Respiratory Syncytial Virus is commonly known as RSV. It is a respiratory pathogen most often associated with severe respiratory illness in infants and young children.
However, recent scientific research and epidemiological studies have highlighted the growing burden of RSV in older adults. As the global population ages, understanding RSV in this demographic—particularly its clinical implications, risk factors, and potential for severe outcomes—has become a priority for researchers and healthcare providers alike.
his article explores the science behind RSV in older adults, its clinical manifestations, risk factors, and the latest advancements in prevention and treatment.
What is RSV?
RSV is a single-stranded RNA virus belonging to the Pneumoviridae family. It was first identified in 1956 and is a leading cause of respiratory tract infections worldwide.
It primarily infects the respiratory epithelium, leading to inflammation and damage in the airways. The virus is transmitted through respiratory droplets, direct contact with contaminated surfaces, or close person-to-person interactions.
RSV infections typically surge seasonally, with peaks in the fall and winter months in temperate climates, aligning with flu season.
In older adults, RSV infections often present with nonspecific symptoms, including cough, wheezing, fever, fatigue, and shortness of breath. These symptoms overlap with other respiratory illnesses, making accurate diagnosis challenging without specific testing, such as reverse transcription-polymerase chain reaction (RT-PCR).
Why Are Older Adults Vulnerable to RSV?
As people age, their immune systems undergo changes known as immunosenescence. This weakens their ability to mount effective immune responses against pathogens. Key factors contributing to increased susceptibility to RSV in older adults include:
Aging leads to reduced activity of T-cells, B-cells, and natural killer (NK) cells. This impairs both innate and adaptive immunity. This makes it harder for older adults to clear viral infections like RSV efficiently.
Chronic conditions such as COPD, asthma, heart disease, diabetes, and immunocompromising states increase the likelihood of severe RSV complications. For example, patients with COPD may experience exacerbated airflow obstruction during an RSV infection.
Age-related structural changes in the lungs, such as decreased elasticity and impaired mucociliary clearance, predispose older adults to severe respiratory infections.
Older adults living in congregate settings, such as nursing homes, are at higher risk due to close quarters and frequent exposure to infectious agents.
Low-grade systemic inflammation exacerbates tissue damage caused by RSV and delays recovery.
Symptoms and Complications in Older Adults
In older adults, RSV begins with familiar upper respiratory symptoms: nasal congestion, cough, and fatigue. However, it can rapidly progress to lower respiratory tract involvement. Symptoms of severe RSV infection may include:
- Wheezing or difficulty breathing
- High fever
- Persistent cough with thick mucus
- Cyanosis
- Fatigue and malaise
- Exacerbation of pre-existing conditions
When RSV invades the lungs, it can cause pneumonia or acute respiratory distress syndrome (ARDS), both of which carry significant mortality risks in this age group. Data from the U.S. Centers for Disease Control and Prevention (CDC) estimate that RSV leads to approximately 60,000–160,000 hospitalizations and 6,000–10,000 deaths annually among adults aged 65 and older in the United States alone.
Diagnosis and Treatment Challenges
Diagnosing RSV in older adults is tricky. Its symptoms overlap with those of influenza, COVID-19, and bacterial pneumonia. This leads to misdiagnosis and delayed treatment.
Reverse transcription polymerase chain reaction (RT-PCR) testing of nasal swabs remains the gold standard for confirming RSV, but it’s not always readily available in primary care settings.
There’s no specific antiviral treatment for RSV in adults. Management typically focuses on supportive care: oxygen therapy, hydration, and, in severe cases, mechanical ventilation.
Ribavirin, an antiviral drug, has been used in immunocompromised patients, but its efficacy in older adults is limited, and side effects restrict its widespread use.
Researchers are exploring monoclonal antibodies and new antivirals, but these remain in clinical trials.
Prevention Strategies
Given the significant morbidity and mortality associated with RSV in older adults, prevention is paramount. Several strategies are currently being explored or implemented:
Vaccination: Recent breakthroughs in vaccine development have led to promising candidates specifically targeting older adults. For instance, mRNA-based vaccines and protein subunit vaccines designed to elicit robust neutralizing antibody responses against RSV are undergoing clinical trials.
In May 2023, the U.S. Food and Drug Administration (FDA) approved the first-ever RSV vaccine for older adults, marking a pivotal moment in public health.
Monoclonal Antibodies: Long-acting monoclonal antibodies, such as nirsevimab, show potential for prophylactic use in high-risk populations, although they are primarily studied in infants and young children.
Public Health Measures: Encouraging good hygiene practices, such as handwashing and avoiding close contact with sick individuals, remains crucial. During peak RSV seasons, minimizing exposure in crowded environments help reduce transmission rates.
RSV in older adults is more than a seasonal nuisance—it’s a substantial contributor to morbidity and mortality. A 2022 meta-analysis in Clinical Infectious Diseases estimated that RSV’s global burden in adults over 65 rivals that of influenza, yet it receives less attention in public health campaigns.
As research advances, scientists are unraveling the virus’s complexities—from its molecular tricks to its socioeconomic impact. For now, awareness is key. Older adults, family members, and their caregivers should recognize RSV as a serious threat. The physicians can help in this regard.
