RSV is far more common in adults than most people realize. Among U.S. adults 60 and older alone, an estimated 4.1 million cases occur every year, and between 110,000 and 180,000 adults 50 and older are hospitalized annually because of the virus. The true numbers are likely higher, because RSV in adults is routinely undertested and underdiagnosed.
Why RSV in Adults Is Underestimated
Most people think of RSV as a childhood illness, and that perception shapes how doctors approach it. When an adult shows up at the hospital with a respiratory infection during winter, they’re far more likely to be tested for the flu or COVID-19 than for RSV. Research published in The Journal of Infectious Diseases found that up to 10% of adults admitted with acute respiratory illness during winter actually have RSV, but standard-of-care testing catches only a fraction of those cases.
Adults also tend to carry lower amounts of the virus in their respiratory secretions compared to children, which makes the infection harder to detect even when testing does happen. Samples collected later in the illness, when viral levels have dropped, can come back negative despite an active infection. The result is that official case counts significantly understate how widespread RSV really is among adults.
How Age Affects Your Risk
RSV can infect adults of any age, but the risk of ending up in the hospital rises sharply with age. A Vanderbilt University Medical Center study covering the 2022-2023 season found the overall hospitalization rate was about 31.5 per 100,000 adults. That average, though, masks a dramatic age gap: hospitalization rates among adults 60 to 74 were 10 times higher than among adults 18 to 49, and rates among those 75 and older were 17 times higher.
For younger, healthy adults, RSV typically looks and feels like a bad cold. It causes congestion, cough, fatigue, and sometimes a low fever. Most recover at home within a week or two. The danger increases for older adults because aging weakens the immune response and makes the lungs more vulnerable to inflammation and secondary infections like pneumonia.
Chronic Conditions That Raise the Stakes
Age alone doesn’t tell the whole story. Adults with certain underlying health conditions face a much higher chance of severe illness from RSV, regardless of whether they’re 55 or 80. The CDC identifies several categories of elevated risk:
- Heart disease: heart failure, coronary artery disease, or congenital heart conditions
- Lung disease: COPD, emphysema, asthma, interstitial lung disease, or cystic fibrosis
- Kidney disease: end-stage renal disease or dependence on dialysis
- Complicated diabetes: diabetes with kidney damage, nerve damage, or retinal damage, or diabetes requiring insulin
- Liver disease: cirrhosis or other chronic liver conditions
- Severe obesity: a BMI of 40 or higher
- Weakened immune system: from medications, organ transplant, cancer treatment, or immune disorders
- Neurologic or neuromuscular conditions: anything that weakens the muscles used for breathing or impairs the ability to clear the airway
- Nursing home residence: close-quarters living increases both exposure and vulnerability
If you have one or more of these conditions, an RSV infection is more likely to progress from an upper respiratory nuisance into a lower respiratory crisis involving pneumonia, bronchiolitis, or worsening of your existing lung or heart condition. Hospitalized RSV cases account for a small fraction of total infections (roughly 4%), but they drive 94% of the direct medical costs associated with the virus in adults.
The Financial Toll
RSV costs the U.S. healthcare system an estimated $4 billion annually among adults 60 and older. Of that, $2.9 billion goes to direct medical care, while $1.1 billion reflects lost productivity and other indirect costs tied to illness. Because hospitalized cases are so resource-intensive, even a modest reduction in severe infections could translate into significant savings.
Vaccine Options for Adults
Three RSV vaccines are now available for adults 50 and older: Arexvy (GSK), mResvia (Moderna), and Abrysvo (Pfizer). The CDC recommends a single dose for all adults 75 and older, and for adults 50 to 74 who have any of the high-risk conditions listed above. There is no preferred vaccine among the three.
Unlike the flu shot, the RSV vaccine is not an annual shot. One dose is considered a complete vaccination, and no booster is currently recommended. If you’re eligible and haven’t been vaccinated, the best time to get the shot is late summer or early fall, ideally between August and October, so protection is in place before RSV season peaks in winter. That said, it can be given at any time of year.
RSV Season and Spread
In most of the continental United States, RSV circulates primarily from fall through early spring, following a seasonal pattern similar to the flu. Adults catch it the same way they catch other respiratory viruses: through droplets from coughs and sneezes, direct contact like handshakes, or touching contaminated surfaces and then touching their face. The virus can survive on hard surfaces for several hours, which makes hand hygiene one of the simplest ways to reduce exposure.
Most healthy adults who get RSV won’t know it’s RSV. They’ll assume they have a cold and recover without ever being tested. That’s perfectly fine for people without risk factors. But for older adults and those with chronic health conditions, recognizing that RSV is a real and common threat is the first step toward taking it seriously, whether that means getting vaccinated, being more cautious during peak season, or asking for RSV testing when a respiratory illness hits harder than expected.