Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) has emerged as a significant pathogen in older adults, especially within post-acute and long-term care (PALTC) settings. It can lead to severe respiratory illnesses like bronchiolitis and pneumonia in susceptible older adults.  

Core Considerations in PALTC

• Atypical Presentations: In older adults, RSV might not always present with the classic symptoms seen in children. Instead, exacerbations of underlying chronic respiratory conditions, generalized weakness, or atypical chest symptoms may predominate.
• Complications & Morbidity: RSV can precipitate or worsen heart failure and chronic obstructive pulmonary disease (COPD). Additionally, the virus can contribute to secondary bacterial infections, heightening the risk of severe outcomes.
• Transmission Dynamics: RSV is highly contagious and can swiftly spread throughout PALTC facilities, emphasizing the imperative for stringent infection control measures.

Comprehensive Management Strategies

• Diagnostic Protocols: Rapid antigen detection tests, though expedient, may have reduced sensitivity in adults. Molecular assays like PCR emerge as more reliable, especially during RSV outbreaks.
• Supportive Care: Most cases necessitate supportive management—hydration, oxygen therapy, and bronchodilators. While antiviral agents like ribavirin are available, their utility in older adults remains a topic of ongoing research.
• Prevention and Control: The CDC recommends that the RSV vaccine may be given to adults over age 60, using shared clinical decision making between provider and patient. In addition, rigorous hand hygiene, isolation of symptomatic individuals, and the potential use of RSV monoclonal antibodies in high-risk patients are all critical steps for RSV prevention.

RSV Vaccination Toolkit: Resources for Clinicians

Included Content:

• RSV Vaccine for Older Adults: A Decision-Making Tool for Residents in Long-Term Care
  Settings
• Centers for Disease Control and Prevention (CDC) Fact Sheet: RSV Vaccination for Adults
  60 Years and Older
• PRO Information Sheet: RSV Vaccine Risk/Benefit Analysis
• AHCA: Medicare Billing Guidance for Respiratory Vaccines in LTC

RSV Toolkit