RSV

Like we said, RSV usually just makes you feel kind of lousy, running its course in two to eight days, much like an ordinary cold. For adults and older kids, that typically means some combination of:

• Congestion and runny nose
• Cough
• Sneezing
• Sore throat
• Headache
• Mild fever

Babies and toddlers, meanwhile, often get a stuffy, runny nose and cough, may spike a fever, and might not feel like playing or eating much. In infants (under 6 months), RSV tends to look a little different: Oftentimes, the smallest kids don’t run a fever, but may be fussy, eat less and seem lethargic.

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If RSV manages to dig deep into the lungs, it can cause two major problems: pneumonia, where tiny air sacs in the lungs fill with fluid, or—mainly in babies—bronchiolitis, an inflammation of the lungs’ small air passages. Either condition can make it really hard to breathe, which is why severe RSV sends some people to the hospital. Out of every 100 babies who come down with RSV, two or three need a hospital stay. And among adults ages 60 and older, up to 160,000 are hospitalized for RSV each year, per the CDC.

In adults and older kids, signs of severe RSV include:

• Shortness of breath, which might feel like chest tightness or cause you to gasp for air
• Wheezing, which is a whistling or rattling sound that your airways make when they’re narrowed (due to inflammation, for instance)
• Unrelenting cough
• Extreme tiredness
• A blue or gray tinge to skin, lips or fingernails—a red flag that you’re not getting enough oxygen

When babies have a severe RSV infection they’ll show signs that they’re struggling to take in enough air. Those include:

• Rapid, shallow breathing
• Wheezing sounds
• Grunting at the end of each breath
• Nostrils flaring with every breath
• Using extra muscles to breathe, which can look like belly breathing, muscles in the lower neck working, and/or the skin between the ribs getting sucked in with every inhale (these are called retractions)
• Blue/gray cast to the skin, lips or nails

Any of those problems should prompt a visit to the ER or at least a call to your pediatrician. The same advice applies if your child has a high fever (104 F or higher in most cases, or 100.4 F if your baby is younger than 3 months); shows signs of dehydration (less than one wet diaper every 8 hours, dry mouth, crying with no tears); seems way less active and alert than usual; or has symptoms that don’t improve, or get worse, after a week.

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RSV and other respiratory viruses (there are more than 200!) are the cause of common colds. Antibiotics, which treat bacterial infections, won't do anything to stop such viruses. If you have a mild case of RSV, you can get by with rest, hydration and home hacks like using a cool mist humidifier to help with congestion and coughing. You might try an over-the-counter product, like acetaminophen, to deal with a fever or headache. (Check with your pediatrician if you have questions about giving an OTC to your child.) For babies’ and little kids’ stuffy noses, you can use nasal saline drops or a suction device, like a bulb syringe, to make breathing easier.

If severe symptoms land you or your child in the hospital, treatment typically involves oxygen (through a mask, nasal prongs or sometimes a ventilator) and IV fluids for dehydration.

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While it’s hard to dodge RSV completely, there are definitely ways to lower the odds of getting sick—or, just as important, making someone else sick. Some (probably familiar) basics:

• If you or your kids are sick, stay home—and skip any playdates with kids who are sniffly or coughing. Keep young infants (and their still-developing immune systems) away from crowded public places during cold and flu season.
• Practice good air hygiene by running an air purifier during playdates and dinner parties, opening the windows to improve air circulation if someone in your household is sick, and holding events outdoors when possible.
• Make hand washing a ritual, especially before eating or after using the bathroom or touching any surface that lots of other people touch, too.
• Cover your sneezes and coughs (with the crook of your elbow, not your hands).
• Regularly clean tables, countertops and other surfaces where you and your family or housemates might swap germs. And don’t forget the kids’ toys.
• Wear a mask when you’re out and about, or when at home if you have symptoms

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Up until recently, the rudimentary stuff listed above was the best you could do to stop the virus from spreading and making people sick. But as of 2023, there are new ways to protect babies and older adults: Three new vaccines, plus a shot for babies that’s different from standard vaccines.

Vaccines. The first-ever RSV vaccine, called Arexvy, was approved by the US Food and Drug Administration in 2023. Two others, Abryvso and mRESVIA, soon followed. The CDC currently recommends vaccination for:

• Everyone age 75 or older, and people ages 60 to 74 who have risk factors severe RSV. They can get any of the approved vaccines, at any time of year—though late summer to early fall is ideal. For now at least it’s just a one-and-done, with no need for annual shots.
• Pregnant people. One way to shield babies from severe RSV is to get the Abryvso vaccine during pregnancy. That allows you to develop RSV-fighting antibodies, which then cross the placenta and give infants protection for about six months after birth. You should get the vaccine during weeks 32 through 36, if they fall between September and January. This, too, is a one-time shot: If you’re vaccinated during one pregnancy, you don’t need it during any future ones.

Nirsevimab (Beyfortus). This is a drug that can be given to some babies and toddlers to fortify their immune defenses against RSV. It’s not a vaccine (meaning it doesn’t prompt the body to make RSV-fighting antibodies); it’s a monoclonal antibody shot—which means it provides babies with ready-made antibodies that mimic the body’s natural ones. Infants born between October and March would ideally get the shot in the hospital or within a week of birth. The drug protects against severe RSV for at least five months, and it’s recommended for:

• All babies younger than 8 months whose moms did not receive the RSV vaccine during that pregnancy. (This includes babies whose moms were vaccinated during a prior pregnancy.)
• Certain babies and toddlers who are 8 to 19 months old and at heightened risk of severe RSV.

Based on studies, both the vaccines and the monoclonal antibody shot can prevent a lot of severe RSV infections. The pregnancy vaccine cuts the risk of RSV hospitalization by 57% in a baby’s first six months of life, per the AAP. And babies who get the antibody shot are 80% less likely to get sick enough to need medical care (even a pediatrician visit).

As for side effects, the CDC says the RSV vaccines are similar to other vaccinations—like pain where you get the shot (usually an arm), a headache, and feeling tired. The nirsevimab shot might cause pain or a rash in your little one. Most private health insurance plans cover the RSV vaccine for pregnant people and older adults, and nirsevimab for infants.

Bottom line: RSV is all around us, and usually no big deal. But you can never predict when someone at risk of severe RSV might get unlucky. So keep doing all the things that limit our virus-sharing during cold, flu, and COVID season. And if you or anyone in your family might be a candidate for a stronger preventive tactic, talk to your doctor about it.

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