Are You at High Risk for Severe RSV?

When RSV Is Dangerous

There are several reasons why healthy adults under the age of 65 are generally able to ride out an RSV infection better than older adults and people with chronic health conditions or immunity issues.

“As healthy adults, we have a good lung capacity and we’ve got some antibodies [blood proteins produced by the immune system] from the prior year helping us to fight off the virus — that is, with the exception of 2020 and 2021, when we didn’t have much exposure to RSV due to COVID precautions,” says Sharon Nachman, MD, the chief of the division of pediatric infectious diseases and a professor of pediatrics at Stony Brook University’s Renaissance School of Medicine in Stony Brook, New York.

In most cases, these people can manage RSV symptoms at home with over-the-counter treatments and natural remedies (the steam from a hot shower or bath can relieve nasal congestion, for instance) and feel better within a few days, she adds.

In contrast, people 65 and older are at greater risk for severe RSV because their immune systems are weaker. “These older individuals, while they may have reasonable lung capacity, will often have some limits on it, and more importantly, they will have limits on their immune responsiveness. And so, when they get this virus, as when they get flu or other respiratory viruses, there is an increased tendency to get sick with it,” Dr. Nachman says.

This is especially true for those with certain chronic health conditions, because the virus can make those conditions worse, says Bettina Fries, MD, the chief of infectious diseases and professor at Stony Brook University’s Renaissance School of Medicine in Stony Brook, New York.

“For example, people with asthma may experience attacks as a result of RSV infection, and people with congestive heart failure may experience more severe symptoms triggered by RSV,” says Dr. Fries.

The respiratory illness can also be difficult for people with COPD (chronic obstructive pulmonary disease) because it exacerbates existing inflammation in the airways, making it even harder to breathe, according to the CDC.

Older adults who get very sick from RSV may need to be hospitalized. If a person is having trouble breathing or is showing signs of dehydration, they should seek urgent medical care, according to the University of Oklahoma Health Science Center. They might need IV hydration and supplemental oxygen, says Fries.

Immunocompromised People Are Very Vulnerable to RSV

Another group that warrants extra attention because of RSV are severely immunocompromised individuals, says Dr. Banach. “These include people who have received organ or bone marrow transplants, as they can be very vulnerable to RSV and can get severe infections,” he says.

People who require chronic immunosuppressive treatments (such as those for rheumatoid arthritis, lupus, or other rheumatologic conditions) are also more likely to get a severe case of RSV, according to a study published in the March 2018 BMC Infectious Diseases.

While healthcare providers don’t routinely administer RSV tests to people with symptoms of infection, they may do so more often in severely immunocompromised people, says Banach. “Making the correct diagnosis is especially important because there may be some special ways to treat those individuals, and it may also help rule out other potential causes of the symptoms as well,” he says.

Adults at High Risk Can Take Precautions to Avoid Infection

RSV is what’s called an endemic virus: It’s here to stay and comes back every year, Nachman says. It typically starts circulating in the fall and peaks in the winter.

“If you are part of the population who is at high risk, we always need to be concerned about what’s going to happen if you get RSV,” says Nachman.

Vaccines are a powerful new tool for preventing the worst outcomes from RSV. The U.S. Food and Drug Administration (FDA) recently approved the world’s first RSV vaccine, Arexvy, developed by the pharmaceutical company GSK for adults 60 years old and up. In a second breakthrough, the FDA also approved Pfizer’s RSV vaccine for older adults, Abrysvo.

In addition to vaccination, the CDC recommends the following precautions to avoid getting or spreading RSV.

• Wash your hands frequently and thoroughly with soap and water for at least 20 seconds.
• Avoid close contact with people who are sick, especially people who have cold-like symptoms or who are coughing and sneezing. If you’re experiencing any symptoms of a respiratory virus, stay home until you feel better.
• Cover your nose and mouth when coughing or sneezing with a tissue or the inside of your arm.
• Clean and disinfect frequently touched objects and surfaces. RSV can survive on surfaces for several hours, so it’s important to regularly clean and disinfect frequently touched objects and surfaces, such as doorknobs, light switches, and countertops.