Respiratory Syncytial Virus (RSV) is a common virus that affects the lungs and respiratory tract, it tends to be mild and present with cold-like symptoms. Whilst RSV can affect anybody, it is most common in childhood; with most children having been infected by the age of 2; in older children and adults the symptoms are often mild. The most at-risk groups from severe RSV complications are the extremely young (under 12 months), the elderly (over 60 years of age), those with lung or heart diseases can be at greater risk also, and people with a weakened immune system.¹

As with most viruses that affect the respiratory system, RSV can be more of an issue for the elderly. It can compound existing issues (asthma, COPD), and our immune systems often weaken as we age. It has been reported that the cases of RSV increase in people over 70 years old, however, this infection has been under-reported because it is not always considered a cause of hospitalisation in the elderly. Currently, detection methods, such as polymerase chain reaction (PCR), are more used. Therefore, the cases detected are more than before, making it possible to estimate the mortality of this infection in people up to 65 years old between 6% to 8% of the cases. Although the detection has improved, it is important to continue trying to prevent new cases of RSV. In this article, we will analyse the characteristics of RSV and its impact on the elderly.^1,2    

Causes of RSV

RSV is spread like any other respiratory infection through coughs and sneezes, the virus travels in liquid droplets that can then infect others, entering the body through the nose, mouth and eyes. The first infection, for most people, occurs before the age of 2, but infections can recur several times throughout your life. Those infected with RSV are most contagious during the first week of infection.¹ 

Prevention

Prevention strategies are similar to that of any respiratory infection such as the flu, this involves:

• Avoiding contact with infected persons
• Washing hands thoroughly
• Cleaning surfaces
• Isolating yourself when sick

These approaches can help to ensure that the spread of RSV does not occur in the hope of preventing infection.RSV vaccination is a viable option for those over 60 years of age, this can help as those of advanced age are at a greater risk of infection. Presently, different vaccines are being developed with the aim of having a successful prevention of this disease.³  

Symptoms of RSV

The symptoms in adults and older children are often similar to those of a mild cold, these include:²

• Mild fever
• Dry cough
• Sore throat
• Sneezing
• Headache
• Congested or runny nose

In severe cases; that can lead to hospitalisation, symptoms can be:^2,4

• Fever
• Severe cough
• Wheezing
• Rapid, difficult breathing
• Bluish colour (due to lack of oxygen)

In severe cases, RSV can further affect the respiratory system; causing further problems, such as pneumonia (infection of the lungs) or bronchiolitis (inflammation of air passages into the lungs). This is particularly for those most at risk; the very young, the elderly and those with existing conditions (asthma, COPD etc.).^1,4

RSV Diagnosis

RSV can be diagnosed by testing with methods like PCR. However, it is not usually necessary, as RSV rarely requires doctor visits or hospitalisation. Therefore, testing does not occur and so, RSV is not then officially diagnosed. This can be a big issue with the diagnosis of RSV in adults, additionally, testing for RSV in adults is insensitive compared to children.^2,4  

RSV has an incidence of 6-15% annually in the UK. This may not be representative of actual figures due to the lack of testing that occurs, particularly when there are very mild symptoms. The symptoms being non-specific means that people could confuse their RSV infection with the common cold or influenza.⁴

In the UK, those who are over the age of 65 are estimated to account for nearly 80% of hospitalisations and 93% of deaths from RSV. This proportion of deaths and hospitalisations shows that RSV is particularly dangerous in elderly populations; due in large part to their naturally weakened immune system due to ageing.^4,5

Treating RSV in the Elderly

In less severe cases of RSV, the treatment can be managed at home, in the same way as a common cold, with fluids and rest. In the elderly, there is a greater chance of more severe reactions and symptoms occurring, due to the weakened immune system that occurs as people age. For those that suffer from other respiratory illnesses, they should continue with their previously prescribed medicine.^2,5

More severe symptoms and reactions may require hospitalisation if difficulties breathing increase. Oxygen therapy and IV fluids would be used in the hope of combatting the infection, and antibiotics may be used to treat or prevent a secondary bacterial infection, such as bacterial pneumonia.^2,5

To prevent future RSV infections in those over the age of 60, or in those at risk of potential severe reactions, there is the option of vaccines. Vaccines can be used to protect the elderly from issues that may arise from infection at an advanced age; with a weakened immune system, this is important due to a greater risk of hospitalisation or death from RSV infection compared to other groups.^2,3

Summary

Respiratory Syncytial Virus (RSV) is a respiratory infection that is quite common; particularly in young children, that tends to present with mild cold-like symptoms. In childhood, most children have been infected by the age of 2, complications are most likely to occur in children under 18 months, and in adults over 60 years of age. These groups are most at risk as they are the most vulnerable due to lesser immune systems, and so, they are more likely to be infected and suffer more severe symptoms.

Symptoms are similar to the symptoms of a cold, or flu in severe cases, in very severe cases, RSV can cause pneumonia or bronchiolitis (inflammation of the air passages that enter the lungs). Hospitalisation may be necessary in the most severe cases, this is most likely to occur in the elderly; as they are most likely to be hospitalised, or die as a result of RSV complications.

Treatment of RSV is similar to that of a common cold: fluids and rest are key. Due to treatment generally occurring at home, and the lack of testing in adults, RSV tends to be underdiagnosed;t Vaccines can be given to elderly adults to help protect and prevent RSV infection, as well as reduce the chance of severe complications occurring as a result of infection. The elderly are at a greater risk of more severe complications from RSV, this is due in large part to naturally weakened immune systems that occur because of advanced age.