RSV, or respiratory syncytial virus, is a common respiratory infection that most adults experience as a bad cold. But for older adults and those with chronic health conditions, it can turn serious. During the 2024–2025 season, RSV caused an estimated 190,000 to 350,000 hospitalizations in the United States, and over 80% of recorded RSV deaths occurred in adults 65 and older.
How RSV Feels in Adults
Most adults who catch RSV develop mild, cold-like symptoms: a runny nose, sore throat, cough, and headache. For otherwise healthy people, the illness runs its course like any other upper respiratory infection, and you may not even realize you had RSV rather than a regular cold. There’s no distinctive symptom that separates a mild RSV case from other viruses by feel alone.
The concern starts when symptoms move deeper into the lungs. RSV can progress from the upper airways into the lower respiratory tract, causing pneumonia or inflammation of the small airways (bronchiolitis). When that happens, you may notice worsening cough, wheezing, shortness of breath, or difficulty breathing. Symptoms can also last longer than a typical cold, stretching beyond the one-to-two-week window most people expect.
Who Faces the Highest Risk
Age is the single biggest risk factor. Hospitalization rates climb sharply after 75, reaching levels comparable to those seen in infants. But age alone doesn’t tell the whole story. Specific underlying conditions substantially raise the odds of a severe outcome.
Chronic lung conditions top the list: COPD, emphysema, severe asthma, bronchiectasis, and cystic fibrosis all make the lungs more vulnerable to RSV’s effects. Heart disease is the other major category, including congestive heart failure, coronary artery disease, and congenital heart disease. RSV doesn’t just worsen these conditions temporarily. It can trigger acute flare-ups, turning stable COPD or heart failure into a medical emergency.
Adults 50 and older with any of these conditions are considered at increased risk, though clinicians may also flag other conditions that compromise lung or immune function on a case-by-case basis.
Cardiovascular Complications
One of the less obvious dangers of RSV in older adults is what it does to the heart. A large cohort study of adults 45 and older found that RSV infection carries a significant excess risk of cardiovascular events over the following year, comparable to the cardiac risk seen after influenza. That means heart attacks, strokes, and heart failure episodes can spike well after the respiratory symptoms have cleared. If you have existing heart disease, RSV isn’t just a lung problem.
How RSV Spreads
RSV spreads through respiratory droplets when an infected person coughs or sneezes, and through direct contact with contaminated surfaces. The virus can survive for many hours on hard surfaces like tables and countertops. On softer surfaces, including hands and tissues, it survives for shorter periods, but still long enough for hand-to-face transmission.
This makes basic hygiene your most practical defense outside of vaccination: frequent handwashing, avoiding touching your face, and cleaning commonly touched surfaces during RSV season (typically fall through spring).
How RSV Is Diagnosed
If your symptoms are mild, you probably won’t be tested for RSV. Testing matters more when symptoms are severe enough to affect treatment decisions, particularly in hospitalized patients or those at high risk.
The most reliable tests use molecular detection (PCR-based methods), which have sensitivity ranging from about 63% to 100% in adult populations and specificity above 98%. Rapid antigen tests exist and return results faster, but their sensitivity is more variable, dropping as low as 26% in some studies. That means a negative rapid test doesn’t necessarily rule RSV out. Notably, very few studies have focused specifically on RSV testing in adults, so most diagnostic data comes from pediatric populations where the virus is more frequently tested for.
Treatment and Recovery
There is no antiviral medication routinely used to treat RSV in adults. Treatment is supportive, meaning it focuses on managing symptoms while your body fights off the virus.
For mild cases at home, that looks like staying hydrated (warm soups and broths can help loosen thickened mucus), using saline nasal drops for congestion, and taking over-the-counter pain relievers like acetaminophen to reduce fever and soothe a sore throat. Avoiding cigarette smoke is particularly important, as it irritates already-inflamed airways.
Inhalers and steroids, which many people assume would help with wheezing, have not been proved effective for RSV specifically. If a bacterial infection develops on top of RSV, such as bacterial pneumonia, antibiotics may be prescribed for that secondary infection, not for RSV itself.
Hospitalization is necessary in more severe cases. In-hospital care typically involves IV fluids to prevent dehydration, humidified oxygen to support breathing, and in rare cases, mechanical ventilation. Recovery from a severe RSV infection can take weeks, and for people with underlying lung or heart disease, baseline function may not fully return for some time.
RSV Vaccines for Adults
Three RSV vaccines are now FDA-licensed and recommended for adults 50 and older. This is a relatively new development: the first adult RSV vaccines were approved in 2023, and real-world effectiveness data from the first full season of use is now available.
GSK’s Arexvy showed approximately 83% effectiveness at preventing RSV-related hospitalizations and 77% effectiveness against emergency department visits in adults 60 and older during the 2023–2024 season. Pfizer’s Abrysvo performed similarly, with about 73% effectiveness against hospitalization and 79% against emergency department encounters in the same age group.
Moderna’s mResvia, which uses mRNA technology, showed roughly 80% efficacy against symptomatic RSV in the first four months after vaccination in clinical trials. That protection declined to 56% at 12 months and 34% at 18 months, raising questions about durability and whether booster doses may eventually be part of the picture.
All three vaccines are given as a single dose. Unlike the annual flu shot, RSV vaccination is not yet positioned as a yearly routine for most people. Your age, health conditions, and the timing of RSV season all factor into whether and when vaccination makes sense for you.
Why RSV Gets Overlooked in Adults
RSV has long been treated as a childhood illness, and most public health messaging has focused on infants. But the burden in older adults is substantial. Of 672 RSV-associated deaths tracked through national vital statistics during the 2024–2025 season, 552 were in adults 65 and older. Only 31 were in children and adolescents. Adults aged 75 and up had the second-highest hospitalization rate of any age group, trailing only infants under 12 months.
Part of the reason RSV flies under the radar in adults is that it’s rarely tested for. When an older adult is hospitalized with pneumonia or a COPD exacerbation, the underlying RSV infection may never be identified. The availability of vaccines has begun to shift that awareness, but RSV remains far less recognized than flu as a serious threat to older adults, despite causing outcomes that are comparable in severity.