RSV Infections: What Parents and Caregivers Need to Know About Risks and Prevention

Every winter, something quiet and dangerous moves through homes, daycares, and nursing homes. It starts with a runny nose, a cough, maybe a fever. For most adults, it’s just a cold. But for infants and older adults, it can turn deadly. That something is RSV-Respiratory Syncytial Virus. It’s not new, but in 2025, we finally have real tools to fight it. If you’re caring for a baby under 1, a grandparent over 65, or someone with a weak heart or lungs, you need to know what RSV does, who it hits hardest, and how to stop it.

What RSV Really Does to the Body

RSV doesn’t just give you a stuffy nose. It attacks the small airways in the lungs, especially in young children and older adults. In babies, it causes bronchiolitis-inflammation of the tiniest breathing tubes. In older people, it can trigger pneumonia or make heart failure worse. The virus spreads easily: through coughs, sneezes, or touching a doorknob that an infected person just touched. It can live on surfaces for nearly 10 hours.

Symptoms usually show up 4 to 7 days after exposure. First, it’s like a regular cold: runny nose (78% of cases), sore throat, fever. But in high-risk groups, it quickly turns serious. Rapid breathing, wheezing, chest retractions (when the skin pulls in around the ribs), and trouble feeding in babies are red flags. In older adults, confusion, dizziness, or sudden worsening of heart or lung conditions can mean RSV is taking over.

Why Infants Are Most at Risk

RSV is the #1 cause of hospitalization for babies under 1 year old. About 2 to 3% of all infants under 6 months end up in the hospital each year. That’s tens of thousands in the U.S. alone. Premature babies, especially those born before 29 weeks, are 3 to 5 times more likely to need intensive care. Babies with heart defects or chronic lung disease face even higher risks-up to 25 times more likely to get severely ill.

Why? Their airways are tiny. Even a little swelling blocks airflow. Their immune systems haven’t learned to fight this virus yet. And they can’t clear mucus the way older kids or adults can. A baby with RSV might breathe 60 times a minute-normal is 40. They’ll look tired, refuse to eat, and their lips or fingernails might turn blue. That’s not a cold. That’s an emergency.

And the damage doesn’t always end when they leave the hospital. Kids who had severe RSV before age 2 are over four times more likely to develop asthma by age 7. Their lungs never fully catch up. Studies show their lung function stays 8-12% lower than peers into their teens.

The Silent Threat to Older Adults

For years, RSV was seen as a “kids’ virus.” That changed in 2023. Now we know it kills 6,000 to 14,000 adults over 65 every year in the U.S.-more than the flu in some seasons. People with COPD are 4 times more likely to be hospitalized. Those with heart failure face nearly 3 times the risk.

Why are older adults so vulnerable? Their immune systems weaken with age. They don’t fight off the virus as well. And if they already have a weak heart or lungs, RSV pushes them past the edge. About 78% of hospitalized older adults with RSV see their existing condition get worse. One in three ends up in the ICU. And recovery? It’s not just about healing the lungs. Nearly half of those hospitalized develop new problems-like being unable to bathe or dress themselves. One in four needs to go to a rehab center after leaving the hospital.

And the risk keeps climbing with age. People over 75 stay in the hospital nearly 3 times longer than younger adults. Their death rate is almost double. RSV doesn’t just cause illness in older adults-it accelerates decline.

How RSV Spreads-And How to Stop It

RSV doesn’t need a pandemic to spread. It’s in every household, every daycare, every nursing home. One sick child can infect a whole family in days. The virus travels through droplets from coughs and sneezes (65% of cases), direct contact like kissing a sick child (25%), and surfaces (9.8 hours on stainless steel).

Simple steps cut transmission dramatically:

• Wash hands with soap for at least 20 seconds-before feeding a baby, after changing a diaper, before touching an older adult. This reduces spread by 35-50%.
• Avoid touching your face. Your eyes, nose, and mouth are the virus’s front door.
• Disinfect high-touch surfaces daily: doorknobs, light switches, toys, phones. EPA-approved cleaners kill RSV on contact and reduce surface spread by 85-95%.
• Keep sick people away from babies and older adults-even if they just have a sniffle.
• Wear a mask around high-risk people if you’re sick, even if it’s just a cold.

These aren’t just suggestions. They’re lifesavers.

The New Tools: Vaccines and Antibodies

2023 was the year everything changed. For the first time ever, we have real protection.

For babies: Nirsevimab (Beyfortus™) is a single shot given before or during RSV season. It’s not a vaccine-it’s a lab-made antibody that gives immediate, temporary protection. It cuts the risk of hospitalization by 75% for the first 5 months of life. The CDC now recommends it for all infants under 8 months entering their first RSV season. High-risk kids between 8 and 19 months get it too.

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 one shot. The CDC says adults 60+ should talk to their doctor about getting vaccinated, especially if they have heart or lung disease, live in a nursing home, or have other health issues.

For pregnant people: Abrysvo is also approved to be given between 32 and 36 weeks of pregnancy. It passes protective antibodies to the baby before birth, offering up to 82% protection against severe RSV in the first 6 months of life.

These tools are powerful. But access isn’t equal. In the U.S., they’re available in clinics and pharmacies. In low-income countries, they’re almost impossible to get. The cost of one dose of Arexvy is $295. For a family in rural Kenya or Papua New Guinea, that’s months of income. That’s why 97% of RSV deaths in children happen outside wealthy nations.

What to Do Right Now

If you have a baby under 1 or an older adult in your care, here’s your action list:

1. Check if your infant is eligible for nirsevimab. Ask your pediatrician-even if your baby was born healthy.
2. Ask your doctor or pharmacist about RSV vaccines for adults 60+. Don’t wait for symptoms.
3. Start washing hands like your life depends on it-because it does.
4. Disinfect surfaces daily, especially in shared spaces.
5. Know the warning signs: rapid breathing, flaring nostrils, chest pulling in, blue lips, refusal to eat, extreme lethargy. Call 999 or go to A&E immediately if you see these.

RSV isn’t going away. But it doesn’t have to be a death sentence anymore. We have the tools. We just need to use them.

Long-Term Effects You Can’t Ignore

RSV doesn’t just cause illness-it changes lives. Children who survived severe RSV as babies are more likely to have asthma, need inhalers, and miss school. Their lungs are permanently altered. In older adults, a single RSV hospitalization can trigger a downward spiral: loss of independence, need for home care, or even nursing home placement.

One study found that 42% of adults over 65 hospitalized with RSV couldn’t do basic tasks like bathing or dressing 30 days after discharge. That’s not recovery-that’s a new reality.

That’s why prevention isn’t just about avoiding a cold. It’s about protecting someone’s ability to live well.

What’s Next for RSV?

Research is moving fast. New antivirals like ALS-8176 are showing promise in early trials-reducing viral load by 97%. Maternal vaccination is already saving babies before they’re born. Global efforts are pushing to make vaccines and antibodies affordable in low-income countries. If we get this right, we could prevent half a million hospitalizations a year by 2030.

But progress means nothing without access. Until every baby, everywhere, can get protected-RSV will remain a silent killer.