Understanding RSV in Adults: Symptoms and Prevention

While RSV is more commonly linked to severe illness in infants, it can also lead to serious respiratory problems in adults, particularly those who are older or have underlying health conditions. 

In recent years, health experts have noticed an increase in RSV cases among adults, making it an emerging public health concern. 

This article explores how RSV affects adults, its symptoms, who are most at risk, available treatments, and steps to take to prevent infection.

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Symptoms of RSV in Adults 

In adults, RSV often begins like a common cold but can progress to more serious respiratory issues, especially in those with underlying health conditions or weakened immune systems. 

Common Symptoms

In the early stages, RSV typically causes mild symptoms that resemble a cold or flu, including:

• Cough: A persistent, dry cough that can worsen over time.
• Runny or stuffy nose: Congestion that makes breathing through the nose difficult.
• Sore throat: Mild discomfort, especially when swallowing.
• Fatigue: Unusual tiredness, similar to the flu.

In some cases, RSV can lead to more severe symptoms, especially in vulnerable adults. These may include:

• Wheezing: A high-pitched sound during breathing due to narrowed airways.
• Difficulty breathing: Shortness of breath or a sense of not getting enough air.
• Fever: A body temperature over 100.4°F (38°C), along with chills.
• Chest tightness: Discomfort or pain in the chest, especially with deeper breaths.

If these more severe symptoms occur, seeking medical attention is essential, particularly if they worsen or don't improve.

Symptom Progression and Duration

After exposure to RSV, symptoms typically appear within 4 to 6 days and may develop gradually, often in stages. Early symptoms are usually mild, resembling a common cold, including a runny nose, sore throat, mild cough, and fatigue. 

Symptoms can worsen over the next few days, with a more persistent cough, increased congestion, and possibly mild shortness of breath.

Once symptoms present, they generally last 2 to 8 days in most adults. In most healthy adults, full recovery typically occurs within 1 to 2 weeks. 

However, symptoms may last longer in older adults or those with weakened immune systems or lead to complications, such as pneumonia.

Risk Factors for Adults Contracting RSV

Certain adults are more likely to experience severe RSV infection and complications. Identifying these high-risk groups can help with early prevention and treatment.

High-Risk Populations

The individuals most at risk for severe RSV complications include adults who are:

• Aged 75 and older
• Living with chronic heart or lung conditions
• Immunocompromised or have weakened immune systems
• Managing other health conditions, such as diabetes or obesity
• Residing in nursing homes
  

Impact of RSV in Immunocompromised Adults

Immunocompromised individuals face more significant risks from RSV because their weakened immune systems struggle to fight off infections. 

For those undergoing chemotherapy or managing autoimmune diseases, even a mild RSV infection can quickly progress to serious conditions like pneumonia or severe bronchitis. 

These individuals are also at higher risk of prolonged illness and complications, as their immune systems take longer to recover, and treatment may be less effective. 

Unlike healthy adults, whose immune systems typically clear RSV in 1 to 2 weeks, immunocompromised individuals may experience illness for weeks, increasing the likelihood of secondary infections or organ damage. For them, RSV isn't just a mild illness. It can become life-threatening without prompt medical care.

Diagnosing RSV in Adults

RSV can be difficult to diagnose because its symptoms may overlap with those of other respiratory infections. However, doctors have several methods for accurately identifying the virus.

How RSV is Diagnosed

Diagnosing RSV in adults starts with a physical examination and a review of symptoms, such as cough, sore throat, and shortness of breath. The doctor will also inquire about recent illness and potential exposure to others who may be sick. While these symptoms suggest RSV, they are insufficient for a definitive diagnosis.

A doctor will typically collect a sample from your nose to confirm RSV. The most common tests recommended by the CDC include:

• Rapid RSV antigen tests: These tests detect specific proteins on the virus. These tests provide quick results but are less sensitive and may miss mild cases.
• Molecular tests (RT-PCR): These tests detect the virus's genetic material and are highly accurate. However, they require lab processing and can take 1-2 days to produce results.

Because RSV shares symptoms with other respiratory infections, such as the flu or COVID-19, doctors may also use tests to rule out these conditions. 

This is particularly common during the winter months when RSV, flu, and COVID-19 are more likely to spread. Some labs offer combined tests that can detect multiple viruses at once.

Complications of RSV in Adults

While many adults recover from RSV without serious issues, the virus can lead to complications, especially in certain high-risk groups.

Common Complications

RSV can result in various complications in adults, including:

• Pneumonia: A serious lung infection that can result from RSV or as a secondary bacterial infection. It may cause severe breathing difficulties, chest pain, and fever, often requiring hospitalization for treatment.
• Exacerbation of chronic conditions: For adults with asthma or chronic obstructive pulmonary disease (COPD), RSV can worsen symptoms. This can result in difficulty breathing, increased coughing, and the need for more intensive treatment.
• Heart failure: RSV can worsen heart failure, particularly in adults with existing cardiovascular conditions. The infection strains the heart, leading to shortness of breath, fluid retention, and fatigue, often requiring hospitalization.

Complications are more severe for older adults, immunocompromised individuals, and those with chronic respiratory conditions. While healthy adults can also experience complications, like pneumonia, these are less common.

Hospitalization and Severe Cases

Each year, RSV leads to 100,000–160,000 hospitalizations among adults aged 60 and older.

Cardiovascular disease is linked to 45 to 63% of adult hospitalizations due to RSV. 

In severe cases, hospitalization may be necessary for treatments such as oxygen therapy, intravenous fluids, or mechanical ventilation.

A study of 3,218 adults hospitalized with confirmed RSV between July 2022 and June 2023 found the following:

• 54.1% of patients were aged 75 or older.
• Common pre-existing conditions included obesity, COPD, heart failure, and diabetes.
• Severe outcomes occurred in 18.5% of patients, with 17% requiring ICU care, 4.8% needing mechanical ventilation, and 4.7% dying.
• Nearly 17% of hospitalized cases occurred in long-term care facilities.

These findings suggest that vaccination should be prioritized for adults at higher risk, including those with COPD, heart failure, or those living in long-term care facilities.

In addition, it's essential to recognize the signs that require urgent medical attention, including:

• Difficulty breathing or shortness of breath
• Chest pain or tightness
• Persistent high fever
• Confusion or lack of alertness
• Bluish lips or face (indicating low oxygen levels)

Treatment Options for RSV in Adults

RSV in adults can often be managed at home, but severe cases may require medical intervention.

At-Home Management

For many adults with mild RSV symptoms, self-care and over-the-counter (OTC) medications can help manage the illness:

• Rest: Sufficient rest supports the body in fighting infection and promotes quicker recovery.
• Hydration: Drinking fluids is important to stay hydrated, especially with a fever.
• OTC Medications: Acetaminophen or ibuprofen can help reduce fever, relieve aches, and ease sore throat pain. Decongestants or saline nasal sprays may also help alleviate congestion.

At-home care suits healthy adults with mild symptoms such as a runny nose, sore throat, or cough. If symptoms worsen or breathing becomes difficult, seek medical attention.

Medical Interventions

Severe RSV cases may require hospitalization and medical treatment, which can include:

• Oxygen Therapy: If RSV causes significant breathing difficulties or low oxygen levels, supplemental oxygen helps improve breathing.
• Intravenous (IV) Fluids: Dehydration is a concern, especially if a person has trouble drinking enough fluids. IV fluids can help keep the patient hydrated and support recovery.
• Antiviral Medications: Antiviral drugs may be prescribed for high-risk individuals to reduce the severity or duration of the illness. However, these medications are typically reserved for certain populations and not commonly used for all RSV cases.

Supportive care is essential for recovery in the hospital. This includes monitoring respiratory function, managing symptoms, and ensuring comfort. In more severe cases, mechanical ventilation or intensive care may be required if the patient experiences respiratory failure or other complications.

Prevention of RSV in Adults

Preventing RSV in adults involves practicing good hygiene, avoiding exposure to the virus, and, in some cases, vaccination.

Preventative Measures

Adults can reduce their risk of RSV with these four steps:

1. Hand Hygiene: Regularly wash your hands with soap and water for at least 20 seconds, or, if soap is unavailable, use a hand sanitizer containing at least 60% alcohol.
2. Avoid Close Contact: Since RSV spreads through droplets from coughing or sneezing, avoid close contact with sick individuals, especially during peak seasons.
3. Disinfect Surfaces: Regularly clean commonly touched surfaces, such as doorknobs and remote controls, to reduce the spread of the virus, particularly in shared spaces.
4. Wear Masks: In high-risk settings like hospitals and nursing homes, wearing masks can help prevent the transmission of RSV.

Vaccine Development and Recommendations

In 2023, two RSV vaccines were approved for adults aged 60 and older. These vaccines help reduce the risk of severe illness, hospitalization, and complications from the virus.

The CDC recommends a one-time RSV vaccine for adults 75 and older and those 60-74 at increased risk. This includes those with chronic heart or lung conditions, weakened immune systems, or who live in nursing homes.

Vaccination decisions should be made through shared clinical decision-making between healthcare providers and patients. Along with these vaccines, preventive measures like good hygiene and avoiding sick individuals can help protect those at higher risk for severe RSV complications.

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Key Takeaways

• Recognize Symptoms Early: Be mindful of common RSV symptoms such as cough, shortness of breath, and sore throat, especially in older adults or individuals with chronic conditions.
• Prevention is Key: Practice good hygiene, avoid close contact with unwell individuals, and wear masks in hospitals or nursing homes to minimize exposure.
• Seek Medical Care When Needed: If symptoms worsen or you have underlying health conditions, promptly consult a healthcare provider for diagnosis and treatment.
• Vaccination and Ongoing Prevention: If you're 60 or older or in a high-risk category, consider getting vaccinated and continue preventive measures during cold and flu season.