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

RSV isn’t just a bad cold. For babies under one year and adults over 65, it can turn life-threatening in days. Every year in the U.S. alone, RSV sends about 80,000 children under five to the hospital and causes up to 160,000 hospitalizations in older adults. It’s the number one cause of bronchiolitis and pneumonia in infants, and it’s getting worse for seniors as our population ages. The good news? We now have powerful tools to stop it - if we know how and when to use them.

What RSV Actually Does to the Body

Respiratory Syncytial Virus, or RSV, attacks the lining of your nose, throat, and lungs. It starts like a typical cold: runny nose, sore throat, cough, fever. But in vulnerable people, it doesn’t stop there. The virus spreads down into the small airways of the lungs, causing swelling and mucus buildup that blocks airflow. In babies, those airways are tiny - as thin as a drinking straw. When they get clogged, breathing becomes a desperate struggle. In older adults, RSV worsens existing heart or lung conditions, pushing already weakened systems past their limits.

Symptoms usually show up 4 to 7 days after exposure. Most people feel better in a week or two. But for high-risk groups, the real danger comes in the next few days: rapid, shallow breathing, flaring nostrils, chest pulling inward with each breath, refusal to eat, and extreme tiredness. These aren’t just signs of being sick - they’re signs of oxygen starvation.

Why Infants Are Most at Risk

Infants under six months face the highest risk of severe RSV. Their immune systems haven’t learned how to fight it yet. Premature babies - especially those born before 29 weeks - are 3 to 5 times more likely to be hospitalized. Babies with congenital heart disease face a 20 to 25 times higher risk. Those with chronic lung disease from birth are 10 to 15 times more likely to need intensive care.

Every year in the U.S., 2 to 3% of all infants under six months end up in the hospital with RSV. That’s about 58,000 to 80,000 kids. Globally, RSV kills over 100,000 children under five each year - nearly all of them in countries without access to oxygen tanks, ventilators, or neonatal intensive care. In rural Kenya, the death rate from RSV can be as high as 2.5%. In remote parts of Papua New Guinea, it’s over 15%.

Even after recovery, some children pay a long-term price. Kids hospitalized with RSV bronchiolitis before age two are more than four times as likely to develop asthma by age seven. Their lungs never fully catch up - studies show their breathing capacity remains 8 to 12% lower than peers well into their teens.

Older Adults Are Facing a Silent Crisis

For decades, RSV was seen as a child’s illness. That changed in the last five years. Now we know it’s a major killer of older adults. In the U.S., RSV causes 60,000 to 160,000 hospitalizations and 6,000 to 14,000 deaths in people 65 and older every year. That’s more than the flu kills in some seasons.

The risk spikes sharply after age 75. Seniors in that group stay in the hospital 2.3 times longer than younger adults - an average of nearly 7 days. Their death rate is nearly double. Why? Their immune systems weaken with age, and many already have COPD, heart failure, or diabetes. RSV doesn’t just cause pneumonia - it triggers heart attacks, strokes, and complete loss of mobility.

Three out of four older adults hospitalized with RSV see their existing heart or lung disease get dramatically worse. One in three needs intensive care. And after they leave the hospital, 42% can’t do basic tasks like bathing or dressing without help. Nearly one in three ends up in a nursing home - something they never needed before RSV hit.

How RSV Spreads - And How to Stop It

RSV is contagious before symptoms even appear. It spreads through droplets in the air when someone coughs or sneezes. But it also lives on surfaces - doorknobs, toys, phones - for up to 9 hours. You can get it by touching something infected, then touching your face.

Handwashing with soap for at least 20 seconds cuts transmission by 35 to 50%. Avoiding face-touching reduces risk even more. Clean high-touch surfaces daily with EPA-approved disinfectants - those labeled to kill RSV reduce surface spread by 85 to 95%.

Stay away from crowded places during RSV season (late fall to early spring). If you’re sick, wear a mask around babies and older adults. Don’t kiss infants if you have a cold. Grandparents and caregivers should wash hands before holding a baby, even if they feel fine.

The New Tools That Are Changing Everything

In 2023, two major breakthroughs arrived: a vaccine for older adults and a shot for babies.

For older adults: Two vaccines are now approved - GSK’s Arexvy and Pfizer’s Abrysvo. Arexvy is 82.6% effective at preventing severe lower respiratory disease. Abrysvo is 66.7% effective. Both are given as a single shot before RSV season. The CDC recommends them for adults 60 and older, especially those with heart or lung disease. Talk to your doctor - this isn’t just for the frail. Even healthy seniors benefit.

For babies: Before 2023, only high-risk infants got a monthly antibody shot called palivizumab during RSV season. Now, there’s nirsevimab (Beyfortus™), a single injection that protects for the entire season. It cuts the chance of hospitalization by 75%. The CDC now recommends it for ALL infants under 8 months entering their first RSV season. Babies 8 to 19 months with certain health conditions should also get it in their second season.

There’s another layer: pregnant women can now get Pfizer’s Abrysvo between 32 and 36 weeks. It passes protective antibodies to the baby before birth, offering up to 82% protection against severe RSV in the first 6 months of life.

What’s Still Missing - And Why It Matters

These tools are revolutionary - but only if they reach the people who need them. In the U.S., access is improving, but cost and awareness remain barriers. Arexvy costs $295 per dose. Nirsevimab is even more expensive. Many families don’t know their baby is eligible. Some doctors still don’t offer it.

Outside the U.S., the situation is dire. Low- and middle-income countries account for 97% of all RSV deaths in children. They have almost no access to vaccines, monoclonal antibodies, or oxygen therapy. Global health leaders estimate that if these tools were made affordable and widely available, we could prevent 400,000 to 600,000 hospitalizations a year by 2030 - and cut global RSV deaths by half.

What You Can Do Right Now

• If you’re pregnant: Ask your doctor about Abrysvo between weeks 32 and 36.
• If you have a baby under 8 months: Make sure they get nirsevimab before RSV season starts.
• If you’re 60+: Ask your doctor if you should get an RSV vaccine this fall.
• If you care for an infant or older adult: Wash your hands often. Clean surfaces daily. Stay home if you’re sick.
• If you’re healthy: Get vaccinated. You’re not just protecting yourself - you’re protecting the most vulnerable around you.

RSV is no longer a mystery. We know how it spreads. We know who’s most at risk. And we have the tools to stop it. The question isn’t whether we can prevent these deaths anymore. It’s whether we will.