Respiratory Syncytial Virus (RSV) FAQs

Certain groups of adults and children are more likely to develop a severe case of RSV.

Adults

• Older adults, especially those ages 75 and older
• Adults with chronic heart or lung disease
• Adults with weakened immune systems
• Adults with certain other underlying medical conditions, such as kidney or liver disorders, neurologic or neuromuscular conditions, blood disorders, or diabetes
• Adults living in nursing homes or long-term care facilities 

Children

• Premature infants born before 37 weeks gestation
• Infants up to 12 months old, especially those 6 months and younger
• Children younger than 2 years with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children with neuromuscular disorders (disorders that affect how the nervous system and muscles work together). This includes children who have trouble swallowing or clearing mucus on their own

See the CDC website for more information about adults or children at highest risk for severe RSV.

RSV is spread in the following ways:

• If a person with RSV coughs, sneezes, or blows their nose near you
• Touching, kissing, or shaking hands with someone who has RSV
• Touching shared surfaces or objects also touched by someone with RSV, such as a doorknob or toys

RSV can spread quickly through enclosed, shared spaces, such as day care centers, schools, nursing homes, or crowded households.

In children, the most common complications of RSV are bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs). Babies under 12 months are most likely to have serious complications.

In adults, RSV can cause pneumonia or worsening of chronic conditions, such as asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF).

You should follow the recommendations below. If you have a child, you should help your child do the following:

• Cover your coughs and sneezes with a tissue or your shirt sleeve, not your hands.
• Wash your hands often with soap and water for at least 20 seconds.
• Avoid close contact with others. This includes shaking hands and sharing cups and eating utensils.
• Clean frequently touched surfaces such as doorknobs and mobile devices.
• If a child is in the highest of risk groups mentioned above, consider limiting time spent in crowded or shared spaces, such as day care, grocery shopping or indoor shopping areas.

These prevention tips will help prevent any respiratory illness, not just RSV, and are good practice for the entire family.

A vaccine for RSV is approved by the Food and Drug Administration (FDA) for adults ages 60 and older and pregnant people.

The RSV vaccine is recommended for everyone who is 75 years or older. Otherwise, it depends on your medical history. Older adults with certain conditions are more likely to have severe disease from RSV. RSV can be more severe for some groups of people, putting them at risk for hospitalization. Conditions that increase the likelihood of severe disease include:

• Heart disease
• Lung disease
• Kidney or liver disorders
• Neurologic or neuromuscular conditions
• Blood disorders
• Diabetes
• Immunocompromise
• Advanced age (ages 75 years or older)
• Frailty
• Living in a long-term care facility.

The CDC website has more information about adults at highest risk for severe RSV. The RSV vaccine reduces the risk of lower respiratory tract infections like pneumonia. If you have one of the above conditions, you are more likely to benefit from the vaccine.

Healthy people ages 60-74 with none of those conditions listed may be less likely to benefit from this vaccine as they are at lower risk for severe RSV infection.

Side effects of the vaccine can include injection site pain, tiredness, muscle aches, and headache. More serious side effects are rare. See the CDC website for more information.

It is important for you to consider the benefits of vaccination and the side effects. Read more information about the RSV vaccine.

If you have more questions, please discuss them with your provider at your next visit. Or schedule a virtual visit to talk about whether the vaccine is right for you.

Adults ages 60 and older can get an RSV vaccine at most pharmacies without a prescription.

The RSV vaccine can be given with other adult vaccines, including flu and COVID-19. For patients who wish to separate their vaccines, you can also wait 1-2 weeks between vaccines.

One RSV vaccine, Abrysvo, is now recommended to all pregnant people who are between 32 and 36 weeks pregnant during the months of September to January. Pregnant people can receive this vaccine to help protect their infant after birth. The RSV vaccine is recommended once for now, so, if you had it with a prior pregnancy, please see below about different ways to protect your newborn. For more information, see the CDC website.

When given during pregnancy, the vaccine creates antibodies that pass from mother to baby. These protect the baby whether or not they are breastfed. They help babies fight the infection after birth. Studies show that maternal vaccination reduces the risk of hospitalization for babies with RSV from birth through 6 months of age. Newborns are best protected when the vaccine is given at least 2 weeks before delivery.

The clinical trials showed that there were no serious side effects in mothers who received the vaccine or their infants. This vaccine is similar to other vaccines.

Abrysvo is available at Mass General Brigham for pregnant people this fall. Please check with your OB practice to inquire about availability.

Pregnant people may need a prescription or prior authorization to get the vaccine from a pharmacy. Please call your pharmacy to confirm that they have Abrysvo. The cost may also vary by insurance company. Please call your insurance company if you have questions about cost.

The RSV vaccine can be given with other adult vaccines, including flu and COVID-19. For patients who wish to separate their vaccines, you can also wait 1-2 weeks between vaccines.

There is no vaccine for children. However, there are two monoclonal antibody treatments – nirsevimab (Beyfortus) and palivizumab (Synagis) – that can help protect babies and young children from severe RSV infections. Monoclonal antibodies are not vaccines. They provide an extra layer of defense against RSV infections.

Nirsevimab (Beyfortus)

If a pregnant person is not vaccinated at least 2 weeks prior to delivery, their newborn may be eligible to receive nirsevimab (Beyfortus) after birth. This applies to all infants younger than 8 months old in their first RSV season. There may be limited supply of nirsevimab (Beyfortus). Therefore, to protect your baby this RSV season, we encourage eligible pregnant people to get vaccinated.

Palivizumab (Synagis)

Palivizumab (Synagis) is limited to children under 24 months of age most likely to be affected by severe RSV. This includes:

• Infants born 35 weeks or less and six months or younger at the beginning of RSV season and
• Children under 24 months at the beginning of RSV season with chronic lung or heart conditions.

If you have questions, you can ask your child’s care team. They can discuss the best option for your baby. For more information, see the CDC website.

People infected with RSV usually show symptoms within 4-6 days after getting infected. Symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity and breathing difficulties. 

Mild symptoms – Supportive care at home

What are mild symptoms?

Mild symptoms include a runny nose, coughing, sneezing, mild congestion, and low-grade fever. Low-grade fevers are:

• Babies under 3 months: anything between 99°F (37.2°C) and 100.4°F (38°C)
• Everyone else: anything between 100.4°F (38°C) and 102.4°F (39°C)

You or your child may have decreased appetite but taking enough fluids. You can tell if your child is taking in enough fluids by how often they urinate. In babies and toddlers, this means a wet diaper at least every 8 hours. For children ages 3 years and older, as well as adults, this means urinating at least once every 10 hours.

What do I if my child or I have mild symptoms?

Rest, drink plenty of fluids and monitor symptoms. In most cases, you or your child should start feeling better within a few days.

Do my child or I need to be tested for RSV or other viruses?

There are many respiratory viruses that can cause cold-like symptoms. Most cases of RSV and other viruses go away on their own in 1-2 weeks. Since the symptoms of RSV and other respiratory viruses are similar to COVID-19, you or your child can test for COVID-19 at home. If your child tests positive for COVID-19, follow the CDC isolation guidelines. If you or your child has mild symptoms, it is not necessary to test for other viruses.

Moderate symptoms – Call your care team

Children

Call your child’s care team if your child shows any of the following symptoms:

• Fever:
  • In babies under 3 months: Temperature over 100.4°F (38°C)
  • In babies over 3 months and older children: Temperature over 105°F (40.5°C), temperature over 102.4°F (39°C) that does not respond to fever-reducing medication, or fever that lasts for more than 3 days
• Increased work of breathing. This includes short, shallow, and unusually fast breathing or caving in of the space between the ribs, or nostrils spread out with every breath.
• Wheezing (a whistling noise when breathing)
• Not taking fluids and/or decreased urination. For babies, this means not having a wet diaper for 8 hours. In children ages 3 years or older, no urine output in 10 hours.
• Excessive tiredness or sleeping excessively
• Ear pain or severe sore throat
• Develops a rash covering much of the body

Adults

Call your primary care physician if you develop any of the following symptoms:

• High fever – a fever over 102.4°F (39°C)
• Severe cough
• Shortness of breath
• Wheezing (a whistling noise when breathing)

Severe symptoms – Emergency  

Go to the Emergency Department if you or your child is having severe symptoms, such as:

• Difficulty breathing
• Pauses in breathing for 20 seconds or more
• Inability to wake or stay awake 
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

There are no RSV-specific medications for treatment. Antibiotics do not treat RSV. For severe cases being treated in the hospital, you or your child may receive:

• Oxygen supplementation
• IV fluids for dehydration

You or your child may also receive other medications depending on their underlying conditions.