What are the outpatient treatment options for Respiratory Syncytial Virus (RSV) in older adults?

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Last updated: May 23, 2025 • View editorial policy

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From the Guidelines

Outpatient treatment for RSV in older adults should prioritize vaccination as the primary preventive measure, with the most recent and highest quality study 1 recommending RSV vaccination in adults aged ≥60 years, particularly those with underlying conditions such as COPD, heart failure, or immunocompromised states.

Key Considerations

  • The study 1 highlights the importance of RSV vaccination in preventing severe disease in older adults, with a significant reduction in RSV-associated lower respiratory tract disease (LRTD) and severe RSV-associated LRTD.
  • The Advisory Committee on Immunization Practices (ACIP) recommends RSV vaccination in adults aged ≥75 years and in adults 60–74 years of age who are at increased risk of severe RSV disease, as stated in the study 1.
  • The study 1 emphasizes the need for RSV vaccination in older adults, particularly those with chronic disorders, to prevent LRTD and reduce the burden on the healthcare system.

Treatment and Prevention

  • Supportive care, including rest, adequate hydration, and over-the-counter medications like acetaminophen or ibuprofen, is essential for managing symptoms.
  • Humidifiers and saline nasal sprays can help ease congestion and relieve nasal dryness.
  • Cough suppression with dextromethorphan may provide relief, but older adults should monitor for worsening symptoms and seek medical attention if necessary.
  • Prevention through good hand hygiene and avoiding close contact with infected individuals is crucial, especially during RSV season.

High-Risk Groups

  • Older adults with underlying conditions, such as COPD, heart failure, or immunocompromised states, are at higher risk for severe disease and should be prioritized for RSV vaccination.
  • The study 1 provides a list of risk factors for severe RSV disease, including chronic cardiovascular disease, chronic lung or respiratory disease, and end-stage renal disease.

Vaccination Recommendations

  • The study 1 recommends RSV vaccination in adults aged ≥60 years, with a single dose of RSV vaccine administered intramuscularly.
  • The ACIP recommends RSV vaccination in adults aged ≥75 years and in adults 60–74 years of age who are at increased risk of severe RSV disease, as stated in the study 1.

From the Research

RSV Infection in Older Adults

  • RSV infection is a significant burden on older adults, leading to acute respiratory tract infections with substantial morbidity and mortality 2, 3, 4.
  • The incidence of RSV infections requiring medical attention increases with age, and it is highest among persons ≥ 70 years of age 2.
  • RSV infection can cause significant morbidity and mortality in older adults, especially those with underlying diseases 4.

Outpatient Treatment of RSV Infection in Older Adults

  • The standard of care for RSV-infected patients remains supportive, including fluids, antipyretics, and oxygen support when needed 2.
  • Treatment of RSV infections predominantly involves supportive care, with aerosolised ribavirin reserved for severe cases, especially immunocompromised patients 4, 5.
  • Emerging antiviral agents, including fusion and nucleoprotein inhibitors, offer promising avenues for future therapeutics 4.

Prevention Strategies for RSV Infection in Older Adults

  • RSV vaccination is considered the optimal prevention strategy for older adults 6.
  • Two protein subunit vaccines for protection from severe RSV in adults aged 60 years and older were licensed in 2023, and a third - an mRNA-based vaccine - recently gained market approval in the USA 3.
  • The recent approval of the bivalent RSV prefusion F protein-based vaccine for individuals aged 60 and older represents a milestone in preventive strategies 4.

Diagnosis and Management of RSV Infection in Older Adults

  • Distinguishing RSV from other acute viral infections on clinical grounds alone is not possible, and the reference standard diagnosis is by PCR 3.
  • Testing samples from a single respiratory tract site could result in underdetection of RSV infection 3.
  • Long-term sequelae of RSV infection are common and include deterioration of underlying disease, typically heart failure and COPD 3.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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