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

Every winter, something quiet but dangerous sweeps through homes, hospitals, and daycare centers. It starts with a runny nose, a cough, maybe a fever. For most adults, it’s just a cold. But for infants and older adults, it can turn deadly. That something is RSV - Respiratory Syncytial Virus. It’s not new, but the tools to fight it are finally here.

What RSV Actually Does to the Body

RSV doesn’t just give you a stuffy nose. It attacks the small airways in the lungs, especially in young children and older adults. The virus spreads easily - through coughs, sneezes, or touching a doorknob that an infected person just touched. The virus can live on surfaces for nearly 10 hours. You don’t even need to be sick to spread it. People can pass it on before they feel ill, and kids under 1 can keep spreading it for up to four weeks.

In healthy adults, RSV usually causes mild cold symptoms: runny nose (78% of cases), sore throat, fatigue, and low-grade fever. But in babies under 6 months, it can quickly become serious. The airways swell, fill with mucus, and make breathing a struggle. That’s when you see the signs: fast, shallow breaths, ribs pulling in with each inhale, flaring nostrils, and refusing to eat because breathing takes too much effort.

Why Infants Are Most at Risk

Babies under 1 year, especially those born prematurely or with heart or lung conditions, are the most vulnerable. Their airways are tiny - about the size of a drinking straw. When RSV inflames those tubes, they practically close up. About 2-3% of all infants under 6 months end up in the hospital each year because of RSV. In the U.S. alone, that’s 58,000 to 80,000 hospitalizations for kids under 5.

High-risk infants include:

• Babies born before 29 weeks’ gestation - they face 3 to 5 times higher risk of hospitalization
• Children with congenital heart disease - up to 25 times more likely to get severely ill
• Babies with chronic lung disease - 10 to 15 times higher risk

Global numbers are even starker. Over 97% of RSV-related deaths in children under 5 happen in low- and middle-income countries. In rural Kenya, the death rate from RSV is 2.5%. In remote parts of Papua New Guinea, it’s over 15%. Why? No oxygen, no ventilators, no access to IV fluids or intensive care.

Older Adults Are Now a Major Target

For years, RSV was seen as a "child’s virus." That changed. In 2023, the CDC confirmed RSV causes 60,000 to 160,000 hospitalizations and 6,000 to 14,000 deaths each year in U.S. adults over 65. That’s more than seasonal flu in some years.

Why are older adults so vulnerable? Their immune systems weaken with age. Even if they’ve had RSV before, their bodies don’t fight it off like they used to. And if they have COPD, heart failure, or diabetes, RSV turns into a crisis. One study found:

• People with COPD are 4.2 times more likely to be hospitalized
• Those with heart failure have 2.8 times higher risk
• Adults over 75 stay in the hospital 2.3 times longer than younger patients
• 34% of hospitalized older adults need ICU care

And it’s not just about surviving the infection. After RSV, 42% of seniors develop new problems - they can’t bathe, dress, or walk without help. Nearly 1 in 3 need to move to a rehab center or nursing home after hospital discharge.

The Long-Term Damage RSV Leaves Behind

Even if a child survives RSV, the damage doesn’t always disappear. Kids who were hospitalized with RSV bronchiolitis before age 2 are:

• 4.3 times more likely to develop recurrent wheezing
• 3.2 times more likely to be diagnosed with asthma by age 7

Studies tracking these children into their teens show their lungs never fully catch up. Their lung function - measured by how much air they can forcefully exhale - remains 8-12% lower than normal. This isn’t just a childhood illness. It can shape their health for life.

How to Prevent RSV: The New Tools

For decades, the only prevention for high-risk babies was a monthly shot called palivizumab. It helped, but it was expensive and required 5 shots over the RSV season. Now, everything has changed.

Nirsevimab (Beyfortus™) - approved in July 2023 - is a game-changer. It’s a single injection that protects babies for the entire RSV season (about 5 months). Clinical trials showed it cuts the risk of hospitalization by 75%. The CDC now recommends it for all infants under 8 months entering their first RSV season, no matter their health status. High-risk kids 8 to 19 months old should get it too.

For older adults, two vaccines are now available:

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

Both are single-dose shots recommended for adults 60 and older. The CDC says you should talk to your doctor about whether it’s right for you - especially if you have heart or lung disease.

And there’s more: Pfizer’s Abrysvo was also approved in August 2023 for use in pregnant people between 32 and 36 weeks. It passes protective antibodies to the baby before birth, offering protection from day one. This maternal vaccine cut severe RSV illness in newborns by 81.8%.

What You Can Do Right Now

Even with new vaccines and shots, basic steps still matter - especially if someone in your home is at risk.

• Wash hands with soap for at least 20 seconds - it cuts transmission by 35-50%
• Avoid close contact with sick people, especially around babies and older adults
• Don’t kiss babies on the face or hands if you have a cold
• Clean high-touch surfaces daily - doorknobs, light switches, toys - with EPA-approved disinfectants. This reduces RSV on surfaces by up to 95%
• Stay home when sick - even if you think it’s "just a cold"

For families with high-risk children, avoid crowded places like malls or daycare during peak RSV season (December to February). If you’re over 60, ask your doctor about the RSV vaccine. It’s not optional anymore - it’s essential.

Why Access Still Isn’t Equal

The good news? We have the tools. The bad news? Not everyone can get them.

In the U.S., Beyfortus costs around $500 per dose. Arexvy and Abrysvo are priced at $295 each. In low-income countries, these prices are impossible. Most families there don’t have access to oxygen, let alone monoclonal antibodies or vaccines. As of late 2023, RSV vaccine coverage in these regions is nearly zero.

WHO estimates that if these tools reach everyone who needs them, we could prevent 400,000 to 600,000 hospitalizations worldwide by 2030 - and slash deaths by 30-50%. But that won’t happen without global action, fair pricing, and better distribution.

For now, if you’re in a country with access - use it. Protect your babies. Protect your parents. RSV doesn’t care who you are. But now, you have the power to fight back.