December 5, 2022 – This year’s respiratory syncytial virus (RSV) “season” is notable for a number of reasons, including the relatively early and large spike in cases, which is challenging the capacity of children’s hospitals across the country.
But the spotlight on pediatric cases has been overshadowed as this virus also increases the risk for people aged 65 and over. RSV in older Americans “is underappreciated by both physicians and especially the public,” says Ann R. Falsey, MD, a professor at the University of Rochester School of Medicine in New York.
The family of the president of the National Foundation for Infectious Diseases was not spared either.
“Our family had a pretty typical experience with RSV — where the little ones got it first,” says Patricia (Patsy) A. Stinchfield, president of the foundation, a board-certified pediatric nurse. Her immediate family includes her and her husband, both in their sixties; her daughter and her husband, in their thirties; and two grandchildren who are 3 years and 16 months old.
Stinchfield and her husband help out with the children most of the week, “so we’re with the kids a lot,” she says.
It started when the 3-year-old went to kindergarten and initially came home with a mild cold. Then word came home that three kids in her classroom had tested positive for RSV, “so it was very likely she had that, even though she was never tested,” says Stinchfield. “The way the disease progressed was very similar to RSV.”
The 3-year-old then passed the infection on to the 16-month-old. They both had low-grade fevers, runny noses, and coughs, but not too much wheezing.
Stinchfield, her daughter and her husband each had mild symptoms for less than a week. “My whole career has been in pediatrics with kids coughing right in my face, so I think I have some pretty good RSV antibodies,” she says.
Her husband wasn’t so lucky. “My husband, who is the eldest at 66, just got his cough down four weeks later.”
To illustrate how RSV can be more severe in older adults, “he had a lot of wheezing cough, bad body aches and was actually in bed for the first few days. It was really hard for him to catch his breath,” she says.
“That is typical RSV. After you’re through with the contagious phase and feeling a little better, you can have a persistent cough for 3 to 4 weeks,” says Stinchfield.
Diagnosis can be difficult in both young and old because RSV Symptoms often overlap those of the flu, COVID-19, the common cold and other diseases. Clues that suggest RSV include wheezing — a high-pitched breath sound — and the use of stomach and other muscles to assist in breathing.
The symptoms of RSV in younger and older people are often similar. “A lot of things are the same, especially the importance of severe cough and respiratory disease,” says Dr. Richard G. Wunderink, professor of medicine at Northwestern University’s Feinberg School of Medicine in Chicago.
But because children have smaller airways than adults, the inflammation caused by RSV can cause more problems in younger patients, Wunderink says. For example, it may be more difficult to remove excess mucus.
That much mucus can clog the child’s airways and even cause a lung to collapse. This condition known as atelectasis“is a major reason for admission to pediatric intensive care units,” says Wunderink
In contrast, he says, “Adults have larger airways, so we don’t see as much mucus obstruction and atelectasis.”
RSV risks in the elderly
More older people get RSV from exposure to grandchildren who have the virus, Wunderink says.
The risks in people aged 65 and older differ mainly because of the weakened immune system associated with aging and other health conditions. Wunderink pointed out in a Study 2017 That said, “As the number of older adults and people with chronic illnesses increases, the burden of viral respiratory infections will increase.”
People with heart and lung problems are most at risk, says Falsey. For example, infection can worsen chronic obstructive pulmonary disease, emphysema, heart failure, or asthma.
Falsey co-authored a June 2022 review and analysis of 14 studies that found people over 65 who sought medical help for RSV were up to 28 times more likely to be hospitalized, depending on their health status, compared to their peers without a chronic condition.
It is important to keep a close eye on someone with RSV of any age to make sure this is the case The symptoms don’t get worsen, says falsey. For example, if an elderly person with RSV “is very frail, old, or has serious underlying health conditions, a follow-up visit in a day or two is needed to ensure they don’t run into trouble and need medical attention.”
The weekly RSV rate by age group reported by the CDC shows that RSV are hospitalizations more than 10 times more likely for children under the age of 5 compared to adults aged 65 and over. The rate for the week ended November 19 was 36 hospitalizations per 100,000 people in the younger group, compared to 3 per 100,000 in the older group.
But while it’s less common, RSV can be serious in some older people. Even the CDC estimates 60,000 to 120,000 older Americans are hospitalized with RSV infections each year, and about 6,000 to 10,000 die from the infection.
“What we worry about in older people is that sometimes it can develop into a secondary bacterial infection that lodges in part of your lungs, causing pneumonia and sending you to the hospital,” says Stinchfield. “Here we get some of these frightening numbers” on hospitalizations and deaths for people aged 65 and over.
Stinchfield also shared a handy tip. “RSV is a virus that’s very persistent on surfaces, especially smooth surfaces like kitchen countertops, tables, and remote controls — those surfaces that are frequently touched.” If someone in your household has RSV, frequent cleaning with antiviral wipes could help, to reduce the spread, she says.
Possible RSV vaccines
Because no specific antiviral drug is approved to treat RSV infection, many people are prescribed supportive care. That means treating the symptoms and not the disease directly.
“Until we [had] specific treatments or preventions, it was not important to differentiate between the different types of viral respiratory infections,” says Wunderink. “Treatments for influenza and SARS-CoV-2 have changed that.”
Several vaccines to prevent RSV infection are under development and are expected to be approved for adults first.
On the plus side, RSV is being diagnosed more frequently, Falsey says, because the tests doctors use to diagnose the flu and COVID-19 often also detect RSV.