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Respiratory syncytial virus infection — Clinical Guidelines

Overview

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections, hospitalizations, and mortality, particularly in infants and older adults with comorbidities such as asthma, COPD, and immunocompromising conditions 1 4 5.

Diagnosis

Clinical Presentation: Symptoms include cough, wheeze, shortness of breath, and fever 20.

Laboratory Tests: Nasopharyngeal swab PCR testing is crucial for confirmation 5.

Imaging: Chest X-rays may show infiltrates or hyperinflation in severe cases 1 5.

Serology: Useful for retrospective diagnosis but less immediate than PCR 20.

Management

Supportive Care: Oxygen therapy, hydration, and monitoring in mild cases 1 5.

Hospitalization: Required for severe cases with respiratory distress or dehydration 1 5.

Bronchodilators: May be used in patients with wheezing 1 5.

Antiviral Therapy: No specific antiviral approved; ribavirin used in severe cases under specific conditions 1 13.

Special Populations

Pregnancy: Maternal RSV vaccination during the third trimester (32-36 weeks) recommended to protect infants 1 2 11.

Pediatrics: Nirsevimab recommended for passive immunization in high-risk infants 12.

Elderly and Comorbidities: Increased risk of severe RSV infection in adults with asthma, COPD, and immunocompromising conditions 4 16.

Immunocompromised Adults: Higher susceptibility to severe RSV infections; close monitoring and isolation protocols advised 18.

Key Recommendations

Maternal RSV Vaccination: Administer RSV vaccine to pregnant women between 32-36 weeks of gestation to reduce infant RSV-associated lower respiratory tract disease (Evidence: Strong 1 2 11).

Nirsevimab for Infants: Use nirsevimab for passive immunization in high-risk infants to prevent RSV-associated lower respiratory tract infection (Evidence: Strong 12).

Monitoring in High-Risk Adults: Closely monitor elderly individuals and those with chronic respiratory or immunocompromising conditions for severe RSV outcomes (Evidence: Moderate 4 16).

Post-Marketing Surveillance: Implement rigorous post-marketing safety monitoring for RSV vaccines using systems like VAERS to detect adverse events (Evidence: Moderate 7 8 9).

References

1 Torres-Torres J, Rojas-Zepeda L, Villafan-Bernal JR, Martinez-Portilla R, Espino-Y-Sosa S, Cerda-Flores P et al.. Maternal RSV vaccination for infant protection: A systematic review and meta-analysis of phase 3 trials with an integrated economic evaluation. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2026. link 2 Ramasauskaite D, Savona-Ventura C, Minkauskiene M, Mahmood T. Respiratory syncytial virus vaccination in pregnancy - Position statement by the European board and college of obstetrics and gynaecology (EBCOG). European journal of obstetrics, gynecology, and reproductive biology 2025. link 3 Alfaro T, Froes F, Vicente C, Costa R, Gavina C, Baptista R et al.. Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine. Pulmonology 2025. link 4 Penders Y, Brusselle G, Falsey AR, Rohde G, Betancur E, Guardado ME et al.. Burden of Respiratory Syncytial Virus Disease in Adults with Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. Current allergy and asthma reports 2025. link 5 Trifonov G, Büscher E, Fistera D, Kill C, Risse J, Taube C et al.. Disease Burden of RSV Infection in Adult Patients in Comparison to Influenza Virus Infection. Journal of medical virology 2025. link 6 Guan P, Qi C, Xu G, Sheng C, Sun S, Zhou Z et al.. Designing a T cell multi-epitope vaccine against hRSV with reverse vaccinology: An immunoinformatics approach. Colloids and surfaces. B, Biointerfaces 2025. link 7 Bao Z, Gao W, Yu X, Chai L, Liu Y. Post-marketing safety monitoring of RSV vaccines: A real-world study based on the Vaccine Adverse Event Reporting System (VAERS). Human vaccines & immunotherapeutics 2025. link 8 Moro PL, Getahun A, Romanson B, Marquez P, Tepper NK, Olson CK et al.. Safety monitoring of Pfizer's Respiratory Syncytial Virus Vaccine in pregnant women in the Vaccine Adverse Event Reporting System (VAERS), 2023-2024, United States. Vaccine 2025. link 9 Donahue JG, Cocoros NM, Kieke BA, Hanson KE, Weintraub ES, Yih WK et al.. Near real-time surveillance and tree-based data mining to assess the safety of respiratory syncytial virus vaccines in older adults in the vaccine safety datalink. Vaccine 2025. link 10 Zeng B, Liu X, Yang Q, Wang J, Ren Q, Sun F. Efficacy and safety of vaccines to prevent respiratory syncytial virus infection in infants and older adults: A systematic review and meta-analysis. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2024. link 11 Fleming-Dutra KE, Jones JM, Roper LE, Prill MM, Ortega-Sanchez IR, Moulia DL et al.. Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report 2023. link 12 Jones JM, Fleming-Dutra KE, Prill MM, Roper LE, Brooks O, Sánchez PJ et al.. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR. Morbidity and mortality weekly report 2023. link 13 Chaer FE, Kaul DR, Englund JA, Boeckh M, Batista MV, Seo SK et al.. American Society of Transplantation and Cellular Therapy Series: #7 - Management of Respiratory Syncytial Virus Infections in Hematopoietic Cell Transplant Recipients. Transplantation and cellular therapy 2023. link 14 Hofmeister AM, Seckler JM, Criss GM. Possible Roles of Permafrost Melting, Atmospheric Transport, and Solar Irradiance in the Development of Major Coronavirus and Influenza Pandemics. International journal of environmental research and public health 2021. link 15 Blau DM, Baillie VL, Els T, Mahtab S, Mutevedzi P, Keita AM et al.. Deaths Attributed to Respiratory Syncytial Virus in Young Children in High-Mortality Rate Settings: Report from Child Health and Mortality Prevention Surveillance (CHAMPS). Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2021. link 16 Boattini M, Almeida A, Christaki E, Marques TM, Tosatto V, Bianco G et al.. Severity of RSV infection in Southern European elderly patients during two consecutive winter seasons (2017-2018). Journal of medical virology 2021. link 17 Lalani K, Yildirim I, Phadke VK, Bednarczyk RA, Omer SB. Assessment and Validation of Syndromic Case Definitions for Respiratory Syncytial Virus Infections in Young Infants: A Latent Class Analysis. The Pediatric infectious disease journal 2019. link 18 Jensen TO, Stelzer-Braid S, Willenborg C, Cheung C, Andresen D, Rawlinson W et al.. Outbreak of respiratory syncytial virus (RSV) infection in immunocompromised adults on a hematology ward. Journal of medical virology 2016. link 19 Morrison WI, Taylor G, Gaddum RM, Ellis SA. Contribution of advances in immunology to vaccine development. Advances in veterinary medicine 1999. link80016-0) 20 Tarro G, Smeraglia R, Esposito C. Serological and virological investigations of young children with acute respiratory syndrome associated with respiratory syncytial virus. Diagnostic microbiology and infectious disease 1985. link90072-0) 21 Mandal SK, Joglekar VM, Khan AS. An outbreak of respiratory syncytial virus infection in a continuing-care geriatric ward. Age and ageing 1985. link 22 Wilczyński J. RS virus components. II. Antigenicity. Acta microbiologica Polonica 1976. link

Respiratory syncytial virus infection