What you need to know about RSV

Respiratory syncytial virus (RSV) is a common respiratory illness that has had a lot of parents and vulnerable adults on high alert the past few years.

“RSV is a common virus that causes acute respiratory tract illness in all ages,” says Justin Bowles, MD, FAWM, DiMM, medical director for MultiCare Indigo Urgent Care. “Almost all children are infected by 2 years of age and reinfection can happen throughout life.”

While most healthy children and people who get RSV only experience mild symptoms, this virus can be dangerous for some young babies and others at risk of developing severe symptoms.

What is RSV?

For most infants and young children, RSV shows up as nothing more than a cold. However, the infection can cause more serious — sometimes life-threatening — health issues.

RSV is the most common cause of bronchiolitis (inflammation of the airways) and pneumonia (infection of the lung) in children under the age of 1 in the U.S., according to the Centers for Disease Control and Prevention (CDC).

How do you get RSV?

Just like the common cold and other viruses, RSV spreads through direct contact with another person via saliva, mucus or nasal discharge. RSV can also survive on unwashed hands for 30 minutes or more and on unclean objects or surfaces for up to six hours.

Symptoms of the virus usually start two to eight days after infection. According to the CDC, people who have the virus are usually contagious for three to eight days. But infants and people with weakened immune systems can spread the virus for up to four weeks.

Who is at risk of getting RSV?

Anyone can get RSV multiple times throughout their lives, but symptoms of the virus can be severe for certain populations, including:

• Premature infants
• Infants under 6 months of age
• Infants with congenital heart and lung disease
• Children and adults with weakened immune systems
• Children who have difficulty swallowing or clearing mucus
• Adults 65 and older
• Adults with heart and lung disease

What are the symptoms of RSV in young children?

RSV symptoms in young children typically develop in stages and may include:

• Runny nose
• Coughing
• Sneezing
• Fever (above 100 degrees Fahrenheit)
• Decreased appetite

Very young infants with RSV may develop only a few symptoms, including:

• Fussiness or irritability
• Decreased activity level
• Decreased appetite
• Pauses in breathing

Symptoms of severe RSV in infants may include:

• Short, shallow and rapid breathing
• Blue tint to the skin, especially lips and fingernails (due to lack of oxygen)
• Wheezing
• Dehydration (decrease in wet diapers)

What are the symptoms of RSV in older children and adults?

Often, older children and adults with RSV show no symptoms or very mild cold-like symptoms, including:

• Runny nose
• Congestion
• Mild headache
• Sore throat
• Fever
• Cough
• Tiredness

For children and adults at high risk of developing pneumonia or bronchiolitis because of RSV, more severe symptoms may develop, including:

• Fever
• Severe cough
• Wheezing
• Rapid breathing or difficulty breathing
• Bluish tint to skin

When is RSV considered serious?

RSV typically runs its course within a week or two, and most children and adults will recover from the virus on their own. However, you should see a doctor or other health care provider if:

• Symptoms worsen or don’t improve after seven days
• Your child has difficulty breathing or has decreased urinary output
• Your infant is younger than 3 months and has a rectal temperature of 100 degrees Fahrenheit or higher
• Your child of any age has a fever higher than 104 degrees Fahrenheit

When symptoms are severe, hospitalization may be required. Treatment may include:

• Intravenous (IV) fluids
• Humidified oxygen
• A breathing machine, or ventilator (in rare cases)

The CDC estimates that about 3 percent of children younger than 6 months with RSV require a hospital stay. Most go home after two or three days.

How are mild symptoms of RSV treated?

There is no specific treatment for RSV and, just like the common cold, there is no cure for the viral infection. If your child is experiencing mild symptoms, you can ease their discomfort with these standard remedies:

Pain and fever relievers. If your child is older than 6 months, over-the-counter pain and fever medication such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) should ease fever and discomfort. Always avoid aspirin, which has been linked to Reye’s syndrome in children. The rare but dangerous condition can cause brain swelling and liver damage.

Nasal saline. Nonmedicated saline drops help keep tiny nasal passages clean and moisturized. After applying, use a bulb syringe to gently suction mucus.

Cool-mist humidifier. Adding some moisture into the air will soothe dry breathing passages and help break up mucus.

Lots of liquids. Make sure your child gets plenty of fluids and feedings to prevent dehydration.

Resist the urge to reach for nonprescription cold medications. Some are not recommended for young children. A doctor or other health care provider can offer guidance.

How can I protect my family from RSV?

We picked up some smart habits during the COVID-19 pandemic. Those same precautions will also help protect your child and others from RSV:

• Cover coughs and sneezes with a tissue or your shirt sleeve — not your hand
• Wash hands often with soap and water, especially if you’ve come in contact with someone who has cold symptoms
• Avoid close contact with people who are sick
• Frequently clean and disinfect high-touch areas, including toys, doorknobs and cellphones
• Don’t share bottles, cups, toys or other objects
• Avoid touching eyes, nose and mouth with unwashed hands
• Stay home when sick
• Limit time at large gatherings, especially if you’re prone to sickness or have a weakened immune system or condition that puts you at risk

For adults 60 and older, an RSV vaccine is now available. For babies and very young children, two monoclonal antibody products are recommended as an extra layer of protection — see the CDC’s Preventing RSV page for more information.

Concerned about RSV? How to get help

If you or a loved one has worrying symptoms of RSV, it’s important to seek the right level of care. Emergency departments experience high volumes of sick patients during cold and flu season; seeking this type of care when it is not necessary can result in treatment delays for yourself and others.

Unless symptoms are life-threatening (please see the list below), contact your primary care provider or visit an urgent care facility.

MultiCare Indigo Health offers walk-in access at several urgent care locations across the state of Washington as well as online care appointments. You can also search MultiCare’s directory for a list of additional urgent care options throughout the Puget Sound and Inland Northwest.

Anyone experiencing the following symptoms should visit the nearest emergency department immediately:

• Difficulty breathing
• High fever
• Blue tint to the skin (especially lips and fingernails)
• Signs of dehydration (decrease in wet diapers)
• Confusion

Editor’s note: This article was originally published Nov. 1, 2022, on Indigo Health Tips & News, and updated in September 2023.