When we hear the phrase highly contagious respiratory virus, we may think instinctively of the coronavirus, in light of the recent COVID-19 pandemic. But Respiratory Syncytial Virus (RSV; where Syncytial is pronounced sin-SI-shull) has been around for many more decades, first isolated in 1955 from chimpanzees with respiratory illness.¹

RSV is the leading cause of lower respiratory tract infections in children under 2 years old. However, it can also be present in adults (more commonly in the upper respiratory system).²  Evidence suggests that psychological stress can increase the risk of developing acute respiratory illness, through adversely altering the immune system.³ In this article, we will explore the potential mechanisms by which this happens and what could be done to reduce the risk.

What is RSV?

RSV is a contagious virus that typically causes mild cold-like symptoms and spreads through droplets from sneezes or coughs.⁴ It can lead to more acute lower respiratory system infections, such as bronchiolitis and pneumonia. 

Almost all children will have contracted an RSV-related infection by the age of 2, with some developing more serious symptoms and requiring hospital admission.² Worldwide, it is a leading cause of death, particularly in low- and middle-income countries.²

Common symptoms of typical RSV infections include

•   Shortness of breath
•   Coughing
•   Wheezing
•   Runny nose
•   Fatigue
•   Fever

Those at highest risk of developing more severe RSV infections include:⁴

• Children: born prematurely; under 2 years of age; with chronic lung or heart diseases
• Adults: with chronic lung or heart diseases; over the age of 65
• Populations who are immunocompromised 

The economic burden of RSV infections on healthcare systems worldwide is substantial.⁵ It is estimated that of the adults tested for RSV, 33% of them have an undetected RSV infection.⁵ During the COVID-19 pandemic, rates fell as people adhered to national public health guidelines for infection control. However, since then, rates of hospitalisation for RSV have increased in older adult populations.⁵ The pattern of RSV infections has changed since COVID-19 also: in the US before the COVID-19 pandemic, RSV infections occurred primarily between October to March and peaked in December; but from 2022-23, infections occurred from June to January and peaked in November.⁵

How can stress increase our risk?

Psychological stress may impact the immune system, via the nerves that innervate the lymphatic tissue.³ Stress may also mediate immune cells through a hormone-related response.³ These immune system changes are unclear and the evidence base is still growing. 

Additionally, there is a further discussion that stress may detrimentally alter behaviours, weakening the immune system and making one more susceptible to catching a bug. For example, coping behaviours induced by stressful life events, such as alcohol consumption, substance misuse, and smoking, have detrimental impacts on the body.³  

Chronic stress can also impact sleep, and a poor night’s sleep can detrimentally affect the immune system, leading to disease vulnerability.⁶ In addition, chronic stress can lead to the activation of latent viruses, which further weaken the immune system and increase the likelihood of contracting other illnesses.⁶

It is unclear which factors determine susceptibility to RSV in adults; additional study is needed. The exact relationships between stress and susceptibility to respiratory illness, let alone specifically to catching the RSV, are even less clear. Some evidence does show a relationship between psychological stress and increased risk of acute infectious respiratory illness. However, the results were largely inconsistent and required further research.³

A challenging situation can cause stress; it can also be a physiological or psychological response to a circumstance. What is known is that stress can cause dysregulation of the immune system, with the level and duration of stress impacting the outcome. 

Short-term acute stress prepares the body for ‘fight or flight’. It increases pro-inflammatory cytokines in the bloodstream (signalling molecules secreted by immune cells). ⁷ Chronic, long-term stress where these molecules are circulating longer can lead to other detrimental health effects that wear away at the immune system and lead to chronic disease. 

Chronic or exaggerated stress responses can dysregulate the immune system and lead to latent virus activation.⁷ Studies have found that those who have experienced early life adversity (such as abuse, maltreatment, and bullying) are more likely to have a heightened immune response to stress and higher rates of latent virus activation.⁷ Psychological stressors, such as assuming a caregiving role, have also been found to cause inappropriate immune responses that lead to higher rates of latent virus reactivation.⁷

Although the exact link between stress, the immune system, and RSV is not understood, evidence shows that psychological distress dysregulates the immune system, leading to inflammation and impairing our defences to new and latent viruses. However, much more targeted research is needed. 

FAQs

Why do many adults get RSV?

Our immune system weakens with age, making us more susceptible to viral infections like RSV. In addition, adults with pre-existing medical conditions related to the heart or lungs, increase susceptibility to catching RSV and experiencing illness.

How can I prevent myself from getting RSV?

It is essential to maintain a healthy lifestyle to ward off illness and stay fit. To prevent RSV, wash your hands often with warm soapy water for at least 20 seconds (or use a hand sanitiser), clean surfaces touched by multiple people frequently, and avoid close contact with anyone who has contracted the RSV infection.  

Reduce psychological stress by being mindful, meditating, connecting with others, avoiding unhealthy habits, and sleeping well. 

How does stress influence susceptibility to infection?

Stress causes the body to enter ‘fight or flight’ and increases the number of inflammatory markers in the bloodstream (known as pro-inflammatory cytokines). When out of homeostasis, these proteins can suppress the immune response, making you more vulnerable to catching an infection.

What are the first symptoms of RSV?

The initial symptoms of an RSV infection are similar to those experienced with the common cold. These include cough, runny nose, and sometimes a fever. Babies may seem tired or easily irritated, or have trouble breathing if they have RSV. Wheezing occurs in those with RSV, compared to other respiratory viruses.

Can RSV cause stress and anxiety?

RSV can cross the blood-brain barrier and infect the brain and nervous system. It leads to inflammation and widespread damage, and this uncontrolled immune response is detrimental to severe infections. It can lead to psychiatric conditions such as anxiety. Further research is needed in this area and is currently ongoing.

When should I seek help?

If you have any pre-existing conditions that may put you or someone you know at risk of a severe RSV infection (such as chronic lung or heart disease, or a weakened immune system; infants under 12 months), seek immediate medical attention if you have any difficulty breathing, a high fever, or blue colouration of your skin, lips or nails.

Summary

RSV is a highly contagious virus that leads to respiratory infections. It typically presents before the age of 2 and can lead to severe illnesses like bronchiolitis and pneumonia. Stress is known to weaken the immune system through various mechanisms. However, the exact role of stress in susceptibility to RSV is unclear and warrants further investigation.