From the Guidelines
The primary treatment option for Respiratory Syncytial Virus (RSV) infection in adults is vaccination, specifically for those aged ≥60 years or with underlying conditions, as it has proven efficacy and safety in preventing RSV-associated disease, as recommended by the Portuguese Society of Pulmonology and other medical associations 1.
Treatment Overview
Treatment for adult RSV primarily focuses on supportive care since there are no specific antiviral medications approved for adults with RSV. This includes:
- Rest
- Adequate hydration
- Over-the-counter pain relievers such as acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours to manage fever and pain
- A humidifier to ease congestion and breathing difficulties
- For more severe symptoms, prescription medications may include bronchodilators like albuterol (2 puffs every 4-6 hours) to open airways if wheezing is present
- In cases of significant respiratory distress, supplemental oxygen therapy may be necessary
Vaccination
Vaccination is recommended for people aged ≥50 years with risk factors (such as chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years, as stated in the position paper from the Portuguese Society of Pulmonology 1. Two RSV vaccines are currently available, with proven efficacy, effectiveness, and safety in adults aged ≥60 years, including those with comorbidities and those of more advanced age 1.
Key Considerations
- Adults with underlying conditions like asthma, COPD, or compromised immune systems should seek medical attention promptly as they're at higher risk for complications
- RSV typically resolves within 1-2 weeks, but symptoms can persist longer in some cases
- The virus spreads through respiratory droplets, so practicing good hand hygiene and avoiding close contact with others while symptomatic helps prevent transmission
- Antibiotics are not effective against RSV since it's a viral infection, but may be prescribed if a secondary bacterial infection develops
Evidence-Based Recommendations
The recommendations for RSV vaccination in adults are based on the latest evidence, including the position paper from the Portuguese Society of Pulmonology and other medical associations 1, which highlights the importance of vaccination in preventing RSV-associated disease and its complications in adults. Further research is needed to evaluate the efficacy and safety of RSV vaccines in certain populations, such as immunocompromised individuals, and to better understand the potential interactions with other vaccines 1.
From the Research
Treatment Options for RSV Infection in Adults
- The standard of care for RSV-infected patients remains supportive, including fluids, antipyretics, and oxygen support when needed 2
- Treatment of RSV in adults is limited to antiviral therapy with ribavirin (aerosolized, oral, intravenous) and immunomodulation with intravenous immunoglobulins, corticosteroids, and palivizumab 3
- Aerosolized ribavirin is the most studied treatment option and should remain the backbone of multidrug regimens 3
- Addition of an immunomodulator to ribavirin may provide a survival benefit over ribavirin alone, particularly in immunocompromised adults 3
- In the elderly, treatment of RSV is largely supportive, whereas early therapy with ribavirin and intravenous gamma globulin is associated with improved survival in immunocompromised persons 4
Prevention Strategies
- Palivizumab may be a viable option for prophylaxis against RSV in high-risk adults 5, 3
- Preventing RSV disease would be possible through RSV vaccine development, with several candidate vaccines being developed 5, 2, 6
- Infection control measures are critical to limit spread of RSV, including hand washing and the use of gowns and gloves 4, 6
Diagnosis and Clinical Features
- Diagnosis of RSV infection in adults is difficult because viral culture and antigen detection are insensitive, but early bronchoscopy is valuable in immunosuppressed patients 4
- Clinical features of RSV infections overlap with other respiratory viruses, so laboratory tests are required to establish the diagnosis, including reverse transcriptase polymerase chain reaction (RT-PCR) of samples from nasal swabs, sputum, or bronchoalveolar lavage 6
- Clinical features may be difficult to distinguish from those of influenza but include nasal congestion, cough, wheezing, and low-grade fever 4