RSV in older adults: what's different
Most people think of RSV as a baby disease. That's accurate — RSV is the leading cause of infant hospitalization. But it is also a significant and chronically underestimated threat to adults 60 and older, who account for a large share of RSV-associated hospitalizations and deaths each year in the US.
How serious is RSV in older adults?
The numbers are striking:
- An estimated 60,000–160,000 older adults are hospitalized for RSV in the US each year
- An estimated 6,000–10,000 older adults die from RSV-associated causes annually
- RSV hospitalization rates in adults 65+ are comparable to influenza and significantly higher than was historically assumed
For much of medical history, RSV was dismissed in adults because it presents as "just a cold." In healthy younger adults, that's true. But in older adults — particularly those with COPD, heart failure, asthma, diabetes, or weakened immune systems — RSV frequently causes severe lower respiratory tract disease, including pneumonia and respiratory failure.
Why RSV is underrecognized in adults
RSV in adults presents as an upper respiratory infection — runny nose, cough, sore throat, malaise. It's easy to attribute to "a cold" or "a bad flu." Historically, RSV testing in adults was rarely done outside of clinical research settings. Now that adult RSV vaccines exist and testing is more common, recognition has improved, but RSV is still frequently missed in older adult patients.
Who is most at risk (adults)
- Adults 65 and older, especially those 75+
- Adults with COPD or asthma
- Adults with congestive heart failure
- Immunocompromised individuals (transplant recipients, those on immunosuppressive therapy)
- Nursing home and long-term care residents
- Adults with diabetes or other chronic conditions
RSV vaccines for adults 60+
Two RSV vaccines are now FDA-approved for adults 60 and older:
Abrysvo (Pfizer)
A protein subunit vaccine. Also the same vaccine approved for use in pregnancy. In clinical trials, Abrysvo reduced RSV-associated lower respiratory tract disease by approximately 66% in adults 60+ over two RSV seasons.
mRESVIA (Moderna)
An mRNA-based RSV vaccine — the same technology platform as Moderna's COVID-19 vaccines. Approved for adults 60+. Showed similar efficacy to Abrysvo in clinical trials.
Both vaccines are one-time doses (unlike the annual flu vaccine). Boosters and long-term protection durability are still being studied. The CDC recommended RSV vaccination for adults 60+ using shared clinical decision-making — meaning your doctor can advise you based on your individual health situation rather than a blanket recommendation for all adults over 60.
If you're 60+ and haven't discussed RSV vaccination with your doctor or pharmacist, it's worth asking — especially if you have COPD, heart disease, or another chronic condition. Both vaccines are available at most pharmacies.
Symptoms in older adults
RSV in adults often causes:
- Runny nose, nasal congestion
- Cough — often worsening over days 3–5
- Wheezing or new shortness of breath (a red flag in adults, especially those with COPD)
- Low-grade fever (less common than in infants)
- Fatigue and malaise
- In severe cases: pneumonia, respiratory failure requiring hospitalization
Older adults with COPD may experience RSV as an acute exacerbation — sudden worsening of their baseline respiratory symptoms. This is frequently misattributed to COPD flare rather than viral infection.
Treatment for adults
Like in infants, there is no approved antiviral treatment for RSV in most adult outpatients. Management is supportive: rest, fluids, fever management. In hospitalized patients, supplemental oxygen and respiratory support are used. Research into antiviral options for adults with RSV is ongoing.
Not medical advice. RSV vaccine recommendations for older adults are evolving. Discuss your individual situation with your doctor or pharmacist.