RSV Infections: Risks for Infants, Older Adults, and How to Prevent Them

RSV isn’t just a bad cold. For babies and older adults, it can turn deadly. Every year in the U.S. alone, RSV sends about 80,000 children under 5 to the hospital and causes up to 14,000 deaths in adults 65 and older. It’s the top reason babies end up in the ICU with breathing trouble. And yet, many people still think it’s just a harmless winter sniffle. That’s not true - especially when you’re under 1 year old or over 65.

What Is RSV, Really?

Respiratory Syncytial Virus, or RSV, is a common virus that attacks the lungs and breathing passages. It’s so widespread that nearly every child gets infected by age 2. Most adults get it too - often every few years. But for most healthy people, it feels like a cold: runny nose, sore throat, cough, maybe a low fever. The problem is, it doesn’t stay mild for everyone.

RSV spreads easily. You can catch it from someone coughing or sneezing nearby. You can pick it up by touching a doorknob, toy, or phone that an infected person touched - the virus lives on surfaces for up to 10 hours. And you’re contagious for 3 to 8 days, sometimes longer if you’re an infant or have a weak immune system. That’s why it spreads fast in daycares, nursing homes, and households.

Why Infants Are at Highest Risk

Babies, especially those under 6 months, have tiny airways. When RSV hits, those airways swell and fill with mucus. Their lungs can’t handle it. That’s why RSV is the #1 cause of bronchiolitis (inflamed breathing tubes) and pneumonia in infants.

About 2 to 3% of babies under 6 months with RSV end up hospitalized. That’s 58,000 to 80,000 kids in the U.S. every year. And globally, RSV kills more than 100,000 children under 5 annually - 97% of those deaths happen in countries without access to oxygen tanks, ventilators, or neonatal care.

Some babies are at even higher risk:

• Preemies born before 29 weeks
• Babies with congenital heart disease
• Children with chronic lung disease from birth

These kids are 3 to 25 times more likely to get seriously ill. Signs of trouble in babies include:

• Fast, shallow breathing (more than 60 breaths per minute)
• Chest muscles pulling in with each breath (retractions)
• Nostrils flaring
• Refusing to feed or drinking less than half their usual amount
• Limpness, extreme fussiness, or not waking up to eat

If you see any of these, get help right away. Waiting can be dangerous.

Why Older Adults Are in Danger Too

People over 65 are now recognized as one of the most vulnerable groups for RSV. The CDC estimates 60,000 to 160,000 hospitalizations and 6,000 to 14,000 deaths each year in this group.

Why? As we age, our immune system weakens. That makes it harder to fight off viruses. And if you already have heart or lung problems, RSV can push your body over the edge.

Older adults with COPD are 4 times more likely to be hospitalized with RSV. Those with heart failure face nearly 3 times the risk. Once hospitalized, adults 75+ stay in the hospital almost 3 times longer than younger patients. And 1 in 5 of them don’t survive.

RSV doesn’t just cause pneumonia in older adults - it often makes existing conditions worse. Nearly 8 out of 10 hospitalized seniors see their heart or lung disease get significantly worse because of RSV. About 1 in 3 end up in intensive care. And after recovery, 42% can’t do basic tasks like bathing or dressing without help. Many need to move to a rehab center or nursing home.

How RSV Spreads - And How to Stop It

RSV doesn’t need fancy conditions to spread. It thrives in homes, schools, and nursing facilities. Here’s how it moves:

• Through coughs and sneezes (65% of cases)
• By touching contaminated surfaces like toys, light switches, or phones (10% of cases)
• Through direct contact - like kissing a child with a cold (25% of cases)

The good news? Simple habits cut transmission dramatically.

• Wash hands with soap for at least 20 seconds - the same time it takes to sing "Happy Birthday" twice. This cuts spread by up to 50%.
• Don’t touch your face, especially eyes, nose, and mouth.
• Sanitize high-touch surfaces daily with EPA-approved disinfectants. RSV dies quickly on clean surfaces.
• Avoid close contact with sick people. If you’re sick, stay home.
• Keep babies away from crowded places during peak RSV season (late fall to early spring).

The Big Breakthroughs in Prevention (2023 and Beyond)

For decades, we had almost nothing to protect the most vulnerable. Then, in 2023, everything changed.

For babies: The FDA approved nirsevimab (brand name Beyfortus) in July 2023. It’s a single shot given before or during RSV season. It cuts the risk of hospitalization by 75% for all infants under 8 months. Even high-risk kids 8 to 19 months old get protection if they’re getting their second RSV season.

For older adults: Two vaccines are now available:

• GSK’s Arexvy - 82.6% effective at preventing severe lower respiratory disease
• Pfizer’s Abrysvo - 66.7% effective

Both are recommended for adults 60+ by the CDC, especially if you have heart or lung disease, live in a nursing home, or have other health risks. Talk to your doctor - it’s a one-time shot, given in the fall before RSV season hits.

For pregnant people: Abrysvo is also approved for use between 32 and 36 weeks of pregnancy. It passes protective antibodies to the baby, offering up to 82% protection against severe RSV in the first 6 months of life.

These tools are game-changers. But access isn’t equal. In the U.S., nirsevimab costs about $400 per dose, and vaccines cost around $300. In low-income countries, they’re almost impossible to get. That’s why global RSV deaths remain high - not because the tools don’t exist, but because they’re out of reach.

Long-Term Effects You Might Not Know About

Even after a baby recovers from RSV, the damage can last.

Children who were hospitalized with RSV before age 2 are:

• 4 times more likely to develop recurrent wheezing
• 3 times more likely to be diagnosed with asthma by age 7
• Showing reduced lung function that lasts into their teens

This isn’t just coincidence. RSV seems to permanently alter how the lungs develop in early life. That’s why prevention isn’t just about avoiding the hospital - it’s about protecting a child’s long-term health.

For older adults, severe RSV can trigger a downward spiral. Many never fully recover their strength. They lose muscle mass, become less active, and start depending on others for daily tasks. That’s why preventing RSV in seniors isn’t just about survival - it’s about staying independent.

What You Can Do Right Now

If you have a baby:

• Ask your pediatrician about nirsevimab - it’s recommended for all infants under 8 months.
• Wash your hands before touching your baby.
• Keep them away from crowded places and sick people.
• Don’t let anyone smoke near your baby.

If you’re over 65:

• Ask your doctor about the RSV vaccine - even if you’ve had it before.
• Get the flu shot and COVID booster - they help reduce overall respiratory strain.
• Keep your home clean, especially doorknobs, remotes, and phones.
• If you’re sick, wear a mask around others.

If you’re around either group:

• Stay home if you have a cold, even if it’s "just a sniffle."
• Wash your hands before hugging a baby or visiting a nursing home.
• Don’t assume RSV is harmless - it can be deadly for the people you love.

RSV Is Not Just a Cold. It’s a Threat. But It’s Not Unstoppable.

We now have the tools to protect babies and older adults from RSV. We have vaccines. We have monoclonal antibodies. We know how to stop the spread.

The challenge isn’t science - it’s action. If you’re a parent, ask about the shot. If you’re an older adult, talk to your doctor. If you’re a caregiver, be the one who washes hands and wipes surfaces.

RSV doesn’t care if you’re rich or poor, young or old. But you can care enough to act. And that’s what saves lives.