Although you're probably hearing about it more often these days, respiratory syncytial virus (RSV) isn’t new — in fact, before 2020, most children caught this virus at least once before their second birthday.[1]
But after the RSV infection rate plummeted at the start of the COVID-19 pandemic, cases are surging in 2022, resulting in an increase in ER visits and hospitalizations in the U.S.[2] Here’s what parents should know about the recent rise in RSV infections, including how to keep your little one safe.
What is behind the current RSV surge?
No one knows for sure why the RSV season began a little early this year (it usually starts circulating between October and April), but there are a few theories.
One guess: There were fewer cases of RSV during the 2020 pandemic — likely in part due to quarantining, masking and social distancing — but the virus came roaring back once COVID-19 safety protocols were relaxed, says Gina Posner, M.D., F.A.A.P., a pediatrician at MemorialCare Medical Group in Fountain Valley, California and member of the What to Expect Medical Review Board.
Another theory is that because so few people were exposed to RSV during 2020 and 2021, more children are catching the virus now for the first time.
“For the last two years, children didn’t get infected with the virus as much,” says Micah Resnick, M.D., a pediatrician with TriHealth in Cincinnati, Ohio and member of the What to Expect Medical Review Board. “So kids over the age of 2 who would have been exposed to RSV [in the past] are now getting sick, while children under the age of 2 are getting sick at the same time.”
How can you tell the difference between RSV, the flu, the common cold and COVID-19?
Some of the symptoms of RSV can overlap with those of other illness, such as the flu, the common cold and COVID-19. Overlapping symptoms can include:
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- Fever (temperature of 100.4 degrees Fahrenheit or higher)
- Cough
- Congestion
- Runny nose
- Sneezing
- Fussiness
- Poor feeding
As a general rule, however, babies tend to become more congested when they have RSV, and therefore might have more difficulty breathing.
RSV replicates in the respiratory tract, which eventually triggers a lot of mucus production, says Dr. Resnick. All that mucus can then linger in the lower airways, called the bronchioles,[3] where it can cause an infection called bronchiolitis. Some symptoms of bronchiolitis include:
- Fast breathing
- Flaring of the nostrils
- Head bobbing with breathing
- Grunting during breathing
- Wheezing
- Belly breathing
- Tugging between the ribs
“With RSV, you tend to have fast, labored breathing, even in kids who don’t have a history of asthma or [breathing] diseases,” says Dr. Resnick.
Are the signs of RSV different in babies and toddlers?
Some symptoms of RSV, like congestion, coughing and a runny nose, can be more severe in babies than toddlers.[4]
Babies can also have a harder time breathing than toddlers, in part because they “can’t really generate as much force to clear mucus from their lungs,” says Dr. Resnick.
If your baby is having a difficult time breathing, his rib cage may look as if it’s caving in or forming an upside-down “V” under the neck. If you think that your baby is struggling to breathe, call your pediatrician or go to the emergency room right away.
Can you get RSV multiple times?
Yes — most children will get at least one RSV infection before their second birthday, according to the Centers for Disease Control and Prevention (CDC), and you can catch it more than once throughout your lifetime.
It’s even possible to catch RSV more than once during a single season, according to the American Academy of Pediatrics (AAP). The good news is that later infections tend to be less severe than the first one.
Can adults get RSV?
You can catch RSV at any age. Most people recover from RSV in a week or two, but babies and older adults can have a higher risk for severe RSV infections like bronchiolitis than younger adults.
What should you do if your older child gets RSV and you have a newborn in the house?
If your older child gets RSV, it’s a good idea to try to keep him away from your newborn as much as possible until he’s recovered. Most people with the virus will be contagious for about three to eight days, according to the AAP.
“You don’t necessarily have to quarantine and disrupt your life that much, but you should try to have your older child follow the same infection control practices that we’ve been following throughout the pandemic,” says Dr. Resnick.
That includes frequent hand washing, especially after coming home from school or day care, wearing a mask and regularly wiping down frequently touched objects, like toys and door knobs. RSV can survive for at least 30 minutes on a person’s hands, and for up to six hours on surfaces, according to the AAP.
That said, some babies and children — including preemies and those with certain heart or lung diseases — are more at risk for a severe RSV infection than others. If that’s the case for your child, ask your doctor if you should take more serious steps like quarantining.
Is there a vaccine for RSV?
There isn't currently a vaccine available for RSV, but there are a few in development, including one from GSK[5] and another from Pfizer.[6]
There’s also an injection called Synagis (palivizumab)[7] that can help prevent severe RSV in babies under the age of 24 months who are at high risk for the infection, including babies born prematurely or those with certain heart or lung conditions, says Dr. Posner.
The shot, which is usually given once a month during RSV season, helps slow the spread of the virus in the body, though it doesn’t treat the symptoms of RSV once a baby has the infection.
When should you bring your baby to the doctor if you suspect RSV?
Most babies and toddlers will make a full recovery from RSV. While the symptoms usually peak on the third, fourth and fifth day of the infection, there are times when your child shouldn’t wait out the illness. Call your doctor right away if:
- His symptoms don’t improve (or start to worsen) after seven days
- Your baby is younger than 12 weeks old and has a fever of 100.4 degrees Fahrenheit or higher
- He has a fever of 104 degrees Fahrenheit or higher
- He seems unusually fussy, isn’t sleeping well, has chest pain, or is tugging on his ear or having ear drainage
- He’s showing signs of dehydration (fewer than one wet diaper every 8 hours)
- He is having difficulty breathing
- His tongue, lips or skin look gray or bluish
- He’s significantly less alert and active than usual
Your doctor will likely diagnose your child with RSV based on her symptoms and a physical examination.
Almost all children will recover from an RSV infection on their own, but some little ones — approximately 3 percent — will need to be hospitalized and receive breathing help or an IV line for fluids for two to three days.
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