Signs and Symptoms of Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) is a viral infection that primarily affects your lungs and respiratory tract. RSV is most common in children; almost all children get the virus before they turn 2. This quickly developing virus can also affect adults, especially older adults. It can cause symptoms such as a stuffy nose, sore throat, and lung mucus, so it can easily be mistaken for the common cold.

If left untreated, RSV symptoms may overwhelm your immune system. You could develop a more concerning condition such as pneumonia. If you have a compromised immune system before contracting RSV, you may need to be hospitalized. Identifying RSV early on can help prevent complications, so it's important to know the signs and symptoms.

Common Symptoms

Children are more at risk of developing RSV because they have less robust immune systems. The virus causes 63% of childhood upper respiratory infections and 80% of lung infections in children younger than age 1.

RSV travels on airborne (respiratory) droplets and finds new hosts (humans) via your nasal passages and lungs. You can also contract it by touching surfaces with contaminated droplets and putting your fingers in your mouth or nose. It’s one of the reasons why kids develop RSV more than adults.

A typical RSV case causes:

• A wet, productive cough
• Congestion and runny nose
• Fever
• Headache
  

Lifecycle of the Virus

RSV symptoms generally follow a lifecycle, with most people recovering within a few days of becoming symptomatic. Understanding the lifecycle can help you know when you are and aren't contagious and if you should seek further medical care.

Asymptomatic

Once respiratory syncytial virus enters your body, it takes time for it to multiply. You will likely still be asymptomatic—meaning you're not experiencing any symptoms—during this time. Initial RSV symptoms develop four to six days after the virus enters your lungs. At the end of this time, you may start experiencing classic RSV symptoms, including a headache, a low-grade fever, congestion, and a sore throat.

Symptomatic

RSV symptoms will likely progress to a thicker cough, a stuffier nose, and a higher fever. If you are an adult, you will generally deal these symptoms for a few days until the virus loses to your immune system.

Young children and infants may take a few more days to overcome their symptoms, but typically recover successfully at home. It depends on their symptoms and any potential preexisting health conditions. Most children do not experience serious illness or long-term complications due to RSV.

Most adults and children will recover from RSV at the end of this time period and will not experience any complications.

Hospitalization

While more than 2.1 million children are treated for RSV in the U.S. each year, about 58,000-80,000 children ages 5 and under require hospitalization. Their less mature immune systems may not be strong enough to fight the virus. They may develop severe symptoms like wheezing, shortness of breath, or dangerous fevers over 104 degrees.

One in five kids admitted to a hospital with RSV needs to go to the intensive care unit (ICU) to treat these symptoms. However, children and infants hospitalized with RSV typically go home after three to four days.

Research indicates that childhood RSV hospitalization levels are rising as newer viruses compromise the immune systems of young kids, although the percentages of child hospitalization are still relatively low compared to how many children contract the virus each year.

Approximately 177,000 adults are hospitalized each year for RSV, with most cases affecting people ages 65 and over.

Complications

Complications are rare for children and even less common in adults. They occur when RSV causes organ or tissue damage due to cellular inflammation, mostly after hospitalization or ICU care. Symptoms of this damage include long-term low oxygen intake with each breath, neurological complications like seizures, and anemia.

When to Contact a Healthcare Provider

It’s always good to contact your healthcare provider when you feel sick. If you or your child have RSV symptoms, your primary care provider can answer any questions you might have. They may recommend taking an over-the-counter medication like Tylenol (acetaminophen) to reduce your fever.

Some extreme symptoms warrant immediate emergency evaluation, such as experiencing a high fever or shortness of breath caused by low oxygen levels. You may notice that your oxygen level is low if you see discoloration in your skin or lips. If you have lighter skin, you may notice that your skin or lips appear blue if you can’t get enough oxygen with each breath. If you have darker skin, you may notice your skin or lips appear gray.

If your case is severe and you need to go to the emergency room, you may be given intravenous (IV) fluids and humidified oxygen (O2) to make you more comfortable. IV fluids provide hydration for immune cells that need more strength. Meanwhile, humidified oxygen masks can send oxygen directly to your lung tissue and raise your O2 levels if they are critically low. In either case, hospital staff can provide an oxygen mask to make it easier for your lungs to absorb oxygen,

Questions to Ask Your Provider

When you contact your healthcare provider, these questions may guide your conversation to make RSV recovery easier. They ensure you’ll get the most assistance possible for simplified at-home recovery.

• Is RSV spreading in my community? Your healthcare provider will know if there are higher levels of RSV in your community than usual and provide some tips for you to help protect yourself and your family.
• Is my cough a sign of RSV, or something else? You may wonder if you or your child have RSV or other common conditions like a wet pneumonia cough. Your healthcare provider may inquire about your other symptoms to better provide a diagnosis.
• How long should I or my child stay home from work or school? Parents often wonder if they should keep their children at home when they have a cough or stuffy nose. Your healthcare provider may recommend it until the symptoms go away, depending on their evaluation of your other existing symptoms.

RSV Prevention Methods

RSV symptoms may not appear in your household if you and your family take preventive measures. Infants younger than 8 months of age may receive Beyfortus (nirsevimab), an RSV antibody injection (vaccine) that reduces hospitalization by 76%.

Children younger than 24 months may also receive the vaccine Synagis (palivizumab). It prevents severe RSV symptoms in children in 70% of cases and prevents hospitalization 82% of the time. Both medications require continuous doses and may be more effective for kids with compromised immune systems.

There is also an RSV vaccine for adults. The U.S. Food and Drug Administration (FDA) approved the Arexvy (RSVPreF3 antigen-AS01E) vaccine in 2023 for adults ages 60 and older. It has been shown to have a 82% efficacy rate against RSV.

A Quick Review

RSV is a viral infection that causes common symptoms such as a sore throat, fever, and a wet cough. Young children and older adults are primarily at risk of severe RSV symptoms and hospitalization. However, anyone can contract the virus. The treatment for a mild case is resting at home and taking fever-reducing medications that are available over the counter.

If you have wheezing or shortness of breath, contact a healthcare provider for emergency assistance. If you are at a higher risk of RSV, ask your healthcare provider about your eligibility for an RSV vaccine.