Update on RSV: The Virus, Vaccines for Older Adults & Antibodies for Kids
Your guide to the 2023-2024 RSV season
Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
Q: What is RSV?
A: Respiratory syncytial virus (or “RSV”) is an RNA virus that causes cold-like symptoms in most people. Other symptoms that can include fever, cough, shortness of breath and wheezing. Severe infections can lead to bronchiolitis (inflamed airways clogged with mucus) and pneumonia.
Q: When does RSV season start?
A: In the U.S., RSV season usually starts in the fall, peaks in the winter months (usually December to February), and tapers off in the spring. However, the timing and intensity of the RSV season can vary by year and region.
Q: Who is at highest risk for RSV?
A: Primarily infants, young children and older adults. The CDC reports that every year in the U.S., RSV infections cause up to 160,000 hospitalizations and 10,000 deaths among adults 65 and older. In some seasons, RSV is associated with more deaths than influenza. RSV results in 58,000-80,000 hospitalizations among children younger than 5 years old and claims the lives of 100 to 300 children younger than 5 annually. About 80 percent of pediatric hospitalizations occur in children less than 6 months of age who were otherwise healthy.
Q: How does RSV spread?
A: It spreads predominantly person-to-person and in the air. It is more likely to spread in crowded, indoor environments with poor ventilation.
Q: What’s the deal with the new RSV vaccines?
A: The CDC recently recommended that anyone 60 and older consider the newly approved vaccines against RSV. Both vaccines—Arexvy from GSK and Abrysvo from Pfizer—appear to be highly effective. GSK’s vaccine is 88 percent effective against RSV infection that is serious enough to require medical attention; Pfizer’s is 85 percent. This high effectiveness implies that the vaccines are probably effective in reducing transmission, too.
Q: What about the RSV vaccine for babies, toddlers, and pregnant women?
A: The FDA recently approved an RSV vaccine for pregnant women to help protect infants. This is great news.
We are still waiting for guidance on the RSV vaccine for babies and toddlers. But, exciting news: earlier this month, the CDC approved an antibody injection (called “Beyfortus”) for babies and toddlers that is approximately 80 percent effective at preventing hospitalizations and 90 percent effective at preventing intensive care unit admissions. It is not a vaccine (i.e., it doesn’t prompt the body to produce antibodies); it is a one-time intramuscular injection of synthetic antibodies. It is recommended for all infants under 8 months and for high-risk babies 8-19 months old. It can be administered at the same time as other vaccines. My favorite expert on vaccines,, wrote a great piece about it here.
How important is it to get the RSV vaccine?
It is more important if you are in a high-risk category (i.e., infants, young children and older adults). There are two reasons to get the RSV vaccine: 1) to reduce the chance of severe disease and 2) to reduce the likelihood of transmitting the virus to other people.
Which RSV vaccine should I get?
The two shots are thought to be comparable in effectiveness, so I’d get whatever shot you can get your hands on.
When should I get the RSV vaccine?
The RSV vaccine appears to have good durability, lasting at least eight months. RSV typically surges in late fall and winter, but it could begin as early as the end of August (as it did last year). Therefore I suggest that eligible adults consider getting the RSV shot now.
What are the downsides of getting the RSV vaccine?
In the studies, some participants had extremely rare inflammatory neurological conditions such as Guillain-Barré syndrome. Note that these conditions are also associated with the virus itself. Once more people have had the RSV vaccine, we will know a lot more about potential safety signals.
Q: Are there medicines available to treat RSV?
There is no targeted treatment for RSV, however the FDA recently approved a monoclonal antibody to help prevent RSV in babies. (See above.)
In general, we treat respiratory viruses with rest, aggressive hydration (with Pedialyte, for example), Ibuprofen or Acetaminophen for fever and aches, and, of course, time.
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