The management of severe respiratory syncytial virus (RSV) infections in adults remains a significant clinical challenge, with treatment options largely limited to supportive care, according to leading infectious disease experts. This therapeutic gap underscores the critical importance of prevention through vaccination for vulnerable populations.
"It really is just supportive care," explains Dr. Angela Branche of the University of Rochester Medical Center. "This is why the focus is largely in prevention." This limitation in treatment options comes at a time when research demonstrates RSV's substantial threat to adult patients.
Severe Disease Burden in Hospitalized Patients
Recent research reveals concerning statistics about RSV severity compared to other respiratory infections. A CDC study found that RSV patients were significantly more likely to require intensive care unit admission than those with COVID-19 (adjusted OR 1.49) or influenza (adjusted OR 1.55). Moreover, the likelihood of requiring invasive mechanical ventilation or death was double that of flu patients.
"RSV and COPD do not go well together," Dr. Branche emphasizes, noting that infected high-risk patients frequently experience serious complications including heart failure exacerbations, myocardial infarction, and arrhythmias.
Limited Treatment Options
For severely ill patients, particularly those with compromised immune systems, clinicians have few evidence-based therapeutic options. Dr. Albert Shaw of Yale School of Medicine notes that antiviral agents like ribavirin are sometimes used in high-risk patients, such as lung or bone marrow transplant recipients, despite unclear benefits and potential toxicity.
Intravenous immunoglobulin has been utilized in some medical centers based on clinical experience, but lacks sufficient evidence for broader recommendation. These interventions are typically reserved for patients facing substantial mortality risk from RSV infection.
Prevention Through Vaccination
Given the limited treatment options, prevention has become the primary focus of RSV management. Three FDA-approved vaccines are now available:
- GSK's Arexvy
- Pfizer's Abrysvo
- Moderna's mRESVIA
The CDC currently recommends RSV vaccination for all adults 75 and older, as well as those 60-74 years old with increased risk factors. Recent expanded approvals have made these vaccines available to younger at-risk populations, with Arexvy approved for at-risk adults 50-59 years old and Abrysvo for at-risk adults 18-59 years old.
Clinical Management Recommendations
Healthcare providers are advised to carefully manage patient expectations and maintain close monitoring of infected high-risk individuals. Dr. Branche recommends establishing a low threshold for emergency department visits when necessary.
"One thing that often gets missed is that RSV is associated with a lot of exacerbations of underlying health problems," Dr. Branche notes, emphasizing the importance of vigilant monitoring and prompt medical attention when symptoms worsen.
The severity of RSV disease in adults, particularly in vulnerable populations, continues to shape vaccine policy evolution and highlights the urgent need for more effective therapeutic interventions. Until such treatments become available, prevention through vaccination and careful monitoring of high-risk patients remain the cornerstone of RSV management.
