RSV and older adults: what you should know

 RSV is often flagged as a risk for infants and
young children, but anyone can get RSV and adults 60 years and older are
vulnerable to serious effects from the virus.
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Respiratory Syncytial Virus, or RSV, is a seasonal respiratory virus that can severely impact older adults. Infection control measures and the arrival of expected vaccines to prevent RSV will make it easier than ever to stay healthy this fall and winter. Here’s what you need to know.

Although talk of viruses might be getting stale, Dr. Alan Kaplan, Chair of the Family Physician Airways Group of Canada, can attest to the impact of RSV after personally contracting the virus last December and taking months to recover.

“For months after, I had a lingering cough, and my exercise capacity and recovery weren’t what they used to be.” He wants to educate older Canadians about RSV, not to cause alarm, but because, “there are viruses that people may not be aware of. As a primary care practitioner, my job is not only to treat illness, but also to help prevent it.”

The peak season for getting RSV in Canada is typically from October until May, with most cases occurring in the winter months.1 RSV impacts the lungs and breathing passages2 and is spread by inhaling or coming into contact with respiratory droplets on contaminated surfaces.3,4 While RSV can start out mild, it can become a serious illness and is a major cause of hospitalization and death for older adults.5

Dr. Kaplan notes, “It can be very nonspecific at first, with slight congestion, a bit of a sore throat, and maybe a small fever. So, people may overlook the early signs of the virus and not pay much attention to it initially.”

Dr. Kaplan explains that RSV can cause damage to the airways, stripping the top layers of the lining of the lungs, leaving people breathless, coughing up mucus, and vulnerable to bacterial pneumonia.

RSV can be life-changing in terms of recovery, functionality and living independently.6,7  “About one third of people who are hospitalized with RSV never get back to how they functioned before the infection. Additionally, eight per cent are no longer able to live independently. This may not seem like a large number, but it’s certainly significant if it happens to you.”

RSV is often flagged as a risk for infants and young children, but anyone can get RSV and adults 60 years and older are vulnerable to serious effects from the virus. As we age, the immune system ages also, and it becomes less able to fight off illness, a phenomenon called “immunosenescence.” 8,9,10

As well, older adults are more likely to have other health conditions,11,12 which can exacerbate the impacts of the illness.13,14

Finally, Dr. Kaplan notes that age can increase the likelihood of inflammation when our body responds to an infection, an event called “cytokine release,” and inflammation can increase the risk of a heart attack in the 30-60 days after a viral infection. “So, it’s not just the infection that’s a risk, it’s also the immune response,” Dr. Kaplan sums up.

Who is at risk for severe complications from RSV?

adults aged 60+
those with lung diseases like COPD and asthma
those with underlying conditions like diabetes, congestive heart failure, kidney disease
the immunocompromised
those in communal living, such as long-term care or retirement residences, with ongoing exposure to viruses 15,16,17

While diagnostic tests for RSV exist, they are not widely available through family physicians and testing outside a hospital setting is uncommon. Dr. Kaplan thinks accessibility may well change, “Being able to do the nasal swabs and test to differentiate between virus types is going to make a difference down the road because of treatments we do have for influenza and COVID.”

The immunity that comes from RSV infection is short-lived,18 which means that a person can be infected by the virus again, even if they’ve already had it. The usual protective measures – washing hands, disinfecting surfaces, avoiding close contact with people who are ill – particularly during the fall or winter, can be helpful in preventing infection.

Vaccines for RSV are expected to be available this fall for older adults and Dr. Kaplan is positive about the recent innovations and what they might mean for the future. “It won’t be long before we are going to have the opportunity to vaccinate against this very important respiratory virus. Managing chronic illnesses, getting vaccinated, going for cancer screenings, eating well, and taking care of ourselves are all crucial steps to take for our longevity and overall health.”

1 Government of Canada. Respiratory syncytial virus (RSV): For health professionals; https://www.canada.ca/en/public-health/services/diseases/respiratory-syncytial-virus-rsv/health-professionals.html#Surveillance (accessed May 3, 2023).

2 Centers for Disease Control and Prevention. Disease of the Week: Respiratory syncytial virus (RSV); https://www.cdc.gov/dotw/rsv/index.html#:~:text=Respiratory%20syncytial%20virus%20(RSV)%20is,similar%20to%20the%20common%20cold (Accessed April 24, 2023).

3 Centers for Disease Control and Prevention. RSV Transmission; https://www.cdc.gov/rsv/about/transmission.html (Accessed April 24, 2023).

4 Meister TL, Dreismeier M, Vidal Blanco E, et al. Low risk of severe acute respiratory syndrome coronavirus 2 transmission by fomites: a clinical observational study in highly infectious coronavirus disease 2019 patients. J Infect Dis 2022;226(9):1608-1615.

5 RSV in Older Adults and Adults with Chronic Medical Conditions | CDC

6 Branche A et al. Influenza Other Respi Viruses 2022;16:1151–1160

7 Curran D et al. Influenza Other Respir Viruses 2022;16:462–473

8 MedlinePlus. Aging changes in immunity; https://medlineplus.gov/ency/article/004008.htm (Accessed April 24, 2023).

9 Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci 2015;282:20143085.

10 Weiskopf D, Weinberger B, Grubeck-Loebenstein B. The aging of the immune system. Transpl Int 2009;22:1041–1050.

11 Divo MJ, Martinez C, Mannino D. Aging and the epidemiology of multimorbidity. Eur Respir 2014; 44(4) 1055-1068.

12 Aging and chronic diseases: A profile of Canadian seniors. PHAC. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/aging-chronic-diseases-profile-canadian-seniors-report.html#a3 Accessed: May, 2023.​

13 Centers for Disease Control and Prevention. RSV Transmission; https://www.cdc.gov/rsv/about/transmission.html (Accessed April 24, 2023).

14 Centers for Disease Control and Prevention. RSV in Older Adults and Adults with Chronic Medical Conditions; https://www.cdc.gov/rsv/high-risk/older-adults.html (Accessed April 24, 2023).

15 Hamilton MA, Liu Y, Calzavara A, et al. Predictors of all-cause mortality among patients hospitalized with influenza, respiratory syncytial virus, or SARS-CoV-2. Influenza Other Respir Viruses. 2022;16(6):1072-1081. doi:10.1111/irv.13004

16 Childs A, Zullo AR, Joyce NR, et al. The burden of respiratory infections among older adults in long-term care: a systematic review. BMC Geriatr. 2019;19(1):1-10. doi:10.1186/s12877-019-1236-6

17 Falsey AR, Treanor JJ, Betts RF, Walsh EE. Viral respiratory infections in the institutionalized elderly: clinical and epidemiologic findings. J am Geriatr Soc. 1992;40(2):115-119. doi:10.1111/j.1532-5415.1992.tb01929.x

18 Openshaw PJM, Chiu C, Culley FJ, et al. Protective and Harmful Immunity to RSV Infection. Annu Rev Immunol 2017;35:501–532.

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