the virus for up to 4 weeks.
Is there a vaccine for RSV in adults?
Yes. The FDA approved RSV vaccines for adults aged 60 and older in 2023 (Arexvy by GSK and Abrysvo by Pfizer). The CDC recommends RSV vaccination for adults 75 and older, and for adults 60-74 who are at increased risk due to chronic conditions. These vaccines have shown 80-90% efficacy in preventing severe RSV lower respiratory tract disease. Talk to your provider about whether RSV vaccination is appropriate for you.
When should I see a doctor for RSV symptoms?
See a provider if you experience difficulty breathing or shortness of breath, wheezing or chest tightness, high fever (above 103°F), symptoms that worsen after initial improvement, bluish color to lips or fingertips, inability to keep fluids down, or symptoms lasting more than 10 days without improvement. Seek emergency care for severe breathing difficulty, confusion, or inability to stay awake.
How is RSV different from the flu or COVID in adults?
RSV, influenza, and COVID-19 all cause respiratory symptoms and overlap significantly, so they cannot be distinguished by symptoms alone. RSV more often causes wheezing and a prolonged cough, the flu typically has more abrupt high fever and body aches, and COVID can include loss of taste or smell. A rapid multiplex respiratory test is the only reliable way to tell them apart.
Are there antiviral treatments for RSV in adults?
There is no widely available outpatient antiviral for RSV in adults. Treatment is generally supportive: rest, fluids, fever and pain control with acetaminophen or ibuprofen, and bronchodilators if wheezing is present. Severe cases in high-risk adults may need hospital care, oxygen, or specialized therapy.
Can RSV cause a flare of asthma or COPD?
Yes. RSV is a common trigger for asthma and COPD exacerbations in adults and can cause significant wheezing, chest tightness, and shortness of breath. People with underlying lung disease should contact a provider early in the illness so that inhaled bronchodilators or a short course of oral corticosteroids can be started if needed.
How long is an adult with RSV contagious?
Most healthy adults are contagious for 3 to 8 days, usually starting just before symptoms appear. Immunocompromised adults can shed the virus for up to 4 weeks. Hand hygiene, avoiding close contact with vulnerable people, and not visiting infants or older adults during illness are key to limiting spread.
Can a telehealth provider help me manage RSV at home?
Yes. For adults and adolescents 12 and older with mild to moderate RSV symptoms, an Innocre provider can confirm the likely diagnosis, recommend supportive care, prescribe inhalers if wheezing is present, and identify warning signs that require in-person or emergency care. Patients with severe shortness of breath should be evaluated in person right away.
Atul S. Vellappally, DNP, CRNP, FNP-BC
Founder, InnoCre Telehealth. Board-certified Family Nurse Practitioner with doctoral-level training in evidence-based and precision medicine. Licensed in Maryland, Washington, and Delaware.
This article is for informational purposes only and does not constitute medical advice. If you are experiencing a medical emergency, call 911.
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