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

Haig Sandavol Nov 19 0

Every year, around November, hospitals in Houston and across the U.S. start seeing more babies with wheezing, older adults struggling to breathe, and parents frantic over a cold that won’t go away. It’s not just flu season - it’s RSV season. Respiratory Syncytial Virus, or RSV, is the most common cause of bronchiolitis and pneumonia in babies under one year old. It’s also a silent threat to older adults, especially those with heart or lung conditions. And while many think of it as just a bad cold, RSV can land kids in the ICU and send seniors to their graves.

What RSV Really Does to Infants

RSV doesn’t just give babies a runny nose. In infants, especially those under six months, it attacks the small airways in the lungs - the bronchioles - causing them to swell and fill with mucus. This makes breathing painfully hard. About 2-3% of all babies under six months end up in the hospital because of it. That’s roughly 60,000 children in the U.S. every year.

Premature babies are at highest risk. Those born before 29 weeks are three to five times more likely to need hospital care. Babies with congenital heart disease face up to 25 times the risk. And even healthy full-term infants aren’t safe. Their tiny airways are easily blocked. Signs to watch for: rapid breathing (more than 60 breaths per minute), flaring nostrils, chest muscles pulling inward with each breath, and refusing to feed because they’re too tired to suck.

A study from the Tucson Children’s Respiratory Study followed kids for 30 years. It found that infants hospitalized with RSV before age two were more than four times as likely to develop asthma by age seven. Their lung function never fully caught up - measurements showed an 8-12% drop in breathing capacity that lasted into their teens.

Why Older Adults Are in Danger

For decades, RSV was seen as a child’s virus. That changed after 2020. New data showed RSV kills 6,000 to 14,000 adults over 65 every year in the U.S. - more than the flu in some seasons. And it’s not just about age. It’s about what’s already inside their bodies.

If you have COPD, your risk of being hospitalized with RSV is more than four times higher. With congestive heart failure? Nearly three times higher. The virus doesn’t just cause pneumonia - it triggers heart stress, spikes blood pressure, and can lead to heart attacks in vulnerable people. One study found that 78% of older adults hospitalized with RSV had worsening of their existing heart or lung disease.

Older adults also take longer to recover. Those over 75 stay in the hospital nearly three times longer than younger patients. And after discharge, 42% of them can’t do basic things like shower or dress themselves without help. That’s not just illness - it’s a loss of independence.

How RSV Spreads - And Why It’s So Hard to Stop

RSV is contagious before symptoms even show up. You can spread it by coughing, sneezing, or even just touching a doorknob after wiping your nose. The virus survives for hours on surfaces - up to 9.8 hours on stainless steel. A kiss on the cheek, a handshake, or a shared toy can pass it along.

Most people shed the virus for 3 to 8 days. But babies and people with weak immune systems can keep spreading it for up to four weeks. That’s why a grandparent might catch it from a toddler who seems fine - and then end up in the hospital.

Handwashing helps. Soap and water for 20 seconds cuts transmission by 35-50%. But it’s not enough. You can’t sanitize every surface your child touches. You can’t stop your grandkids from hugging you. That’s why prevention now goes beyond hygiene.

Breakthroughs in Prevention: Vaccines and Antibodies

In 2023, everything changed. For the first time ever, we had real tools to stop RSV before it starts.

For babies under eight months, there’s now nirsevimab (Beyfortus™). It’s a single shot given before RSV season. It doesn’t prevent infection - but it cuts the chance of hospitalization by 75%. The CDC now recommends it for every infant under eight months entering their first RSV season - no exceptions. Even healthy, full-term babies get it. It’s given at the same time as other newborn shots.

For older adults, two vaccines are now available: Arexvy by GSK and Abrysvo by Pfizer. Arexvy reduces severe RSV disease by 82.6%. Abrysvo cuts it by 66.7%. Both are given as one shot. The CDC says adults 60+ 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 the kicker: Abrysvo is also approved for pregnant women between 32 and 36 weeks. When mom gets the shot, her antibodies pass to the baby. That protects the newborn for the first six months of life - right when they’re most vulnerable.

What You Can Do Right Now

You don’t need to wait for a vaccine or antibody shot to protect someone you love.

• Wash your hands before touching a baby or older adult - especially after being in public.
• Keep sick kids away from newborns and seniors. Even a mild cough can be deadly.
• Use EPA-approved disinfectants on high-touch surfaces: doorknobs, light switches, toys, phones.
• Avoid crowded places during peak RSV season (December-January).
• If you’re over 60, ask your doctor about the RSV vaccine. If you’re pregnant, ask about Abrysvo.
• If your baby is under six months and has trouble breathing, feeding, or seems unusually sleepy - go to the ER. Don’t wait.

The Global Picture - And Why Equity Matters

In the U.S., we have vaccines, monoclonal antibodies, and ICU beds. In many parts of the world, we don’t. The WHO says 97% of all RSV deaths in children under five 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 care.

The cost of a single dose of nirsevimab in the U.S. is around $400. In a village in Malawi, that’s more than a year’s income. The vaccines for older adults cost $295 each. That’s not affordable in most places.

The science is here. The tools exist. But unless we fix who gets them, RSV will keep killing the most vulnerable - not because it’s unstoppable, but because we didn’t share what we have.

What Comes Next

Researchers are already working on next-gen antivirals. One drug, ALS-8176, cut viral load by 97% in early trials. If it works in kids, it could become an oral treatment - something you take at home, not in the hospital.

We’re also learning more about long-term effects. Kids who had severe RSV as babies may need lung function tests into adulthood. Older adults who survived RSV pneumonia may need rehab to regain strength.

The good news? We’re no longer powerless. We have vaccines. We have antibodies. We have data. What we need now is action - for every baby, every grandparent, every family who’s ever watched someone struggle to breathe.