Adult Respiratory Syncytial Virus (RSV) Infection: 5 Things to Know

Respiratory syncytial virus (RSV) is commonly associated with respiratory infections in children, but it can also pose a significant threat to adults — particularly older persons and individuals with weakened immune systems. Adult RSV infection can manifest as a mild cold-like illness, but in some cases, it can lead to more severe respiratory complications such as pneumonia or bronchiolitis. Common symptoms include cough, shortness of breath, wheezing, and fever.

The virus is highly contagious and spreads through respiratory droplets, making crowded environments a potential breeding ground for transmission. Preventive measures, such as frequent handwashing, avoiding close contact with infected individuals, and vaccination where applicable, are crucial for reducing the risk for adult RSV infection.

Given the potential severity of the illness in certain populations, increased awareness and vigilance are essential to safeguard public health. Here are five things to know about RSV infection in adults.

1. RSV vaccination is recommended for adults aged 60 years or older.

As of 2023, the US Centers for Disease Control and Prevention (CDC) issued a recommendation for RSV vaccination, specifically targeting adults aged 60 years or older regardless of preexisting medical conditions. This initiative addresses the heightened vulnerability of this age group to severe RSV infections. The approved vaccines for this demographic are RSVPreF3 (respiratory syncytial virus vaccine, adjuvanted [Arexvy]) and RSVpreF (respiratory syncytial virus vaccine [Abrysvo]), offering a targeted approach to enhance immunity against RSV infection.

Notably, RSVpreF is the only RSV vaccine approved for pregnant individuals, with the CDC endorsing its use during weeks 32-36 of pregnancy. This dosing window is a strategy to provide protection to newborns, emphasizing the importance of maternal immunization in preventing RSV-related complications in infants. These advancements underscore the ongoing efforts to expand vaccination strategies, offering a comprehensive approach to mitigate the impact of RSV infections across diverse population segments, including older adults and pregnant individuals.

2. It is important to recognize which RSV-infected patients may be considered at high risk for progressing to severe disease.

Certain medical conditions in adults may result in an increased risk for severe disease due to RSV infection. These features can help healthcare professionals identify individuals who may require closer monitoring and more aggressive management. Key clinical features associated with high risk for severe RSV disease in adults include:

• Age: Advanced age, especially 65 years or older, is a significant risk factor for severe RSV infection in adults.

• Underlying respiratory conditions: Adults with chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), asthma, or interstitial lung disease are at higher risk for severe RSV disease.

• Cardiovascular disease: Individuals with heart conditions, including congestive heart failure, coronary artery disease, or other cardiovascular diseases, may experience more severe outcomes from RSV infection.

• Immunocompromised status: Patients with compromised immune systems due to conditions such as HIV/AIDS, organ transplantation, or immunosuppressive therapies have an increased risk for severe RSV disease.

• Diabetes: Individuals with diabetes, particularly those with poorly controlled disease, are at increased risk for severe RSV disease.

• Chronic kidney disease: Increased risk for severe RSV disease and hospitalization has been noted in patients with chronic kidney disease.

• Liver disorders: Patients with liver disease such as cirrhosis may be more susceptible to severe RSV infection.

• Functional impairments: Adults with limitations in functional status, such as difficulty with mobility or activities of daily living, may face challenges in effectively managing respiratory symptoms, potentially leading to more severe outcomes.

• Malnutrition: Poor nutritional status can weaken the immune system, making individuals more susceptible to severe infections, including with RSV.

• Smoking or exposure to secondhand smoke: Smoking damages the respiratory system, and exposure to tobacco smoke increases the risk for severe respiratory tract infections.

• Living or working in congregate settings: Individuals in settings in which there is close contact with others, such as long-term care facilities or crowded households, may be at a higher risk for exposure and transmission.

Identifying these clinical features allows healthcare providers to assess risk for increased severity of RSV infection in adults more accurately and to tailor monitoring strategies accordingly. Early recognition of high-risk individuals enables prompt intervention and may help prevent severe complications.

3. No antiviral medications have been approved for RSV infection, but numerous strategies are available to manage symptoms.

Treatment of adult RSV infection is generally supportive in nature and aims to alleviate symptoms while the body fights off the virus. As of early 2024, there is no specific antiviral medication approved for treating RSV in adults. However, there are antiviral medications in development. Currently, prophylaxis with vaccines is the best defense for older individuals.

There is significant interest in the role of monoclonal antibodies for adults with severe RSV disease, but these agents are currently only approved by the US Food and Drug Administration for use in neonates and infants born during or entering their first RSV season, and in children aged up to 24 months who remain vulnerable to severe RSV disease through their second RSV season.

Treatment measures may include:

• Symptom relief: Over-the-counter medications may be used to relieve symptoms such as fever, cough, and congestion. Nonprescription cough suppressants and expectorants may be recommended.

• Antipyretics: Acetaminophen or nonsteroidal anti-inflammatory drugs can help reduce fever and alleviate discomfort.

• Fluids and rest: Staying well-hydrated and getting adequate rest are important for supporting the body's immune response.

• Bronchodilators: Patients with significant bronchospasm or wheezing may be prescribed bronchodilators such as albuterol to help open airways and improve breathing.

• Minimizing mucus formation: Mucotrapping agents are being explored to combat the ability of RSV to evade the immune system by forming thick mucus plugs in the airways. These agents are designed to disrupt mucus formation, preventing viral replication and aiding clearance.

• Oxygen therapy: Severe cases of RSV infection, especially those leading to respiratory distress, may require supplemental oxygen therapy.

• Hospitalization: For individuals with severe RSV infection, particularly those with underlying health conditions, hospitalization may be necessary. In extreme cases, admission to the intensive care unit and mechanical ventilation may be required.

4. Adult RSV infection poses a significant public health threat.

Annually in the United States, RSV infection results in an estimated 60,000-160,000 hospitalizations and 6000-10,000 deaths among adults aged 65 years or older. A concerning statistic reveals that approximately 18% of those hospitalized with RSV infection require the intensive care unit, emphasizing the severity of the infection. Furthermore, the mortality rate among hospitalized individuals is 10%. Finally, RSV places a significant burden on the US healthcare system, with annual direct costs for hospitalization exceeding $1.3 billion.

5. RSV infections in adults can lead to various complications, especially in individuals with underlying health conditions or those in high-risk groups.

Common complications in adult patients include:

• Pneumonia: RSV is a common cause of viral pneumonia in adults. The infection can lead to inflammation of the lungs, causing symptoms such as cough, difficulty breathing, and chest pain.

• Exacerbation of chronic respiratory conditions: Individuals with preexisting respiratory conditions such as COPD or asthma may experience worsening symptoms, resulting in an acute exacerbation as well as increased frequency of exacerbations.

• Bronchiolitis: Inflammation of the small airways in the lungs, known as bronchiolitis, can occur and lead to wheezing, shortness of breath, and respiratory distress.

• Hospitalization: Adults, particularly those with underlying health conditions, may require hospitalization owing to the severity of RSV infection. Hospitalization is more common in older adults and individuals with weakened immune systems.

• Acute respiratory distress syndrome (ARDS): Severe cases of RSV infection can result in ARDS, a life-threatening condition characterized by rapid onset of severe respiratory failure. ARDS can require admission to the intensive care unit and mechanical ventilation.

• Secondary bacterial infections: RSV infection can weaken the immune response and make individuals more susceptible to secondary bacterial infections, such as bacterial pneumonia.

• Cardiovascular complications: Some studies suggest a potential link between RSV infection in adults and an increased risk for cardiovascular events, including heart attacks and strokes. However, more research is needed to fully understand this potential association.

• Mortality: Although mortality from RSV infection in healthy adults is generally low, the risk for death is higher among older adults and those with underlying health conditions, especially if the infection leads to severe respiratory complications.

It is important to note that the severity of complications can vary widely among individuals, and not everyone with RSV infection experiences severe outcomes. Prompt medical attention is crucial for individuals with respiratory symptoms, especially those in high-risk groups.

Medscape Infectious Diseases © 2024  WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Denyse Lutchmansingh. Adult Respiratory Syncytial Virus (RSV) Infection: 5 Things to Know - Medscape - Mar 20, 2024.