Every year, as the weather turns cooler, a quiet but powerful virus begins to spread-RSV. It doesn’t make headlines like flu or COVID-19, but for babies and older adults, it can be deadly. Respiratory Syncytial Virus, or RSV, is the most common cause of bronchiolitis and pneumonia in infants under one year old. It’s also a major reason older adults end up in the hospital. And while many people think of it as just a bad cold, the reality is far more serious-especially for those most vulnerable.
What RSV Actually Does to the Body
RSV doesn’t just give you a runny nose. It attacks the small airways in the lungs, causing them to swell and fill with mucus. In healthy adults, this might mean a few days of coughing and fatigue. But for babies, whose airways are tiny and still developing, even a little swelling can block breathing. In older adults, especially those with heart or lung disease, RSV can push already weak systems past their limit.
The virus spreads easily. It lives on doorknobs, toys, and countertops for up to 10 hours. A single sneeze can send droplets flying several feet. And unlike the flu, people can spread RSV before they even feel sick. That’s why it’s so hard to stop-it moves through homes, daycare centers, and nursing homes without warning.
Why Infants Are at Highest Risk
Almost every child gets RSV by age two. But for some, it’s not just a cold-it’s a medical emergency. About 2 to 3% of infants under six months end up in the hospital each year because of RSV. In the U.S., that’s 58,000 to 80,000 hospitalizations annually for kids under five. Globally, RSV kills over 100,000 children under five every year, with nearly all of those deaths happening in places where oxygen, IV fluids, and hospital care aren’t easy to get.
Some babies are at even greater risk:
- Those born before 29 weeks of pregnancy
- Babies with congenital heart disease
- Children with chronic lung disease from prematurity
These kids aren’t just more likely to get sick-they’re more likely to die. A premature baby can be three to five times more likely to be hospitalized with RSV. A child with heart disease? Up to 25 times more likely.
Signs you need to act fast: rapid, shallow breathing (more than 60 breaths per minute), chest muscles pulling in with each breath, refusing to feed, or turning unusually quiet and sluggish. If you see any of these, don’t wait. Go to the ER.
The Hidden Dangers for Older Adults
Most people assume RSV is just a child’s illness. But in adults over 65, it’s a silent killer. Each year in the U.S., RSV sends 60,000 to 160,000 older adults to the hospital and causes 6,000 to 14,000 deaths. That’s more than the flu kills in this age group.
Why? Because aging weakens the immune system. And if you already have COPD, heart failure, or diabetes, RSV doesn’t just make you sick-it makes your existing condition spiral out of control. One study found that 78% of hospitalized older adults with RSV saw their heart or lung disease get worse. Nearly one in three needed intensive care.
And the damage doesn’t end when you leave the hospital. Nearly half of those over 65 who survive a serious RSV infection struggle with new problems-like not being able to bathe or dress themselves. About one in four need to move to a rehab center or nursing home. That’s not just health-it’s independence lost.
How RSV Spreads-And How to Stop It
RSV doesn’t need fancy conditions to spread. It just needs people. A handshake. A kiss on the cheek. A sneeze in a crowded room. The virus survives on hard surfaces like stainless steel for nearly 10 hours. That’s why cleaning isn’t optional-it’s lifesaving.
Here’s what actually works:
- Wash hands with soap for at least 20 seconds-before touching a baby, after using the bathroom, and when you come home from outside.
- Don’t let anyone kiss a baby on the face if they have a sniffle, cough, or even just a sore throat.
- Disinfect high-touch surfaces daily: door handles, light switches, phones, toys, and crib rails.
- Avoid crowded places during peak RSV season (late fall to early winter).
- If you’re sick, stay home. Even if you think it’s "just a cold."
These aren’t suggestions. They’re the difference between a mild illness and a trip to the ICU.
The New Tools: Vaccines and Monoclonal Antibodies
For the first time ever, we have real tools to fight RSV-not just hope.
For babies: In 2023, the FDA approved nirsevimab (brand name Beyfortus™). It’s a single shot given before RSV season starts. It protects infants for about five months-the critical window when they’re most vulnerable. Studies show it cuts the risk of hospitalization by 75%. The CDC now recommends it for all babies under 8 months entering their first RSV season. High-risk babies between 8 and 19 months should get it too.
For older adults: Two RSV vaccines were approved in May 2023: Arexvy by GSK and Abrysvo by Pfizer. Arexvy reduced severe RSV disease by 82.6%. Abrysvo cut it by 66.7%. Both are given as one shot. The CDC says adults 60 and older should talk to their doctor about getting vaccinated, especially if they have heart or lung disease, live in a nursing home, or have other health issues.
And here’s something powerful: Abrysvo is also approved for use in pregnant people between 32 and 36 weeks. The vaccine passes protection to the baby before birth. In trials, it cut severe RSV in newborns by over 80%.
These aren’t just medical breakthroughs. They’re game-changers.
The Global Inequality in RSV Care
While wealthy countries now have vaccines and monoclonal antibodies, most of the world doesn’t. In low- and middle-income countries, 97% of all RSV deaths in children under five happen. Why? Because the tools we have cost too much. Arexvy costs $295 per dose in the U.S. For a family in rural Kenya or Papua New Guinea, that’s months of income. And monoclonal antibodies like nirsevimab? They require cold chain storage and trained staff-things many clinics don’t have.
RSV isn’t just a virus. It’s a mirror. It shows us who gets protected-and who gets left behind.
Long-Term Effects No One Talks About
Even after recovery, RSV leaves a mark. Children who were hospitalized with RSV bronchiolitis before age two are more than four times as likely to develop asthma by age seven. Studies tracking kids for decades show their lung function never fully catches up. By their teens, they’re still breathing 8-12% less air than peers who never had RSV.
For older adults, the damage is just as real. One study found that those who had a severe RSV infection were more likely to need help with daily tasks-even three months after being discharged. That’s not just recovery. That’s permanent change.
What You Can Do Right Now
You don’t need to wait for a vaccine. Protection starts today.
- If you’re pregnant and between 32 and 36 weeks, ask your doctor about Abrysvo.
- If you’re over 60, talk to your provider about the RSV vaccine.
- If you have a newborn, insist that anyone who holds them washes their hands first.
- Keep surfaces clean. Especially in homes with babies or older adults.
- Stay home if you’re sick. Even if it’s "just a cold."
RSV is predictable. It comes every year. And now, for the first time, we have the tools to stop it. But tools only work if they’re used.