RSV: There’s More Than One Serious Respiratory Illness Out There

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Nov 04, 2024

Many of us have spent the last four and a half years focusing on a single respiratory illness above all others. But just because that COVID test comes up negative, don’t trick yourself into thinking that the coast is clear. We live in a world teeming with all kinds of viruses and bacteria that can cause the symptoms we know so well: The cough, the runny nose, the fever, the fatigue, the congestion. Sometimes it’s the common cold. But sometimes it’s not. As winter approaches, it’s time to talk about respiratory syncytial virus, better known as RSV.

“RSV is a common transmissible illness that primarily affects the respiratory system, causing symptoms similar to a cold or flu,” explains Craig Thompson, Senior Director at the Public Health Association of British Columbia and Miss Trust co-founder. "While the symptoms of these diseases may overlap, recognizing the differences can save lives. Severe RSV infections can lead to pneumonia and bronchitis in vulnerable populations like infants, the elderly, and those with weakened immune systems. When a patient presents with RSV, it's important that we take quick action. If we can prevent the illness in the first place, that's even better."

The Dawn of a New Age of RSV Prevention

That’s right, we can prevent RSV. In the last few years, new vaccines and monoclonal antibody medicines have become available, giving us options for protecting both infants and older adults from this illness. This is a remarkable development, considering that RSV affects millions globally every year and is estimated to cause over 100,000 annual deaths in children under the age of 5[1].

“The most affected populations are infants and the elderly. Almost all children have an RSV infection by the time they are two years old,” says Dr. Lori Handy, Associate Director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “While it can look like the common cold, RSV is particularly dangerous for young infants because of how the virus infects the lining of their airways, leading to an illness called bronchiolitis. Their airways are so small that, when this occurs, it leads to trouble breathing and they often need to be hospitalized. We are extremely lucky that in the past two years we have seen a flurry of approved immunizations for children and pregnant people. Specifically, infants can receive a monoclonal antibody at birth or anytime up to 8 months of age prior to or during their first RSV season. Alternatively, infants can also be protected through vaccination of a pregnant person, allowing the passage of protective antibodies across the placenta prior to the baby being born. Both methods of protection will reduce infections and hospitalizations due to RSV.”

Because RSV is a seasonal illness, like the flu, it is important to be especially alert as the colder times of year approach. The RSV season generally begins around October in the northern hemisphere, April in the southern. This is the time to be especially vigilant for cold-like symptoms that persist or worsen, or any symptoms of a lower respiratory tract infection (fast breathing, head bobbing or rhythmic grunting while breathing, wheezing, caved in belly while breathing). When an infant shows any of these symptoms, even if they’ve been immunized, it would be wise to talk to a doctor.

Protecting Adults as well as Infants

For older adults—who are also at elevated risk of severe illness or even death from RSV - we know that risk goes up with age, but it can also depend on location, living conditions, and overall health, particularly when a person has other medical conditions that impact their breathing or immune system. Individual decisions about when exactly to vaccinate will come down to a discussion between the individual and their health care provider. There’s no one-size-fits-all answer, but with the power of critical thought, it is possible to weigh the data and the risk factors to make an informed and rational individual decision. What this means is that the best time to vaccinate older adults against RSV is going to be at the point when their risk of severe disease is just beginning to get serious. But figuring out exactly when that moment can be a difficult proposition, both in the individual case and in the population.

Immunization is the Heart of Prevention, but It’s not the Whole Story

We are extremely fortunate to be entering an era of widespread RSV immunization. Immunization programs for RSV are still being rolled out and fine-tuned in many countries but the benefits are certain to be felt globally, not only in lives saved, but also in a general reduction of the burden of illness. This is a great time to be optimistic about the future.

“Whenever there is a virus that impacts the entire population and leads to hospitalization and death, the introduction of multiple immunizations is likely to make an impact on the health of society at large,” says Dr. Handy. “We anticipate future developments and studies to demonstrate how we can also protect people who are immune compromised. We will likely also realize benefits such as reducing days off work for parents and reduced pressures on our health care system during peak viral season with more widespread use of RSV immunization.”

At the same time though, it is important to remember that preventing the spread of illnesses like RSV is a responsibility we all share. And it doesn’t begin and end with immunization. The spread of RSV can also be slowed through many of the same measures we use against other contagious respiratory viruses like COVID. Wash your hands. Avoid close contact with others when you or they are sick, realizing that especially between late fall and early spring respiratory symptoms may not simply be the result of “allergies.”. Cover your mouth when you cough. And stay home when you’re sick—regardless of what the COVID test says.

Even with immunization now on the table, RSV is not going to just go away, and there will always be people in our society who are at risk of severe illness if they get RSV. For that matter, there will always be other contagious respiratory illnesses that people aren’t immunized against at all. So, as winter approaches, talk to your health care provider about all the seasonal respiratory infections out there. Ensure that you’re immunized against the right ones and that you’re taking the right precautions against the others. We’re all trying to not get sick together.

RSV: There’s More Than One Serious Respiratory Illness Out There

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