Often mistaken for the common flu, Respiratory Syncytial Virus can have significant impact on those 60 and above, and those with heart and lung diseases.

 

A 76-year-old female patient (prefers not to be known), who typically leads a healthy lifestyle by keeping herself occupied and taking supplements regularly, did not know that what she had contracted was Respiratory Syncytial Virus (RSV). She had started having flu-like symptoms and thought it was a common flu.

Though she had hypertension and no asthma, she was down with a mild cough, fever and runny nose for two to three days, which escalated to more frequent coughs, wheezing and breathlessness. She panicked when she encountered breathlessness for the first time, as she was under the impression that only asthmatic patients would experience such symptoms.

Three days after her admission to Mount Alvernia Hospital where X-rays of her heart and lungs were conducted, she was diagnosed with RSV in July 2024. During the course of her RSV infection, she required two to three litres of oxygen in the first two to three days, as well as regular doses of nebulised Salbutamol, Atrovent and steroids. She recovered speedily post-infection and took up the vaccination for RSV subsequently.

Though the patient was discharged from the hospital within the week, she mentioned she still does not feel fully recovered from RSV and could not give further details. She describes her encounter with RSV as a near-death episode and strongly encourages her friends to seek out professional advice and not undermine even the simplest symptoms.

 

What is RSV?

RSV is often mistaken as a common flu due to the cold-like symptoms including runny nose, sore throat, cough and headache. This misconception results in RSV flying below the radar when it can have a significant impact, particularly on those over 60, and individuals with underlying chronic conditions such as heart and lung diseases. Though not as common as the flu, a four-year study conducted in 2014 found that one in four individuals aged 65 and older in Singapore tested positive for RSV.

Dr Jim Teo, internist, intensivist and pulmonologist at The Respiratory Practice, called the condition a “highly contagious respiratory virus”. He shared that it can be transmitted through contact with contaminated surfaces or when an infected individual coughs or sneezes, releasing droplets that may come into contact with another person’s eyes, nose or mouth.

For seniors over 60 with existing health conditions such as chronic obstructive pulmonary disease, asthma, heart disease, diabetes, or chronic kidney disease, they may be at a higher risk for severe RSV. RSV may also lead to serious illness in individuals living in long-term care facilities and those with weakened immune systems.

“Most recover well from RSV infections, but for vulnerable groups above 60, those with chronic heart and lung diseases, obesity, chronic liver and renal disease, and those who are immunocompromised, they are likely to suffer from more serious respiratory complications in the form of bronchitis and pneumonia. This is associated with high morbidity and death,” Dr Teo added.

As RSV is very similar to cold and flu, he explained that it is hard to tell the difference unless a patient is swabbed and goes through a Polymerase Chain Reaction test, which can cost a few hundred dollars. “We usually don’t do it [the test] unless the patient is very sick or hospitalised,” he said.

Another common misconception about RSV is that it is a winter disease only, which is incorrect as it is found in Singapore, just like flu throughout the year. “Most cases are upper respiratory tract infection and patients are down for less than a week. But in vulnerable groups, this can be severe,” said Dr Teo.

 

Treatment & precautionary measures

There is currently no effective antiviral treatment for RSV. Shared Dr Teo, “Care focuses on relieving symptoms and providing supportive measures. Preventing the virus, particularly among high-risk groups, should be the priority.”

“Similar to cold and flu, when you are sick, you should put on a mask and stay at home to recover. You should wash your hands and practise good hygiene. Whatever we learnt during Covid-19 still holds true. If you are at a higher risk of RSV, do consider getting vaccinated. Prevention is better than cure.”

Dr Teo said that he has administered the RSV vaccination to around 100 patients who are seniors and those with chronic lung diseases following vaccination, Arexvy’s (by pharmaceutical company GSK) approval in Singapore in May. Currently, there is also another approved RSV vaccine called Abrysvo by pharmaceutical company Pfizer.

One dose is all that is needed  and it costs more than S$300. According to the US’ Centers for Disease Control and Prevention, experts are still learning how long a dose of RSV vaccine will last but they note that in those 60 and older, it is expected to last at least two years. Dr Teo also noted that no serious side effects from the vaccine have been detected.

He advised seniors to speak to their doctors if they are of higher risk of RSV. “Awareness is important, because much like flu and Covid-19, this virus can now be prevented effectively.”

 

(** PHOTO CREDIT: GSK)