RSV in Aging & the New RSV Vaccines

It used to be that influenza was the main respiratory virus that got a lot of attention during the wintertime.But now theres another one thats become known for its potential to cause serious illness in older adults: respiratory syncytial virus (RSV).Unlike COVID-19, which only appeared in the U.S.in 2020, RSV has actually been around for decades.However, until recently, many doctors treated it mostly as a pediatric concern, because RSV is a top cause of hospitalization in young children.This is now changing.

RSV is actually similar to the flu, or even COVID, in that its older adults (along with young children) who are most likely to get dangerously ill.Hence, this is a respiratory virus that all older adults should know about.Furthermore, in 2023, the FDA approved an RSV vaccine for people aged 60 or older.So in this article, Ill explain what is RSV, and what older adults and families should know about it.What is RSV (Respiratory Syncytial Virus)?RSV is a virus in the Orthopneumovirus family.In most healthy people, it infects the upper respiratory tract, which means the nose, throat, and upper airways.This basically causes cold symptoms (although some people may have no noticeable symptoms), and most people recover within 1-2 weeks.However, in people who are very young, very old, or medically vulnerable, RSV can worsen and cause more severe illness, such as pneumonia or even death.Adults with lung conditions, such as asthma or chronic obstructive pulmonary disease (COPD), are also at higher risk for severe illness from RSV.RSV is a top cause of hospitalization among young children.

However, RSV also often affects older adults: a study published in 2017 found that among older adults, RSV was likely the cause of a serious respiratory infection in 12% of cases.And among older adults hospitalized with RSV, the mortality rate was 6-8%.The CDC has estimated that every year RSV causes approximately 58,00080,000 hospitalizations and 100300 deaths in children ages <5 years, as well as 60,000160,000 hospitalizations and 6,00010,000 deaths among adults ages 65 years and older.How is RSV transmitted?RSV is thought to spread the way many colds are: through a combination of droplets, direct contact, and airborne transmission.So you could catch RSV by being near someone who is coughing or sneezing.Or you could catch it by touching a person or surface infected with RSV, and then touching your own nose, eyes, or mouth.Per the CDC, people with RSV are usually contagious for 3-8 days; people with weakened immune systems may be able to transmit the virus for even longer.Outbreaks of RSV can definitely happen in nursing homes, and in other settings where frailer older adults congregate.

(There are surely outbreaks among younger adults as well, but these dont get diagnosed as RSV because they are colds for most people.)RSV is usually seasonal, with RSV transmission highest in the fall and winter.You can view current RSV activity via the CDCs RSV Surveillance page.What are the symptoms of RSV?In adults, RSV causes cold symptoms, such as nasal congestion, cough, and sometimes low-grade fever.It can also cause some wheezing and shortness of breath.This is most common in older adults who have a pre-existing lung condition, such as asthma or COPD, but can happen to anyone.RSV can also cause a worsening of a chronic heart condition such as heart failure.In some more vulnerable adults, RSV can worsen into a pneumonia.The symptoms of pneumonia include cough, shortness of breath, and weakness.

Fever is also common (although it is harder to generate fever as the immune system gets older).How is RSV diagnosed and treated?RSV can be detected in the emergency room or the hospital with a special PCR test.(There is also a rapid test available, but does not work as well in adults as it does in young children.)How RSV is diagnosed and treated depends on whether the persons symptoms are mild or not.Mild RSVMost of the time, when an adult gets RSV, the symptoms are mild.This means the person has cold symptoms and might feel blah, but they do NOT have RSV danger signs such as:Shortness of breathWheezingSignificant weaknessWhen it comes to mild respiratory illnesses, it can be nearly impossible to tell whether the person is sick with RSV, a cold, COVID, or a mild case of influenza.Unless the person seems to be sick with COVID (in which case treatment with Paxlovid can be considered, especially for older adults), the treatment for all other mild respiratory illnesses is supportive care, meaning rest and over-the-counter medications to help with congestion and cough, if needed.(You can check for COVID using an over-the-counter rapid test; if its still negative after 3-4 days of symptoms, youre probably not dealing with COVID.)Severe RSVIf an older person is experiencing more significant symptoms, such as shortness of breath, wheezing, or weakness, then its important to get a medical evaluation to check for pneumonia or other signs of severe illness.In the emergency room, doctors will often test for COVID, influenza and RSV.At this time, there is no particular pharmacologic treatment available for RSV, meaning there is no drug or medication that is specifically designed to treat RSV in older adults.When older adults are hospitalized with RSV, the treatment usually includes IV hydration plus treatments to stabilize breathing.What to know about the RSV vaccineIn 2023, two RSV vaccines became available for older adults aged 60 or older.

The CDCs official recommendation is that older adults may receive a single dose of RSV vaccine, using shared clinical decision-making.This basically means that the CDC is saying the vaccine is available, its approved, and talk to your doctor to see if its a good idea for you.The details about the two RSV vaccinesThey are:Arexvy, which is made of recombinant RSV F protein antigen (based on the RSV-A subtype), combined with an adjuvant (the same adjuvant used in the shingles vaccine Shingrix)Abrysvo, which is made of recombinant RSV F protein antigen (based on RSV-A and RSV-B subtypes)The CDCs Advisory Committee on Immunization Practices (ACIP) approved these vaccines in the summer of 2023, based on the data presented at their meeting on June 21, 2023.(You can view the slides presented here.)Briefly, the vaccine efficacy results presented were:Arexvy: a single dose reduced symptomatic lower respiratory tract disease by 82.6% during the first RSV season, and by 56% during the second RSV season.Abrysvo: a single dose reduced symptomatic lower respiratory tract disease by 89% during the first RSV season, and by 77% during a partial second RSV season.The vaccine was deemed to be overall safe.You can learn more about the efficacy and safety data for these vaccines on the CDCs RSV Vaccination page for health providers.Note: the RSV vaccines available for older adults are NOT the same as the preventive RSV monoclonal antibody treatment (nirsevimab) approved in 2023 for young children.Which older adults should get the RSV vaccine?In general, the older adults who are most likely to benefit from RSV vaccination are the ones at higher risk of severe RSV.

This includes older adults who:are frailhave chronic lung conditions or chronic heart conditionsare immunocompromisedlive in nursing homes or assisted livinghave other serious chronic medication conditionsof advanced age (the CDC does not define this; I would say to consider this age 85+)But any older adult who prefers to minimize their risk of getting sick from RSV should consider getting vaccinated.To get vaccinated, or to discuss whether RSV vaccination might be good for you, be sure to talk to your health provider.In SummaryRSV has been around for a long time, and has probably had more of an impact on frail older adults than many people realize.Especially now that RSV vaccines have become available for older adults, its good for us all to be more aware of RSV in older adults.Be sure to talk to your doctor about RSV vaccination if you or if your older loved one has a lung condition or is otherwise at higher risk for severe RSV.Otherwise, the good news is that you can reduce transmission of RSV by taking the same precautions that help reduce exposure to COVID, influenza, and other respiratory viruses:Keep indoor spaces well-ventilated (and advocate for cleaner indoor air standards in public places!Steer clear of people with cold symptomsWash your hands oftenConsider a KN95 or N95 mask in crowded indoor environments or when on public transitIf an older person seems significantly unwell from a respiratory illness, make sure to bring them into urgent care, or even the emergency room if they are quite short of breath or very weak.Its important to check and see if its the flu, COVID, or RSV.(Or it could be a bacterial pneumonia, or something else!)Hopefully this winter, well experience less respiratory illnesses than we have these past few winters.