Duration of RSV Illness
Most people with RSV infection will be sick for 1-2 weeks, with symptoms typically resolving within 7-10 days, though cough and nasal congestion can persist for 2-3 weeks. 1, 2
Typical Symptom Timeline
Acute Phase (Days 1-7)
- Initial symptoms appear after a 4-6 day incubation period and include rhinorrhea, congestion, sneezing, and fever 3
- Peak illness occurs during the first 3-5 days, when fever and systemic symptoms (myalgia, malaise) are most prominent 4
- Lower respiratory symptoms (cough, shortness of breath, wheezing) develop as the infection progresses 2
Recovery Phase (Days 7-14)
- Fever and myalgia typically resolve by day 5 4, 5
- Most patients recover within 7-10 days without complications 6, 1
- Upper respiratory symptoms (sneezing, sore throat) generally improve during this period 5
Prolonged Symptoms (Beyond 2 Weeks)
- Nasal congestion and cough are the most persistent symptoms, commonly lasting into weeks 2-3 4, 5
- This prolonged cough and rhinorrhea is entirely consistent with uncomplicated RSV infection and does not indicate bacterial superinfection 6
- Approximately 7-13% of cases may have symptoms lasting more than 15 days 6, 5
Age-Specific Considerations
Children
- Mean duration ranges from 6.6 to 8.9 days depending on age and care setting 5
- Children in daycare may experience longer symptom duration due to repeated viral exposures 6
- Most children recover within 1-2 weeks, though some may require hospitalization 1
Older Adults and High-Risk Patients
- Symptoms can last for weeks in immunocompromised or high-risk adults 2
- Hospital length of stay ranges from 6-15 days when hospitalization is required 2
- Recovery may be prolonged in patients with underlying cardiorespiratory conditions 7
Contagious Period
You remain contagious for approximately 3-7 days, with peak transmission during the first 3 days of illness 4
- Viral shedding begins before symptoms appear and can continue for ≥7 days after symptom onset 4
- Days 1-3 represent the highest transmission risk when viral shedding is maximal 4
- Standard isolation recommendations suggest staying home for 7 days from symptom onset 6
When to Seek Further Evaluation
Consider bacterial superinfection or complications if:
- Symptoms worsen after 5-7 days or persist beyond 10 days without improvement 6
- Development of severe unilateral facial pain, high fever, or "double sickening" (initial improvement followed by deterioration) 6
- New fever appearing at day 10 or later, which is not typical of uncomplicated viral RSV 4
Important Clinical Caveats
- Mucopurulent (colored) nasal discharge does NOT indicate bacterial infection—this commonly occurs after a few days due to neutrophil influx and is normal for viral RSV 4, 6
- Persistent cough for 2-3 weeks is expected and does not require antibiotics 4, 5
- Antibiotics are not effective for RSV and bacterial superinfection occurs in less than 2% of cases 6
- Treatment remains supportive with fluids, antipyretics, and oxygen support when needed 1, 7