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Whether you, your grandma, or your 6-month-old niece get a cold, chances are, you’ll all feel pretty much the same (mildly rotten). But with respiratory syncytial virus, or RSV, how old you are can affect how sick you get. “Respiratory syncytial virus does present differently in folks of different ages,” says Kisha Davis, MD, a member of the board of directors of the American Academy of Family Physicians and the chief health officer for Montgomery County, Maryland.
A little background: RSV causes infection in your respiratory tract, which includes your lungs and other organs that make it possible for you to breathe. The virus is very contagious and can spread quickly in daycares and nursing homes through sneezing and coughing. It’s also transmitted through close contact, like touching your nose or mouth after touching a contaminated doorknob, countertop, or other hard surface or object, where the virus can live for hours. People with RSV are most contagious during the first week of infection, though the virus can continue to spread up to a month after symptoms have disappeared, according to the Mayo Clinic.
Healthcare providers can test for RSV using a rapid antigen test or a molecular test, which is able to pinpoint smaller amounts of the virus. (Molecular tests may be used for older children and adults, who tend to have less of the virus in their noses than infants and young children do.) The most common way to collect a sample from your nose is to insert a saline solution and gently suction it out, though your doctor may also swab the inside of your nose. They may also do a chest X-ray to test for inflammation in the lungs. Healthy adults and older children don’t usually need RSV testing, though some at-home kits test for Covid-19, flu, and RSV all at once. You should seek immediate medical attention if your infant—or anyone at high risk of severe RSV infection, which you’ll learn more about in a second—has difficulty breathing, a high fever (a temp higher than 100.4 in infants under 3 months old and 104 or higher for everyone else), or blueish lips or skin.
Now, back to those symptoms. Here’s what they look like depending on how old you are, plus, what you can do to treat them (and how you can help prevent getting infected in the first place!).
Babies & Young Children
RSV is so common, most kids have been infected with it by the age of 2. But that doesn’t mean it can’t be dangerous, especially for infants. In fact, according to the Centers for Disease Control and Prevention, the virus is the leading cause of infant hospitalization.
Infants with RSV infection almost always show symptoms, which tend to start about two to five days after contracting the virus. “In babies, RSV can show up as irritability, decreased activity, and eating and drinking less,” says Davis. “But really, the signs are respiratory: trouble breathing, wheezing, their noses kind of flare out and sometimes their chest sucks in. It looks like they’re really struggling to breathe.” Their symptoms may start out mild and then become more severe a few days into the illness. Infants and young children with infection, for example, tend to start out with a runny nose and a decrease in appetite, then develop a cough one to three days later. Soon after that, sneezing, fever, and that wheezing Davis mentioned may occur. While RSV usually causes cold-like symptoms, it can spread to the lower respiratory tract and cause respiratory infections, like pneumonia or bronchiolitis, an infection of the small airways in your lungs. (Bronchitis, FYI, affects your larger airways and usually happens to older children and adults.)
“The best protection we have—in addition to staying away from babies when you’re sick—is vaccination,” says Davis. Women who are 32 to 36 weeks pregnant between September and January can get the maternal RSV vaccine and pass that protection along to their baby. Otherwise, babies under 8 months old can get immunized directly with the injectable RSV monoclonal antibody, nirsevimab, between March and October. (Unlike active vaccinations, monoclonal antibodies do not activate the immune system. “Vaccines help you create antibodies, but babies can have a hard time making them, so they give them antibodies,” explains Davis.)
RSV can also be dangerous for some young children. The younger they are, the higher the risk. The children at greatest risk include American Indian and Alaska Native children; children born prematurely; and children with chronic lung or congenital heart disease, weakened immune systems, and severe cystic fibrosis. For these children, a dose of RSV antibody is recommended between the ages of 8 and 19 months when they are entering their second RSV season, which typically starts in the fall and peaks in the winter.
Adults
In healthy adults, RSV doesn’t generally cause severe illness. In fact, “a lot of folks have probably had RSV and thought they had the common cold,” says Davis. Symptoms, which include runny nose, sore throat, and cough, typically take about four to six days to show up and last for between two and eight days, according to the Cleveland Clinic, and they appear in stages rather than all at once. The best way to treat your symptoms is with (you guessed it!) fluids and rest; a cool-mist humidifier; and over-the-counter medications, like acetaminophen or ibuprofen for pain. Antibiotics don’t work against RSV, though your doctor may prescribe them if you develop bacterial pneumonia or another bacterial infection in addition to RSV. And antivirals aren’t routinely recommended either.
With that said, RSV can make adults really sick. Those with chronic lung or heart disease, a weakened immune system, or severe diabetes or obesity are at the highest risk of complications, such as pneumonia or bronchitis. When this happens, it can lead to extreme tiredness, low appetite, wheezing, and shortness of breath. If complications develop, you may need to be hospitalized. Hospitals can use intravenous fluid for hydration and a breathing machine or humidified oxygen to make sure you get enough oxygen. In most cases, hospitalization lasts just a few days.
Elderly Adults
Certain older adults are at higher risk for severe RSV infection. These adults fall into two main categories, and the CDC recommends that both should get one dose of any of the three FDA-approved RSV vaccines in late summer or early fall. The first category: Americans who are 75 and older. The second category includes people between the ages of 60 and 74 who have chronic heart or lung disease, have a weakened immune system, live in a nursing home, or have any of the other risk factors listed on the CDC’s website. The CDC is not currently recommending a booster, says Davis, like they do with the Covid vaccine.