Everything You Need to Know About the 2022-2023 RSV Season

The respiratory syncytial virus (RSV) emerges each fall, causing cold and flu symptoms. Although healthcare workers are most familiar with this illness in children and the elderly, it can affect all age groups. 

The virus infects the lungs and breathing passages. In rare cases, it leads to serious complications including apnea, acute respiratory failure, and even death. Because this respiratory virus circulates at the same time of year as many other seasonal illnesses, it has been called a “hidden annual epidemic.”

According to the Centers for Disease Control and Prevention (CDC), healthcare providers need to consider RSV when caring for patients with respiratory illness — particularly during the RSV season. In most regions, that means October to January. In states with warmer climates, RSV season may start earlier and last longer. 

As we head into the winter season, nurses and other healthcare providers must be aware of this viral threat so they can protect their patients, families, and themselves. This post will arm you with everything you need to know for the 2022-2023 RSV season. 

What is RSV?

RSV is a single-stranded RNA virus from the Pneumovirus genus. Its structure consists of a ribonucleoprotein core surrounded by a bilipid-layer envelope that attaches itself to host cells. There is only one RSV serotype, but it is classified into two strains (“A” and “B”) based on the membrane proteins. 

RSV Transmission

RSV spreads through large respiratory droplets (greater than 5 micrometers). When the virus enters the body through the nose, mouth, or eyes, it incubates for between 2 and 8 days. Most often, symptoms start about five days after exposure.

RSV Risk Factors

Although the virus may affect anyone, certain groups are at greater risk of RSV infection. 

• Immunocompromised individuals

• Adults over age 65

• People with heart or lung conditions

• Premature infants 

• Bottle-fed babies

• Children exposed to tobacco smoke and air pollution

• Children with comorbid conditions, including immunodeficiency, neuromuscular disorders, and congenital heart problems

Infants are more susceptible to RSV than adults because of anatomical differences, including narrower air passages, softer tracheas, and shorter necks.  

Symptoms of RSV

The symptoms of RSV are similar to other common respiratory viruses like rhinovirus and influenza. It usually causes mild, cold-like symptoms, including:

• Runny nose

• Nasal congestion

• Cough

• Sneezing

• Fever

• Myalgia

• Irritability in children and infants

With RSV, symptoms usually appear in stages rather than all at once.

RSV causes an upper respiratory illness but can progress to the lower respiratory tract. When this happens, bronchiolitis often occurs. Symptoms of bronchiolitis and lower respiratory infection include the following:

• Wheezing

• Tachypnea

• Rhonchorous breath sounds

• Accessory muscle use

• Prolonged expiration

The infection can lead to pneumonia, hypoxia, apnea, and acute respiratory failure in severe RSV cases. Infants, elderly adults, and people with underlying medical problems are more prone to serious complications from RSV.

Facts about RSV

• In the US, RSV is the most common cause of bronchiolitis.

• Each year in the US, the virus is estimated to cause about 60,000-120,000 hospitalizations and 6,000-10,000 deaths among adults over age 65.

• Annually, approximately 58,000 children under age five are hospitalized due to RSV. 

• Each year, RSV affects an estimated 64 million people worldwide and causes about 160,000 deaths.

• Nearly all children get the virus by age 4.

• Most RSV infections go away on their own, typically within two weeks.

• You are contagious for about 3–8 days if infected with RSV.

• There is no vaccine to prevent RSV.

How RSV is treated

Currently, the treatment for RSV is to manage symptoms and wait for the illness to resolve on its own. Symptom management in RSV illness may consist of:

• Over-the-counter fever reducers and pain relievers

• Adequate fluids to prevent dehydration

Treatments that may be recommended for RSV-related bronchiolitis include:

• Supplemental oxygen for O2 sats less than 90%

• Hydration and nutrition supplementation

• Pulse oximetry

Rarely, people with severe infections may need to be hospitalized. They might also get a breathing tube or be put on a ventilator.

Rarely, doctors may give monthly injections of a drug called palivizumab during RSV season. This treatment is only available for infants and children who are most likely to suffer serious breathing problems from RSV — like children with lung disease or those born prematurely. This treatment is preventative and does not treat or cure the virus.

Researchers are working on vaccines to prevent RSV and antivirals to fight the illness. 

Ways to prevent the spread of RSV

Decreasing exposure to RSV and limiting transmission are the best ways to prevent infection.

Since the virus is spread through contact with droplets, the CDC recommends these steps to prevent the spread of the virus.

• Covering coughs and sneezes with a tissue or clothing, not hands

• Frequent hand washing

• Disinfecting high-traffic surfaces like cellphones, doorknobs, and tabletops

Anyone with cold-like symptoms should avoid contact with children, seniors, and high-risk individuals with health problems or a weakened immune system. 

Specifically, they should refrain from kissing babies or holding hands with children.

Parents of high-risk infants and children can help protect their children during RSV season by:

• Cleaning their hands frequently since children tend to touch their eyes, nose, and mouth often

• Restricting contact with family and friends who have cold symptoms

• Limiting time spent in crowded places or settings like daycares where there may be high RSV activity

Likewise, caregivers of aging parents or elderly adults must be on guard this RSV season. “The virus is increasingly recognized as a significant cause of respiratory illness in older adults,” says William Schaffner, MD, medical director of the National Foundation of Infectious Diseases. 

RSV outbreaks can happen in nursing homes and assisted living settings as well. To prevent the spread of illness among seniors, it is important that people with cold symptoms avoid close contact and sharing cups or utensils. Also, good hand hygiene is paramount.

The Takeaway

Even though RSV is common and often goes away on its own, it can be a dangerous pathogen in certain groups like children and seniors. Nurses and other health care professionals must be knowledgeable about this illness, including symptoms and treatment, so they can educate and support their patients and families during the 2022-2023 RSV season.