How to Prevent RSV

During the winter months, cases of the respiratory syncytial virus (RSV) — a common respiratory virus that typically causes mild, cold-like symptoms – tend to rise. Since the virus can cause serious illness in older adults and infants, it is important to understand how to prevent RSV.

“Taking preventive measures is crucial, especially for those who are at higher risk like premature babies or children with other risk factors,” says Dr. Hossein Sadeghi, a pediatric pulmonologist and director of the Sue and John L. Weinberg Cystic Fibrosis Center at NewYork-Presbyterian Morgan Stanley Children’s Hospital. “Avoid close contact with anyone who is sick, and of course, for any infection that we have vaccinations for, it’s important to immunize those who are eligible,” he said.

RSV cases are rising in most areas of the United States, especially in young children, according to the Centers for Disease Control and Prevention (CDC). During December 2024, New York City had 4,647 positive RSV results overall – more than double the number of diagnoses compared to early November 2024, which saw around 1,000 cases.  

Every year in the U.S., there are about 58,000 to 80,000 hospitalizations caused by RSV in children younger than five years. That number is higher in adults 60 and older – between 100,000 to 150,000 are hospitalized annually.   

Dr. Sadeghi spoke with Health Matters to help understand the signs and symptoms of RSV, how to protect your family from the virus, and when to seek medical attention.

Who does RSV affect? Who is most vulnerable?
Dr. Sadeghi: RSV can affect anyone, typically presenting like a cold and usually clearing up with plenty of rest and fluids, but those who are most at risk for developing severe symptoms are premature infants or people with underlying conditions or a weakened immune system. For example, babies who are born after less than 29 weeks of gestation, people who are 65 years or older, and anyone with chronic lung disease, congenital heart disease, or neuromuscular conditions, may experience RSV symptoms more severely.

What are the signs and symptoms?
They typically include a runny nose, coughing, sneezing, wheezing, fever, and a decrease in appetite. Symptoms can appear within four to six days and last for seven to 10 days.

A sign of RSV in babies, which may be more serious since their immune system is still developing, is when they appear to be having a harder time breathing, such as wheezing, nasal flaring, or belly breathing. Belly breathing is when their ribs are visibly going in and out. Another clue is when they are feeding less, meaning their milk or food intake has reduced compared to before.

What are a few tips to help prevent RSV?
For any infection that we have vaccinations for, it’s important to immunize those who are eligible. The best defense against respiratory illnesses is to get vaccinated. In October 2023, the Food and Drug Administration approved a single-shot RSV vaccine, called Abrysvo, for pregnant people that can protect infants from severe illness. The vaccine should be given between September through January, the CDC recommends.

An RSV antibody, nirsevimab, is also available, and the recommended timing of administration is between October through March. The antibody is for infants whose mother did not receive the RSV vaccine during pregnancy, and for children between eight to 19 months who are at an increased risk for severe RSV.

Other preventative measures include wearing a mask around infants, children under five, and adults 60 and older, and avoiding close contact with anyone who is sick. RSV can stay on hard surfaces for up to six hours, so handwashing and regularly disinfecting high-touch surfaces like doorknobs, countertops, and sinks are very important.

If there is an older child in the family who goes to school or daycare, I recommend changing their clothes as soon as they get home, washing their hands, and maybe even giving them a bath to reduce the risk of RSV transmission to a younger sibling.

Why is RSV dangerous for infants?
RSV is more dangerous in babies because their immune system is still developing. In infants, RSV can cause bronchiolitis (inflammation in the small airways of the lungs), pneumonia, or croup, which can lead to breathing difficulties and a persistent cough. For premature babies, they could end up in the intensive care unit.

What are your recommendations for parents? How can they tell the difference between RSV and other viruses, like COVID-19?
Caregivers should be vigilant about infection control, know the signs and symptoms, and when to seek medical attention — the sooner the better. It is hard to distinguish one virus from another, so it is best for parents to contact their child’s pediatrician if the child is displaying signs and symptoms that continue with little to no improvement. The pediatrician can also help determine when to take a baby with RSV to the hospital.

Are there medications to relieve symptoms? How can RSV be treated at home?
There is a medication called palivizumab (Synagis), a monoclonal antibody — an immune system protein — which works for infants who have chronic lung disease, are born prematurely, or if they have congenital heart disease. They can be immunized on a monthly basis so that when they get an RSV infection, they can handle it better. There are reduced rates of intensive care unit admissions or hospitalizations with this medication but taking it does not mean that they are not going to get it. They can still get it. But the whole idea is that it is less severe.

In cases that are not severe, RSV can be treated at home by getting plenty of rest and fluids. Most RSV infections will go away on their own within a week or two. Parents can help relieve fevers with an over-the-counter fever reducer and pain relievers like acetaminophen or ibuprofen. For high-risk infants, parents should talk with their pediatrician about the RSV antibody, or palivizumab, which can be given to them every 28 to 35 days during the RSV season.

Hossein Sadeghi, M.D., is a board-certified pediatric pulmonologist and sleep medicine specialist with extensive experience in cystic fibrosis, asthma, and global health. He is the director of the Sue and John L. Weinberg Cystic Fibrosis Center at NewYork-Presbyterian Morgan Stanley Children’s Hospital. An associate professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons, he focuses his research on asthma, RSV bronchiolitis, and cystic fibrosis.