RSV is a serious illness that is worse for older adults

For most adults, an RSV infection (respiratory syncytial virus) may cause cold-like symptoms in the upper respiratory system – or no symptoms at all, according to Jonathan Costa, DO, a hospitalist at Falmouth Hospital. But for adults over 60, the infection may spread to the lower respiratory system – the windpipe and lungs – and progress to severe illness, even death.

According to the Centers for Disease Control and Prevention (CDC), immune systems become less able to fight off disease with age, making older adults more susceptible to infection. Older adults with conditions affecting the heart, lungs or immune system are especially at risk from RSV.

These conditions, according to Dr. Costa, include:

• Asthma
• COPD (chronic obstructive pulmonary disease)
• Emphysema
• Congestive heart failure
• Rheumatoid arthritis
• Lupus
• Being on immune suppressants, or having a suppressed immune system

Residents of long-term care facilities and nursing homes also face heightened risk. The CDC estimates 60,000-160,000 older Americans become hospitalized each year due to RSV infections and 6,000-10,000 die.

Winter is Peak Season

RSV infections typically begin to mount in the fall and hit their high in winter. This season, it’s part of a circulating mix of contagions including COVID and influenza.

“We are seeing a peak with COVID,” Dr. Costa said. “People with RSV come in a little sicker than COVID, recently.”

On a recent shift he had in the Falmouth Hospital Emergency Department, nine of the 12 people there for medical reasons had either RSV or COVID, he said.

If you do get infected with RSV, it can happen again, even in the same season, as your body does not develop full immunity to it, according to the American Lung Association.

Treatment for the infection consists mainly of handling the symptoms, Dr. Costa said. Your body “is going to fight it on its own,” he said.

Hospitalized patients may get fluids to prevent dehydration or supplemental oxygen to aid breathing, but nothing to directly fight the viral infection.

“There’s no specific antiviral,” Dr. Costa said. “We don’t treat them with antibiotics.”

Vaccine Works

Two RSV vaccines have been approved by the FDA for adults over 60. The CDC recommends older adults discuss vaccination with their doctor.

“The main tool now is the vaccine,” Dr. Costa said. “I haven’t seen any patient admitted to the hospital that has had the RSV vaccine. It’s very effective.”

Despite effectiveness, and the real risk RSV poses to older adults, acceptance of the vaccines has been slow, perhaps due to people tiring of health precautions during the COVID pandemic, he said. For the week ending January 6, 2024, only 20.1 percent of adults over 60 have been vaccinated against RSV, according to the CDC. For the same time period, this compares with 46.8 percent of adults over 18 who have received flu vaccinations and 21.4 percent who have gotten COVID vaccinations.

Those that do get severely ill often regret not getting vaccinated, Dr. Costa said.

“A lot of times people say they should’ve gotten the vaccine.”

He urged people over 60 to get vaccinated, especially if they have a chronic illness.

“It (RSV infection) can take two weeks to get over,” Dr. Costa said. “Personally, I’d rather have a sore arm for a day.”

Young children form the other age group that can get seriously ill from RSV. A vaccine different from the one for older adults can be given to women 32-36 months pregnant to help prevent serious illness from RSV in their baby up to 6 months old. A monoclonal antibody may also be administered to infants younger than 6 months and children 8 to 19 months with certain conditions or risk factors, according to the CDC.

To avoid catching RSV, wash hands often, avoid being around sick people – especially young kids with colds, and wear a simple mask in crowds, Dr. Costa said.

“RSV is very contagious,” he said. “Get the vaccine.”