Respiratory syncytial virus (RSV) is a virus that commonly causes mild, cold-like symptoms. However, in some cases, RSV may cause serious lung infections, especially in high-risk individuals, such as infants, older adults, adults with chronic medical condtions and people with compromised immune systems. Keep reading to learn about treatments for RSV symptoms and how is RSV treated.

RSV Overview

According to the Centers for Disease Control and Prevention (CDC), annual community outbreaks of RSV occur in late fall, winter or early spring.

RSV is spread from person to person by sneezing, coughing, direct contact or touching an object with the virus on it and then proceeding to touch your mouth, nose or eyes. Common symptoms of RSV include runny nose, reduced appetite, cough, sneezing, fever, sore throat and wheezing. The symptoms in very young infants with RSV may only be irritability, decreased activity, and difficulty breathing. Symptoms typically occur in stages, and not all at once.

The National Institute of Allergy and Infectious Diseases estimates that RSV causes about 14,000 deaths in adults older than 65 in the U.S. each year. In children one year and younger, RSV is also the most common cause of bronchiolitis (inflammation of the airways in the lungs). Unfortunately, RSV hospitalizes about 58,000 children younger than 5 in the U.S. annually.

Self-Care and Symptom Management

RSV can usually be managed at home without medical care for individuals who are generally healthy and not considered at high risk. The CDC recommends the following self-care measures for managing the symptoms of RSV at home:

• Rest. It takes time for a virus to run its course. Even mild infections can make you feel tired and weak. If possible, take off from work and ask a support person to help with daily obligations. Allowing yourself plenty of time to sleep and recharge will help you bounce back into your everyday life more swiftly.

   

• Hydrate. Drinking plenty of fluids prevents dehydration when you're ill. Dehydration can make you feel worse and even result in hospitalization if severe. Staying hydrated potentially reduces the duration of your illness. The National Academy of Medicine recommends approximately 9 cups of fluid per day for healthy women and 13 cups per day for healthy men, but this doesn't need to be plain water. Soups, teas, sports drinks, milk and even fresh fruits and vegetables count toward your fluid intake. Please note that this is a general guide and not a daily target, as body weight, physical activity, medical conditions and other factors could affect how much fluid one should consume.

   

• Symptom management. RSV commonly causes sore throat, headache and fever. Over-the-counter (OTC) medications often serve as treatments for RSV symptoms. OTC analgesics like acetaminophen or ibuprofen can reduce fever and ease pain. Your pharmacist can help you select a pain reliever and fever reducer that is safe for you. They can also assist you in determining the proper dosage for you or your loved one.

   

Medical Evaluation and Monitoring

The duration of RSV symptoms and the contagious time frame varies. People who are generally healthy are contagious for three to eight days, which may begin a day or two before RSV symptoms appear. People with weaker immune systems, such as infants, the elderly and immunocompromised individuals, cannot fight the infection as quickly and may spread the virus for up to four weeks. The following are immunocompromised:

• People with certain health conditions such as HIV/AIDS, autoimmune disorders or history of an organ transplant.

• People receiving cancer treatments, like chemotherapy or radiation.

• People taking medications that suppress the immune system, such as steroids.

   

For these higher-risk individuals, it is essential to seek medical attention if RSV symptoms become severe or persist longer than 10 days. It is important not to delay medical attention in these cases because RSV can cause inflammation of the airways in the lungs, leading to severe breathing problems or pneumonia.

Hospitalization for Severe Cases

At-risk groups are the most likely to be hospitalized for severe RSV. The CDC estimates that out of 100 infants with RSV, two to three of them will develop a severe enough infection to require care in a hospital. The CDC also estimated that 60,000 to 160,000 older adults are hospitalized yearly because of RSV.

More severe infections may require care beyond the self-care approach of fluids, rest and OTC medicines. Severe RSV infection may require more intensive treatment, including supplemental oxygen, intravenous fluids and antiviral medications. These treatments cannot usually be given at home and require hospitalization. In a hospital, the medical team can closely monitor a patient's condition and quickly treat any complications.

Oxygen Therapy

Oxygen therapy may be used in severe RSV cases to maintain adequate oxygen levels. Normally, blood oxygen saturation should be 95% or greater. However, if you're infected with RSV, you may not be able to get enough oxygen to meet this requirement. Healthcare professionals can measure your blood oxygen saturation using pulse oximetry (pulse ox), a device which painlessly clips onto your fingertip.

Supplemental oxygen is used whenever someone cannot breathe enough oxygen from room air. Oxygen is given by placing a tube under the nose, or a face mask over the nose and mouth, to deliver extra oxygen with each breath.

Intravenous Fluids

Remember that hydration is vital to fighting off an infection, which is especially important for infants and young children. However, if you are severely ill, you may not be able to physically consume enough fluids. If this is the case, you may need to receive intravenous fluids during a hospital stay for RSV treatment.

Medications

How is RSV treated? Not everyone who gets RSV needs to receive a prescription medication. Supportive medications are sometimes prescribed to ease symptoms, such as breathing treatments for wheezing.

If a healthcare provider deems it necessary in severe or complex cases, they may prescribe medications to help the immune system fight off the infection.

Ribavirin is the only antiviral medication specifically FDA-approved for treating active RSV infections. It is intended for hospitalized infants and young children with severe, complicated RSV infections affecting the lower respiratory tract. It comes as a solution that is administered via inhalation.

Ribavirin is also used to treat RSV infection in high-risk immunocompromised adults. There is limited evidence on its effectiveness for treating RSV in adults who are not immunocompromised. In general, treatment for RSV infection in adults is supportive and focuses on managing the symptoms.

However, mixed evidence exists regarding ribavirin's effectiveness in improving overall outcomes for adult patients. Also, this medication can be expensive and carries serious risks. As such, the American Academy of Pediatrics recommends ribavirin treatment only for kids with weak immune systems who have severe RSV infections. Prescribers should consult an infectious disease expert before prescribing ribavirin.

Monoclonal antibodies

Monoclonal antibody preventative treatments are available to help protect against severe disease from RSV in premature babies and young children with certain risk factors, such as specific lung and heart conditions. Monoclonal antibodies for RSV are given as injections and include palivizumab and nirsevimab-alip. These treatments prevent severe disease if a child is exposed to RSV, shorten hospital stays for children affected by RSV and limit wheezing symptoms.

Note that these preventative injections are not recommended or necessary for all children.

Prevention

RSV vaccines, Arexy and Abrysvo, are available to help reduce the risk of severe respiratory illness from RSV in certain people who are more likely to experience serious consequences from RSV infection.

The CDC now recommends the Abrysvo vaccine for pregnant women. It should be given once between 32-36 weeks of gestation. This vaccine helps prevent RSV-associated lower respiratory infection in infants under six months old. Pregnant individuals can choose either maternal RSV vaccination or nirsevimab administration for their infants. Most infants do not need both.

Adults age 60 years and older may receive a single dose of an RSV vaccine, either Arexy or Abrysvo. The CDC does not currently recommend the RSV vaccine for all adults in this age group. Rather, individuals should discuss the option with their primary care provider or pharmacist to determine if the vaccine is right for them.

To ensure protection, the CDC recommends considering vaccination as soon as the vaccine is available. Not to worry: You can quickly and easily schedule your appointment online.

Bottom Line

RSV is a common respiratory virus that typically does not require additional treatment by a healthcare provider. It can often be managed at home with self-care measures like OTC pain relievers and rest. However, severe cases may warrant medical treatment and hospitalization, especially for those with less developed or weakened immune systems. Following your healthcare provider's guidance is essential for the best care.

Written by: Patricia Weiser, PharmD

These articles are intended for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment and are not intended to treat or cure any disease. Never disregard professional medical advice or delay in seeking it because of something you have read in these articles. Advances in medicine may cause this information to become outdated, invalid, or subject to debate. Professional opinions and interpretations of scientific literature may vary. Consult your healthcare professional before making changes to your diet, exercise or medication regimen.