RSV is typically mild in healthy adults, causing cold-like symptoms that resolve on their own. But for older adults and those with chronic health conditions, it can be genuinely dangerous. Each year in the United States, RSV is associated with 190,000 to 350,000 hospitalizations and 10,000 to 23,000 deaths, with the vast majority of those deaths occurring in adults 65 and older.
Who Faces the Greatest Risk
Age is the single biggest factor. Among RSV-related deaths tracked through national vital statistics, 82% occurred in adults 65 and older. Hospitalization rates climb steeply with age: adults 75 and older are hospitalized for RSV at rates comparable to infants, a group most people associate with RSV danger.
Beyond age, several underlying conditions make severe RSV illness more likely:
- Chronic heart disease such as heart failure or coronary artery disease
- Chronic lung disease including COPD, emphysema, asthma, or interstitial lung disease
- Weakened immune systems from medication or illness
- Kidney disease requiring dialysis or other replacement therapy
- Complicated diabetes with kidney, nerve, or eye damage
- Severe obesity with a BMI of 40 or higher
- Neurologic conditions that weaken the ability to cough or clear the airway
- Chronic liver disease such as cirrhosis
Living in a nursing home also raises your risk significantly, likely because of close quarters, shared air, and the general frailty of residents.
What RSV Looks Like in Adults
In healthy adults, RSV typically mimics a common cold: runny or stuffy nose, cough, low-grade fever, and decreased appetite. It lacks the body aches and intense fatigue that often come with the flu, and it doesn’t cause the loss of taste or smell, nausea, or diarrhea associated with COVID-19. Most healthy adults recover without ever knowing they had RSV rather than an ordinary cold.
The picture changes for high-risk adults. RSV can move from the upper airways into the lungs, causing pneumonia or bronchiolitis. Warning signs of a more serious infection include wheezing, a worsening cough, breathing faster than normal or struggling to breathe, and in severe cases, a bluish tint to the skin. RSV can also trigger flare-ups of existing conditions, particularly COPD, asthma, and heart failure, sometimes turning a manageable chronic illness into an emergency.
Heart and Lung Complications After Hospitalization
One of the less obvious dangers of RSV in adults is what happens in the weeks after infection. A large study found that the risk of serious cardiovascular events spikes dramatically in the first week after RSV hospitalization. The risk of heart attack was nearly 9 times higher than baseline during that first week. The risk of stroke was about 7 times higher. Heart failure flare-ups were more than 12 times as likely, and COPD exacerbations jumped by a factor of 23.
These risks drop quickly but don’t vanish right away. Heart attack and stroke risk remained significantly elevated for about two months after hospitalization. Heart failure flare-ups stayed elevated for nearly three months. This pattern means that even after someone leaves the hospital and feels better, the cardiovascular strain from the infection lingers.
Long-Term Loss of Independence
For older adults, the danger of RSV extends beyond the infection itself. Research from NewYork-Presbyterian found that 19% of older adults hospitalized with RSV needed a higher level of care at discharge than before they got sick, meaning they could no longer live as independently. Six months later, 37% of participants still had significantly reduced ability to perform daily activities like bathing, dressing, and moving around on their own. An RSV hospitalization, in other words, can permanently change an older person’s quality of life.
Testing and Diagnosis
If you’re a generally healthy adult with cold symptoms, your doctor probably won’t test you for RSV. There’s no specific treatment that would change the course of a mild infection, so knowing whether it’s RSV versus another cold virus doesn’t affect what you’d do. Testing becomes more useful for adults over 65 or those with weakened immune systems who develop moderate to severe symptoms, since identifying RSV can help guide hospital care and monitoring for complications. The most reliable test for adults is a PCR-based nasal swab, which is more sensitive than rapid tests because adults tend to carry lower amounts of the virus in their noses than children do.
RSV Vaccines for Adults
Three RSV vaccines are now available for adults 50 and older. The CDC recommends a single dose for all adults 75 and older and for adults 50 to 74 who have any of the high-risk conditions listed above. There is no preferred vaccine among the three options.
Unlike the flu shot, the RSV vaccine is not an annual vaccine. One dose is currently considered a complete vaccination. If you haven’t been vaccinated, you can get the shot at any time of year, but the best window is late summer or early fall (August through October in most of the continental U.S.) to build protection before RSV season peaks. The vaccine can be given at the same visit as your flu shot or other routine vaccinations.
For adults 18 to 49 with no chronic conditions, RSV rarely causes anything worse than a cold, and vaccination is not recommended. The real danger concentrates in older age groups and people whose hearts, lungs, or immune systems are already compromised.