RSV symptoms in adults vs. children: What's different and how long could it last?

The winter respiratory virus season is still in full swing, with Illinois under a "high" alert level from the Centers for Disease Control and Prevention.

Among the viruses circulating most are COVID-19, flu and RSV.

So far this season, the CDC estimates, there have been at least 24 million flu illnesses, 310,000 hospitalizations and 13,000 deaths — including at least 57 children. Traditionally, flu season peaks around February.

Meanwhile, experts say because COVID-19 and RSV can be limited to cold-like symptoms, many cases go untested.

So what should you know about RSV and who can get it?

In many cases, there is a difference for adults and children:

What is RSV?

RSV is a virus that infects the nose, throat, and lungs and is often difficult to distinguish from other respiratory viruses, according to the Centers for Disease Control and Prevention.

The American Lung Association notes that the common virus often needs lab testing to confirm because "it is typically lumped together with other respiratory infections that cause cold-like symptoms."

Symptoms of RSV

People infected with RSV usually exhibit symptoms within four to six days after getting infected, according to the CDC. The most common symptoms are:

• Runny nose
• Congestion
• Decrease in appetite
• Coughing
• Sneezing
• Fever

Symptoms typically appear in stages and not all at once. The signs might be apparent in adults - but less noticeable in young infants. 

While RSV typically causes a mild, cold-like illness, it can also lead to severe illness such as bronchiolitis and pneumonia.

Other symptoms of severe cases include the following, according to the Mayo Clinic.

• Wheezing — a high-pitched noise that's usually heard on breathing out (exhaling)
• Rapid breathing or difficulty breathing — the person may prefer to sit up rather than lie down
• Bluish color of the skin due to lack of oxygen

Can adults get RSV?

Yes.

"Usually, as an adult, when you become ill with RSV you have mild cold-like symptoms such as a runny nose, sore throat, cough and a headache. But sometimes, and for some people, you can become so ill you need to be hospitalized," the American Lung Association reported, adding that "each year in the United States up to 10,000 older adults die of complications from RSV."

The Cleveland Clinic notes that RSV causes at least 60,000 to 160,000 hospitalizations per year among adults age 65 or older in the U.S.

Symptoms in adults typically include cold-like symptoms, health officials note that if an infection leads to complications like pneumonia or bronchitis, additional symptoms can develop.

Symptoms of RSV in adults

• Congestion.
• Cough.
• Fever.
• Lack of energy.
• Mild headache.
• Runny nose.
• Sore throat.

Severe RSV symptoms in adults

• Extreme tiredness or weakness.
• Low appetite.
• Persistent cough.
• Wheezing.
• Shortness of breath.
• Bluish skin, lips or nails.
• Sudden change in mental state.

When to seek help

Health experts suggest you call 911 if you:

• Struggle to breathe or feel short of breath while sitting still.
• See a bluish skin color around your lips.
• Have new or worsening chest pain.
• Feel confused or can’t think clearly.

RSV in infants

RSV can affect a person of any age but causes the most problems for the very young, according to Cedars Sinai Medical Center.

Infants who contract RSV might not show extensive symptoms and only exhibit irritability, decreased activity and trouble breathing, according to the CDC.

It turns out, most babies have been infected at least once by the time they are 2 years old, Cedars Sinai's website stated. Babies can also be reinfected with the virus -- and infection can happen again anytime throughout life.

In high-risk babies, RSV can lead to severe respiratory illness and pneumonia, which may become life-threatening.

How does RSV spread?

According to the CDC, RSV spreads in multiple ways, including when:

• A person who has RSV coughs or sneezes near you
• You get virus droplets from a cough or sneeze in your eyes, nose, or mouth
• You have direct contact with the virus, like kissing the face of a child with RSV
• You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands

An infected person is most contagious during the first week or so after getting an infection, according to the Mayo Clinic. But in infants and those with weakened immunity, the virus may continue to spread even after symptoms go away, for up to four weeks.

"It is possible to get RSV multiple times, even in the same year, because you do not develop complete immunity to it," the American Lung Association notes.

Treatment for RSV

According to the Cleveland Clinic, there are antiviral treatments for RSV, but they’re generally used in adults with immune problems.

Instead, health experts suggest those with milder symptoms do the following:

• Drinking plenty of fluids to stay hydrated.
• Getting enough rest.
• Using a cool mist vaporizer.
• Using over-the-counter (OTC) medications and home remedies to manage a fever. Talk to your provider before taking any cold medications. Some may interact with other medications you’re taking.

Continue taking prescription medications for asthma, COPD or other conditions as your provider recommends.

Those who develop complications, you may need care at a hospital. Once there, doctors may:

• Give you oxygen through a mask, nasal prongs or a breathing machine
• Remove mucus from your airways
• Give fluids through an IV (intravenous, through your vein) to treat or prevent dehydration

Can antibiotics treat RSV?

No. Antibiotics don’t work against RSV because RSV is viral, not bacterial, health officials say.

"Your healthcare provider may prescribe antibiotics if testing shows you have bacterial pneumonia or another type of bacterial infection in addition to the RSV," the Cleveland Clinic reported.

How long do symptoms last?

Symptoms of RSV usually last a week or two. Those who experience complications like pneumonia, however, could be sick longer.

Prevention

Two options exist for young children:

• An RSV vaccine given to the mother during pregnancy
• An RSV immunization given to infants and some older babies

Older adults:

The Food and Drug Administration has approved RSV vaccines for adults age 60 and older. While two vaccines are available - Abrysvo and Arexvy - the Centers for Disease Control and Prevention doesn't recommend one over the other.

Other steps

The Mayo Clinic recommends the following actions to help prevent the spread of infection: Wash your hands often, avoid exposure, keep things clean, Don't share drinking glasses with others, don't smoke and wash toys regularly.