Respiratory syncytial virus (RSV)

RSV is the most common germ that causes lung and airway infections in infants and young children. Most infants have had this infection by age 2. Outbreaks of RSV infections most often begin in the fall and run into the spring.

The infection can occur in people of all ages. The virus spreads through tiny droplets that go into the air when a sick person blows their nose, coughs, or sneezes.

You can catch RSV if:

• A person with RSV sneezes, coughs, or blows their nose near you.
• You touch, kiss, or shake hands with someone who is infected by the virus.
• You touch your nose, eyes, or mouth after you have touched something contaminated by the virus, such as a toy or doorknob.

RSV often spreads quickly in crowded households and day care centers. The virus can also live for many hours on hard surfaces such as countertops and doorknobs. It can live on soft surfaces such as tissues and hands for shorter amounts of time.

Symptoms appear in 4 to 6 days after infection with the virus. Symptoms can vary, depending on age.

Adults and older children most often have cold-like symptoms, including:

• Runny nose
• Coughing
• Sneezing
• Fever
• Wheezing

In young infants, the only symptoms may be:

• Irritability
• Decreased activity
• Eating and drinking less
• Breathing problems

Young infants may also have more severe symptoms and often have the most trouble breathing:

• Bluish skin color due to a lack of oxygen (cyanosis) in more severe cases
• Breathing difficulty or labored breathing
• Nasal flaring
• Rapid breathing (tachypnea)
• Shortness of breath
• Whistling sound (wheezing)

Any breathing problems in an infant are a medical emergency. Seek medical help right away.

RSV can develop into a severe respiratory infection:

• Bronchiolitis
• Pneumonia

RSV can also make existing medical conditions worse, such as asthma, COPD, and heart failure.

Many hospitals and clinics can rapidly test for RSV using a sample of fluid taken from the nose with a cotton swab.

In most cases, mild RSV infections go away in a week or two without treatment. To help relieve symptoms:

• Take acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever and relieve muscle aches. (Never give aspirin to children.)
• Drink plenty of fluids to stay hydrated.
• Always talk with your child's provider before giving over-the-counter medicines to children.

Antibiotics and bronchodilators are NOT used to treat RSV. Antibiotics kill bacteria. They won't work on the virus that causes RSV.

Infants, children, and adults with a severe RSV infection may be admitted to the hospital. Treatment will include:

• Supplemental oxygen
• Moist (humidified) air
• Suctioning of nasal secretions (in infants and children)
• Fluids through a vein (by IV)

A breathing machine (ventilator) may be needed. Hospitalization usually lasts only a few days.

Most adults and children recover from RSV.

Risk factors for severe RSV in adults include:

• Older age
• Heart or lung disease or other medical conditions
• Weak immune system
• Living in a nursing home or long-term care facility

Risk factors for severe RSV in infants include:

• Being premature
• Age younger than 12 months
• Chronic lung disease
• Weak immune system
• Congenital heart disease (present from birth)
• Neuromuscular disorders

Rarely, RSV infection can cause death in infants and older adults. However, this is unlikely if the person is seen by a health care provider in the early stages of the disease.

Children who have had RSV bronchiolitis may be more likely to develop asthma.

In young children, RSV can cause:

• Bronchiolitis
• Pneumonia

Contact your provider right away if you or your child have:

• Bluish skin color
• Difficulty breathing
• High fever
• Shortness of breath

Any breathing problems in an infant are an emergency. Seek medical help right away.

RSV tends to spread during the fall and winter months in the United States. RSV vaccines help protect children and older adults against RSV infection. The vaccine is recommended for:

• Infants younger than 8 months who are born during or entering their first RSV season.
• Children ages 8 through 19 months who are at high risk for severe RSV disease and entering their second RSV season.
• Women who are 32 through 36 weeks pregnant and entering RSV season. For this reason, most infants younger than 8 months who are born 14 or more days after their mother got an RSV vaccine do not need an RSV vaccine.
• Adults 60 and older. Contact your provider to see if getting the vaccine is right for you.

To help prevent spreading RSV when you are sick, stay home and away from others both inside and outside of your household.

• As much as possible, stay in a specific room and away from others in your home. Use a separate bathroom if you can.
• Keep track of your symptoms. You may receive instructions from your provider on how to check and report your symptoms.
• Stay in touch with your health care provider.
• Wear a well-fitted face mask or respirator that fits well over your nose and mouth without gaps when you see your health care provider and anytime other people are in the same room with you. If you can't wear a mask, for example, due to breathing problems, people in your home should wear a mask if they need to be in the same room with you.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. Throw away the tissue after use.
• Wash your hands many times a day with soap and running water for at least 20 seconds. Do this before eating or preparing food, after using the toilet, and after coughing, sneezing, or blowing your nose. Use an alcohol-based hand sanitizer (at least 60% alcohol) if soap and water are not available.
• Do not share personal items such as cups, eating utensils, towels, or bedding. Wash anything you have used in soap and water.
• Clean all "high-touch" areas in the home, such as doorknobs, bathroom and kitchen fixtures, toilets, phones, tablets, counters, and other surfaces. Use a household cleaning spray and follow instructions for use.
• Take steps for cleaner air in your home. You can do this by opening windows, turning on exhaust fans in your bathrooms and kitchen, using portable high-efficiency particulate air (HEPA) cleaners, and setting the fan on your furnace or air conditioning to "on" if you have central heating and cooling in your home.

You can go back to your normal activities if both of the following things are true:

• For at least 24 hours, you have been feeling better and your symptoms are improving AND
• You have not had a fever for at least 24 hours (and you are not using fever-reducing medicine)

Even though you feel better, you may still be able to spread the virus to others for several days. For this reason, once you go back to your normal activities, continue to protect others from illness by taking these steps for 5 days:

• Practice good hygiene
• Take steps for cleaner air
• Wear a mask around others
• Practice physical distancing by avoiding close contact and avoiding crowds

If your fever returns after resuming normal activities, you should go back to staying home and away from others. Once your fever and symptoms improve for more than 24 hours, you can resume activities while taking steps to protect others for 5 more days.

RSV; Palivizumab; Respiratory syncytial virus immune globulin; Bronchiolitis - RSV; URI - RSV; Upper respiratory illness - RSV; Bronchiolitis - RSV

Centers for Disease Control and Prevention website. Respiratory syncytial virus infection (RSV).  About RSV. www.cdc.gov/rsv/about/index.html. Updated June 5, 2024. Accessed June 19, 2024.

Centers for Disease Control and Prevention website. Respiratory syncytial virus infection (RSV). RSV vaccines. www.cdc.gov/rsv/vaccines/. Updated June 5, 2024. Accessed June 19, 2024.

Centers for Disease Control and Prevention website. Respiratory syncytial virus infection (RSV). Symptoms of RSV. www.cdc.gov/rsv/symptoms//. Updated June 5, 2024. Accessed June 19, 2024.

Centers for Disease Control and Prevention website. Respiratory virus guidance. www.cdc.gov/respiratory-viruses/guidance/. Updated March 1, 2024. Accessed March 6, 2024.

Talbot HK, Walsh EE. Respiratory syncytial virus and human metapneumovirus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 330.

Walsh EE, Englund JA. Respiratory syncytial virus. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 158.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 03/13/2024.