UPDATE (5/4/23): The FDA approved a RSV vaccine for the first time on May 3, 2023. The vaccine is approved for adults 60 years of age or older, and is designed to prevent lower respiratory tract disease caused by RSV. At this time, there aren't any vaccines approved for people in other age groups.
Data from the U.S. Department of Health and Human Services says about 72% of pediatric hospital beds across the country have been occupied throughout October. That high rate in occupied hospital beds coincides with media reports that children’s hospitals around the U.S. are seeing a rise in patients with respiratory syncytial virus, more commonly known as RSV. Data from the Centers for Disease Control and Prevention (CDC) show the current surge of the virus is the largest in the past few years.
While most Americans are likely familiar with COVID-19, the flu and the common cold, RSV isn’t quite as well-known as those other respiratory illnesses. We’ve answered some common questions about the virus.
- Centers for Disease Control and Prevention (CDC)
- American Academy of Pediatrics (AAP)
- National Foundation for Infectious Diseases (NFID)
- American Lung Association
- Juan Dumois, M.D., a pediatric infectious diseases physician at Johns Hopkins All Children's Hospital
- Steven Varga, Ph.D., a University of Iowa professor who researches RSV in laboratory studies
WHAT WE FOUND
RSV is a virus that typically causes cold-like symptoms in most children and adults, which allows its spread to sometimes slip under the radar as some people may assume it’s just a cold. These symptoms, which typically come in stages, can include runny nose, coughing, sneezing, fever, decreased appetite and wheezing, and include irritability, decreased activity and breathing difficulties in very young infants.
But sometimes RSV can cause severe illness, which can lead to hospitalization and even death, especially in vulnerable populations. Infants under 1 year of age and infants born prematurely, people with heart or respiratory problems, people with weakened immune systems and people who are over 65 are all at high risk of severe illness caused by RSV.
The American Lung Association says a barking or wheezing cough may be one of the first signs of severe illness, and the CDC recommends taking a person to the hospital if they are having trouble breathing or are dehydrated.
“Infants with severe RSV will have short, shallow and rapid breathing,” the American Lung Association says. “This can be identified by ‘caving-in’ of the chest in between the ribs and under the ribs (chest wall retractions), ‘spreading-out’ of the nostrils with every breath (nasal flaring), and abnormally fast breathing. In addition, their mouth, lips and fingernails may turn a bluish color due to lack of oxygen.”
Is there a vaccine for RSV?
Yes, there is a vaccine for RSV, but it's only available for older adults.
WHAT WE FOUND
While there is a vaccine for adults 60 years of age or older, scientists are currently working on vaccines to prevent RSV in other age groups, says the AAP.
"It’s been a long time since we’ve been trying to develop an RSV vaccine — since the 1960s," said Steven Varga, a University of Iowa professor who researches RSV in laboratory studies. "And so it’s a long time coming.”
Varga said the vaccine will probably be given annually or every few years to keep your immunity up, like a flu shot. That’s because people can be reinfected with RSV multiple times. The FDA said clinical studies show that the vaccine was effective during the first RSV season following the vaccine's administration.
"Participants will remain in the study through three RSV seasons to assess the duration of effectiveness and the safety and effectiveness of repeat vaccination," the FDA said.
Experts say getting the COVID-19 and flu vaccines can help hospitals manage the RSV surges; those vaccines will reduce hospitalizations for those illnesses, freeing up space and resources for RSV patients.
“That's a benefit for the hospitals: They don't have to admit as many sick patients,” Dumois said. “Most of the patients they see in their emergency rooms can be sent home with medications and be told, ‘You'll be better within a week.’ It's the hospitalization and death that we can prevent with those vaccines, even if those vaccines don't help protect against RSV. There'll be more hospital beds available for the RSV patients who need them if they're not occupied by influenza and COVID patients.”
Both Varga and Dumois addressed false claims that the spread of RSV is directly associated with increased vaccinations for COVID-19 in children. They said there is no scientific evidence that they’re associated, or that the vaccine would leave a child’s body more susceptible to RSV.
“You could just as easily say that RSV is more common because of a new TV show that came out on one of the streaming services,” said Dumois.
Is RSV a common virus?
Yes, RSV is a common virus, especially in children.
WHAT WE FOUND
“Virtually all” children get an RSV infection by the time they’re 2 years old, according to the CDC and other experts, including the American Academy of Pediatrics (AAP), National Foundation for Infectious Diseases (NFID) and the American Lung Association.
“It's very common and we've known about it for many decades,” said Juan Dumois, a pediatric infectious disease physician at Johns Hopkins All Children's Hospital. “It causes infection in the nose and throat and lungs of people of any age.”
In an average year, RSV leads to approximately 2.1 million outpatient visits, those are doctor’s visits without admission to a hospital, among children younger than 5 years old, according to the CDC.
The NFID says RSV causes about 58,000 hospitalizations and an estimated 100 to 500 deaths among children under five each year. In adults 65 and older, RSV causes an estimated 177,000 hospitalizations and 14,000 deaths each year. The NFID believes the actual numbers among all age groups are likely higher because of underreporting of RSV infections.
Since RSV symptoms are so similar to other viral infections that circulate at the same time, such as the flu and COVID-19, the NFID says the only way to tell if you have RSV is through lab testing.
Does the current RSV spike differ from normal seasonal outbreaks?
Yes, the current RSV spike in cases does differ from normal seasonal outbreaks because it’s happening earlier than normal with a higher hospitalization rate.
WHAT WE FOUND
Many cases of respiratory diseases, including the flu and RSV, sharply declined during the first year of the pandemic thanks to lockdowns, widespread masking, social distancing, hand washing and sanitizing. But once people started interacting in person and relaxed masking rules, those seasonal viruses started circulating again.
“With mask-wearing and physical distancing for COVID-19, there were fewer cases of RSV in 2020,” says the AAP. “However, once safety measures relaxed with the arrival of COVID-19 vaccines, a rise in RSV cases began in spring 2021. The spread of RSV and other seasonal respiratory illnesses like influenza (flu) has also started earlier than usual this year.”
RSV infection season in the U.S. normally begins in the fall, peaks in the winter and ends in the spring, the American Lung Association says. CDC data confirms that the peak week of RSV hospitalizations in both the 2018-2019 and the 2019-2020 seasons was the first week of January.
But there were almost no RSV hospitalizations nationwide during what would typically be the next RSV season in 2020-2021, and the disease didn’t begin to surge again until the summer before peaking last December. This year, RSV season again began early — hospitalizations have been rising since July — and Americans are currently being hospitalized by RSV at a rate well above the normal for this time of the year.
There were 1.5 RSV hospitalizations for every 100,000 people during the second week of October. In 2018-2019, RSV didn’t hospitalize people at a rate at or above 1.5 until the last week of December, a week before that season reached its peak at 1.7 hospitalizations per 100,000 people. In 2019-2020, the hospitalization rate didn’t pass 1.5 until the first week of December, four weeks before that season reached its peak of 2.7 per 100,000. RSV hospitalization rates haven’t been at 1.5 for every 100,000 since February 2020 until this month.
Varga credits the spike to the decrease in virus mitigation efforts like widespread masking and hand washing, and less immunity to the virus across the nation because people haven’t been exposed to it for awhile, and some children haven’t been exposed to it at all.
“This is a virus that normally circulates each year, and those small exposures that we get may provide a little bit of immunity for each of us against a larger exposure,” Varga said. “And so many of us haven't had those small exposures over the last couple of years. So I think it's the combination of the decrease in the mitigation efforts, and then the lack of those kinds of constant exposures that we all get.”
Is handwashing an effective way to prevent transmission of RSV?
Yes, handwashing is an effective way to prevent transmission of RSV. While masking and social distancing also help, RSV spreads more effectively on surfaces than some other respiratory viruses, like COVID-19.
WHAT WE FOUND
“RSV spread seems to be different than that of COVID,” Dumois said. “By comparison, COVID-19 is very easily spread in the air between one person and another. A lot of [RSV] spread has been shown to occur by touching an object that's contaminated with the virus.”
Dumois explained both RSV and COVID-19 spread through droplets created when a person sneezes or coughs, it’s just that the RSV virus sticks around longer once those droplets land somewhere. So it definitely helps reduce spread if the person who is sick wears a mask, and Varga added that the spread is likely further reduced if both people in a social situation are wearing a mask.
But masking won’t stop you from touching a surface with the virus on it and then touching your face. That’s why experts recommend you wash your hands or use hand sanitizer regularly, and that you frequently sanitize surfaces like door knobs.
RSV also spreads easily from adults to children. That’s why the AAP says one of the best ways to protect your children from RSV is to wash your hands, and to remind your kids to practice good hand hygiene throughout the whole year.
Do childhood RSV infections have long-term effects on health?
There is research that shows a correlation between severe RSV cases in childhood, and an increased likelihood of asthma later in life, but experts say there isn’t enough evidence yet to say asthma is a direct result of a RSV infection.
WHAT WE FOUND
The CDC says most RSV infections go away on their own in a week or two. But there are rare cases in which RSV may affect a person’s health over a longer period of time.
Dumois said many viruses can cause long-lasting symptoms similar to those associated with long COVID: brain fog, fatigue, achiness and other problems that can persist for months or even years at a time. He said that RSV can cause similar long-lasting symptoms, although it doesn’t cause those lingering symptoms nearly as frequently as other viruses do.
As for permanent health effects, both Dumois and Varga noted a correlation between children hospitalized for severe RSV infection before turning six months of age and the development of asthma and allergies later in life. Dumois noted this has been observed for decades.
But Varga cautioned that a strong correlation between the two doesn’t necessarily mean there’s causation between the two. He said that it may just be that people genetically predisposed to asthma and allergies later in life might also be predisposed to serious RSV infections earlier in life.
“There’s evidence on both sides of that argument,” Varga said in reference to whether RSV causes asthma or is just caused by the same genetics that cause asthma.