RSV (Respiratory Syncytial Virus)

A mother holding her baby

RSV, a common virus similar to a cold, is spreading widely this year, especially among children. It usually causes mild symptoms, but this year more children in the U.S. are getting sick enough to go to hospitals. 

Health experts think RSV is a bigger problem this year because many children under 5 were not in daycare or school the past two years. With less exposure to other people, their immune systems aren’t as used to fighting viruses

Oregon Gov. Kate Brown on Nov. 14 declared a state of emergency to give Oregon hospitals more flexibility in caring for children with RSV.  On Dec. 7, Brown issued an executive order that expands hospitals' flexibility as they continue to see more patients of all ages with RSV, flu and COVID-19. OHSU said in a statement that the executive order "will be invaluable as OHSU works to ensure that everyone is able to get the best possible care."

Partly because of the surge in RSV,  crisis standards of care have been declared at:

  • OHSU Doernbecher Children's Hospital
  • OHSU Hospital's adult inpatient and emergency department units 
  • Other Portland-area hospitals, including Randall Children's Hospital,  Providence St. Vincent's pediatric units and Providence Portland's pediatric units

If your child does not have serious symptoms, contact your provider before coming to the emergency room. If you do not have a provider, call 211 for help finding one.

Learn more: 

What is RSV?

RSV, also called respiratory syncytial virus, infects the nose, throat and lungs. About 2 million children under 5 get it each year. Most children have had an RSV infection by age 2.

In babies and young children, RSV is the top cause of serious lung disease, such as pneumonia and bronchiolitis.

RSV is usually most common in fall and winter. This year it began spreading in late summer.

How RSV spreads

RSV spreads through:

  • Droplets, such as when an infected person coughs, sneezes or talks.
  • Direct contact with:
    • Someone who has RSV.
    • Something with the virus on it. RSV can survive for many hours on hard surfaces and for 30 minutes on unwashed hands.

    How long people with RSV are contagious

    People with RSV are usually contagious for three to eight days. They can be contagious a day or two before they show symptoms. Babies and people with weakened immune systems (immunocompromised) who get the virus can spread it for up to a month.

    RSV symptoms

    RSV symptoms show up four to six days after someone gets infected. 

    Cold symptoms usually appear first. They include:

    • Cough
    • Fever
    • Runny or stuffy nose
    • Sneezing
    • Low appetite
    • Fussiness in babies and toddlers

    Cold symptoms may be followed by symptoms of pneumonia or bronchiololitis, both lung infections. These symptoms include breathing that:

    • Is faster than normal
    • May include:
      • Flaring nostrils and nodding head
      • Grunting
      • Wheezing
      • Ribs pulling in with each breath

    Care and treatment of RSV

    There is no vaccine or specific treatment for RSV.  But several companies are working on RSV vaccines and plan to seek approval for them in the U.S. by the end of the year.

    Dawn Nolt, M.D., M.P.H., a pediatrician at OHSU, said it's hard to make an RSV vaccine that:

    • Is very safe for babies, who are most at risk for RSV.
    • Stimulates babies' immature immune systems enough to protect them.

    Learn more about potential vaccines.

    Care at home

    Most of the time, RSV can be treated at home and goes away on its own in a week or two. OHSU experts suggest:

    • Eating regularly.
    • Drinking lots of fluids.
    • Plenty of sleep.
    • Treating pain or fever with:
      • Acetaminophen (Tylenol).
      • Ibuprofen (Advil, Motrin or PediaCare).
      • (Note: Aspirin should not be given to children.
    • Babies may need mucus cleared from their noses with a bulb syringe.

    When to call a doctor for RSV

    Someone with RSV should see a doctor if:

    • They have trouble breathing or are wheezing.
    • They have trouble eating because they aren’t breathing normally.
    • They are very inactive or not alert.
    • They are dehydrated:
      • Their urine is dark yellow.
      • Babies and toddlers stay dry longer than usual.
    • Their skin, lips, tongue or nails are turning blue.
    • Their symptoms don't improve after a couple of weeks.

    Preventing RSV

    To avoid getting or spreading RSV, health experts suggest:

    • Washing hands often.
    • Not touching the face.
    • Covering coughs and sneezes.
    • Avoiding sick people.
    • Cleaning and disinfecting frequently used surfaces and items, including toys.
    • Not sharing eating utensils.
    • Staying home if you have symptoms.
    • Wearing a mask in indoor public spaces.
    • Staying in well ventilated public spaces.
    • Staying up to date on vaccines, including flu and COVID-19 vaccines.
    • Keeping babies away from frequent visitors and crowds.

      Who’s most at risk for RSV

      Health officials are most concerned about:

      • Children who are younger than 2, especially those:
        • Under 6 months.
        • Who were born early.
        • Had a low birth weight.
        • Have neuromuscular disorders, including those who have trouble swallowing or clearing mucus.
      • People with chronic heart and lung disease.
      • People with weakened immune systems.
      • Adults 65 and older.

        Caring for a child with RSV

        Most children can recover at home over a week or two.

        Seek emergency care for your child if: 

        • The inside of the child’s mouth is blue
        • Their breathing is extremely labored (see "How hard is your baby breathing? What to look for")
        • They aren’t taking in or holding down fluids and haven’t urinated in eight hours
        • They are severely lethargic and you are struggling to wake them

        Call your primary care doctor if your child:

        • Has symptoms that are getting worse or not improving after seven days 
        • Is younger than 3 months (12 weeks) and has a fever (with a rectal temperature of 100.4 degrees F or higher)
        • Has a fever that rises above 104 degrees F repeatedly
        • Is having trouble sleeping
        • Is very fussy
        • Has chest pain
        • Is tugging at the ears or has fluid or wax draining from the ears

        If you don't have a doctor: Call OHSU at 833-647-8222. We can answer your questions 8 a.m. to 8 p.m. seven days a week.

        Same-day care at OHSU: Find care for all ages in person or virtually.