RSV in the older adult

RSV in older adults has hit the news recently. In the last several weeks RSV has circulated heavily in New Zealand communities, with acute care clinics and hospitals waiting rooms overwhelmed and GPs reporting an increase in winter illnesses. RSV appears to have made a comeback due to the 2020 pandemic social distancing restrictions and the subsequent lack of circulating viruses in the last year.

RSV, or respiratory syncytial virus, was first recognised in children in the late 1950s and in older adults due to outbreaks in long term care facilities in the 1970s. Today, it continues to be considered a childhood illness, mostly seen in infants and young children, and as a resurgence virus in older adults. While RSV can present at any age, those at either end of the age spectrum are more at risk.

A look at RSV

Image source: https://phil.cdc.gov/Details.aspx?pid=2175

RSV is common to the winter months and second only to influenza as the primary cause of respiratory illness. Although seen in infants and young children, RSV is a major cause of respiratory illness in older adults and can present as the immune system weakens.

RSV is transmitted by direct or close contact through infected secretions. Symptoms of RSV include runny nose, malaise, fever (less likely in older adults) and a cough. A wheeze and breathlessness are hallmarks of RSV and symptoms are often more pronounced than the common cold.

RSV incubates for a much longer period than influenza, taking between 2-8 days for symptoms to appear, and can remain contagious for a period of up to 10 days, with illness lasting up to 4 weeks.

According to the Gerontological Society of America, RSV in older adults can result in severe secondary complications such as asthma, pneumonia, COPD exacerbation and congestive heart failure.

As most have experienced with COVID-19, testing for RSV is also via nasal swab and secretions. Identifying RSV in older adults can be a challenge due to a reduction in viral load in the nose and throat. Presenting with similar symptoms to other respiratory viruses, the only way to accurately distinguish one from the other is through viral testing.

In older adults, the burden of RSV on hospitalisation rates is similar to influenza, and the mortality rates of RSV complications can be significant: as high as 50% and in some seasons higher than influenza.

Prevention of RSV in older adults

The incubation period for RSV may indicate a window of opportunity for antiviral therapy, however there are currently no available antiviral treatments.

RSV creates immunity for a time; however, this appears to wane and warrants the development of a vaccine. While there are no vaccines available for RSV, several clinical trials are progressing. The development of COVID-19 vaccines has created hope that an RSV vaccine will be available in the near future.

While COVID-19 has changed the mindset of ‘it’s just a cold’, it’s crucial to remember there are other respiratory viruses. The best prevention for RSV is maintaining standard precautions, hand washing, respiratory etiquette, and social distancing until well. Frequent cleaning of high touch surfaces is also recommended.

See here for further CDC information on RSV in the older adult.

If your facility is struggling to contain infections, reach out to Bug Control and see how we can help. With over 25 years of experience in aged care infection control, we can help reduce infections and improve processes. Contact us today for an obligation-free conversation about how we can help.

References

https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/respiratory-syncytial-virus-rsv

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078512/