In recent years, we've become accustomed to asking: "Do you have COVID-19, the flu, or just a regular cold?" The truth is, many viruses can cause respiratory illnesses, potentially leading to significant medical complications. One such virus is RSV, which has become increasingly prevalent, especially among older adults. RSV can cause severe illness in adults, leading to hospitalizations, exacerbation of existing conditions, and even death – similar to the flu and COVID-19. Fortunately, preventive measures are now available.
What is the RSV virus?
RSV affects both the upper and lower respiratory tracts and typically emerges in the winter. In this sense, it resembles other winter viruses like the flu and COVID-19. Historically, RSV wasn't seen as a major factor in adult respiratory illnesses, but recently its prevalence has risen, particularly among the elderly and those with respiratory diseases. We now understand that RSV infections can lead to serious illness, hospitalizations and even death, much like the flu and COVID-19.
What is the extent of RSV illness among adults in Israel?
Over the past year and through various research studies conducted worldwide before the COVID-19 outbreak, it's evident that RSV's prevalence is similar to that of the flu and, in some places, even higher. During the COVID-19 pandemic, other respiratory viruses declined due to mask-wearing and social distancing. This means RSV is common and widespread, causing significant illness in some cases and placing a substantial burden on patients and the health care system.
What happens when someone is infected?
The range of RSV illness among adults is broad. Some experience asymptomatic infection, meaning they don't feel sick or realize they're infected. Others may have mild symptoms like a runny nose, sore throat, and possibly a mild cough, with or without fever, along with muscle aches. More severe cases can involve lower respiratory tract damage, affecting breathing, causing significant coughing and sometimes leading to oxygenation issues that require supplemental oxygen or ventilation. Additionally, the virus can directly damage the lungs and pave the way for bacterial lung infections (bacterial pneumonia), which can occur following RSV infection.
Does age and weakened immunity play a role?
Older adults are at a higher risk of developing severe illness from RSV infection and related complications. Severe illness rates increase from age 60 and become significant from age 75 and above, particularly in those with multiple underlying health conditions or chronic respiratory or heart diseases, such as heart failure. Having additional illnesses, or comorbidities, increases the risk of severe illness from RSV, and the more underlying conditions present, the higher the risk.
Can RSV infection affect existing conditions?
Absolutely. RSV infection can exacerbate existing conditions, such as heart diseases, even after the infection and recovery.
Can the illness be severe?
In young people, severe illness is rare. However, even younger individuals, especially those with weakened immune systems, can develop severe illness from RSV.
What symptoms should be monitored for RSV?
Clinically, it is difficult to differentiate between RSV and other winter viruses like the flu and COVID-19. The key symptom to watch for in all these illnesses is respiratory difficulty. Once there's an impact on the body's ability to oxygenate, the situation is severe and typically requires medical evaluation and monitoring.
Anyone experiencing breathing difficulties should seek urgent medical care. Those with milder illness can consult their family doctor. It's worth noting that there is a significant difference between RSV and viruses like the flu and COVID-19. While medical treatments are available for the flu and COVID-19, especially for severe cases, there is currently no effective medication for RSV. Therefore, the best way to prevent RSV illness in adults is through vaccination. Typically, older patients who contract and recover from RSV receive supportive care to improve the course of the illness, such as fluid or oxygen administration. Patients who also develop bacterial pneumonia will receive additional antibiotic treatment.
How is RSV illness diagnosed, and where does this diagnosis occur?
Diagnosis of RSV infection in adults is not typically done through health clinics or family doctors. In most hospitals, patients admitted with respiratory illness will be tested for RSV using a swab for a PCR test similar to COVID-19 testing, which detects the virus's genetic material. However, while there are rapid antigen tests for COVID-19 and the flu, there is currently no at-home test for RSV on the market.
Are the symptoms similar to those of the flu?
Yes. In the past, RSV infection rates were less frequently tested, if at all. In recent years, more testing is being done to better understand the burden of respiratory illnesses, and we know RSV significantly contributes to the load of winter viruses, similar to the flu and COVID-19.
What is the effectiveness of the vaccine?
Research studies have shown that the vaccine is safe and effective in preventing severe illness and complications from RSV infection for up to two years post-vaccination. The vaccine is particularly effective in preventing complications, hospitalizations, and mortality, but less effective against infection itself, similar to flu and COVID-19 vaccines.
Prof. Yasmin NaorPhoto: Wolfson Medical CenterDoes getting vaccinated prevent severe illness if infected with RSV?
For those currently ill with RSV, getting vaccinated is not beneficial.
Is the vaccine safe for the immunocompromised?
The existing RSV vaccine for adults is not dangerous for immunocompromised individuals. Some vaccines are based on live viruses, which immunocompromised individuals should avoid, as the virus can replicate uncontrollably. However, the vaccine available and offered in Israel for RSV in adults is not based on live virus components and does not contain them, so there is no contraindication for immunocompromised individuals to receive it. At this stage, we have limited data on the vaccine's effectiveness in immunocompromised individuals.
- Prof. Yasmin Maor is head of Infectious Disease Unit at Wolfson Medical Center