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RSV: Symptoms, Protection for Babies & Vaccination for Seniors
At a glance
Who is affectedAlmost every child gets infected with RSV at least once in the first years of life
Risk groupsBabies in the first months of life, premature infants, older adults, people with COPD or heart failure
SeasonUsually October to March in Germany, peak typically January/February
Protection for babiesNirsevimab (passive immunization) — STIKO recommendation for all newborns and infants in their 1st RSV season; covered by statutory insurance
Protection for seniorsRSV vaccination: standard vaccination from age 75, indication-based vaccination ages 60–74 with a severe underlying condition or in a care facility
The respiratory syncytial virus (RSV) is one of the most common pathogens causing respiratory infections — and the most common cause of hospital admissions in babies in Germany. Almost every child gets infected at least once in the first years of life. In most, the infection runs its course like an ordinary cold — but in babies (especially in the first months of life), premature infants and older adults, RSV can lead to severe respiratory illness.¹˒⁶
RSV is also a frequently underestimated problem in older adults: it can cause severe pneumonia and worsen existing lung and heart conditions (e.g. COPD, heart failure).²
Effective protective measures available for the first time
Since the 2024/25 RSV season, there has been a passive immunization for babies (nirsevimab) and an active vaccination for older adults — both recommended by the STIKO (German Standing Committee on Vaccination).¹˒²
2. Symptoms: babies vs. adults
BabiesOften more severe — risk of bronchiolitis
Runny nose, cough, mild fever — at first often like a normal cold
Poor feeding — the child drinks considerably less than usual
Rapid breathing, nasal flaring, visible retractions of the chest
Wheezing breath sounds
Pauses in breathing (apnea) — especially in premature infants, can be life-threatening
Bluish discoloration of the lips or fingernails (cyanosis) — a sign of oxygen deficiency
Bronchiolitis — the typical RSV complication in babies
An inflammation of the small bronchi (bronchioles), in which viscous mucus can block the still-narrow airways. It is the most common clinical picture in an RSV-related hospital admission in infancy.⁶
AdultsOften like a cold — underestimated in seniors
In older adults and the chronically ill: shortness of breath, worsening of existing COPD or heart failure, pneumonia
RSV often goes unrecognized in adults — it is often regarded as "just a cold" and is usually not tested for
3. When to see a doctor? When to call 112?
Seek medical care immediately or call 112 with:
Marked poor feeding (considerably less than usual) · Rapid breathing, visible breathing difficulty, retractions of the chest · Fever in babies in the first months of life · Worsening after an initial improvement · Pauses in breathing (apnea) · Bluish lips or fingernails (cyanosis) · Extreme refusal to drink, striking listlessness · Change in consciousness¹˒⁶
When in doubt: better one check-up too many
RSV in babies in the first months of life should usually be taken seriously. Premature infants and babies with a congenital heart defect or chronic lung disease are particularly at risk.
4. Causes and transmission
Droplet infection — when coughing, sneezing or speaking
Smear (contact) infection — the virus can survive several hours on surfaces (door handles, toys)
Incubation period: usually a few days
Infectiousness: usually a few days after symptom onset (possibly longer in the immunocompromised)
Reinfection is possible — natural immunity only protects partially and temporarily
Important: adults with a seemingly harmless cold can unknowingly transmit RSV to babies
RSV vs. cold vs. flu vs. COVID
The symptoms usually overlap strongly — a reliable distinction without a test is usually not possible. In clinics and pediatric practices, multiplex tests that can detect several pathogens at once are often used. More: Respiratory infections — cold, flu, COVID.
5. Diagnosis
RSV rapid test: A nasal swab with a result within a few minutes. Available in clinics and many pediatric practices. RSV infections have been notifiable in Germany since 2023.
PCR: The most accurate detection — usually used for severe cases in the clinic.
Multiplex test: Simultaneous detection of RSV, influenza and SARS-CoV-2 — helps with differentiation.
6. Treatment
According to current knowledge, there is no specific medication against RSV. Treatment is usually symptomatic:⁶
Mild cases (at home)
Drink enough — for babies, more frequent, smaller feeds (breast or bottle)
Nasal drops (physiological saline solution) — keep the nose clear, especially before feeding
Position the upper body slightly elevated
If needed: lowering fever on medical advice — no ASA (aspirin) in children
In rare cases: respiratory support (CPAP or mechanical ventilation)
Antibiotics do not work against RSV
RSV is a virus — antibiotics only work against bacteria. They are only used when a secondary bacterial infection (e.g. a middle ear infection or bacterial pneumonia) is added.
Possible long-term consequences
In some children who have had RSV bronchiolitis, recurrent wheezing and a possibly increased asthma risk can occur in the following years. Children with severe RSV bronchiolitis should be monitored for respiratory symptoms in the following years.⁶
7. Protection for babies: nirsevimab
Nirsevimab — passive immunization for all infants
What it is: A monoclonal antibody (not a classic vaccination). A single dose usually protects against severe RSV illness over the RSV season. The baby does not form its own antibodies but receives them ready-made. STIKO recommendation: For all newborns and infants in their first RSV season — regardless of risk factors.¹ Timing: Babies born between April and September: in autumn before the start of the RSV season. Newborns during the RSV season (October to March): as soon as possible after birth. Effectiveness: In studies, nirsevimab was able to considerably reduce RSV-related hospital admissions in infants. Tolerability: Most common side effect: a mild, temporary rash at the injection site. Fever occurs rarely and is usually mild. Cost: Covered by statutory insurance for all infants with statutory health insurance.
Second RSV season
For children in their second RSV season, nirsevimab is usually only recommended in certain high-risk constellations (e.g. premature infants with bronchopulmonary dysplasia, hemodynamically relevant heart defects, severe immune defects). In these cases, palivizumab is also an alternative option (an older antibody given monthly).¹
8. RSV vaccination for older adults
The STIKO recommends an RSV vaccination for older adults:²
From 75Standard vaccination — single dose
A single RSV vaccination, ideally in September or early October before the RSV season.
60–74Indication-based vaccination — with a severe underlying condition or in a care facility
With a severe form of a relevant underlying condition (e.g. COPD, heart failure, diabetes with complications, severe immunodeficiency) or for residents of a care facility.
Available RSV vaccines for adults
In Germany, two protein-based and one mRNA-based RSV vaccine are currently approved for adults. The STIKO does not express a preference for a particular vaccine. In studies, high effectiveness against severe courses was shown.²˒⁵ Simultaneous vaccination: The protein-based RSV vaccines can usually be given at the same time as the seasonal flu vaccination (different arms).² Booster: Whether and when a booster is necessary cannot yet be conclusively assessed by the STIKO based on the current data.
9. Everyday life and prevention
Hand washing: The most important single measure. Always wash thoroughly with soap before contact with babies.
Adults with a cold: Do not kiss babies on the face, do not cough or sneeze on them. Adults with a cold can transmit RSV to babies — often without knowing it.
Breastfeeding: Breast milk contains antibodies that can offer a certain additional protection. Breastfeeding alone, however, usually does not reliably protect against RSV.
Room hygiene: Clean toys, pacifiers and bottles regularly. Air the room regularly.
Daycare and nursery: Common places of infection. Children with clear RSV symptoms should usually stay at home.
Tobacco smoke: Passive smoking can considerably increase the RSV risk and the severity of an RSV infection in babies. A smoke-free environment is important.
How brite helps you with RSV
Don't forget the nirsevimab appointment, keep an eye on symptoms, document vaccination dates — brite supports you and your family.
Intake reminder — nirsevimab appointment, fever reducers, vaccination dates: brite reminds you reliably. Set up a reminder
Health history — document fever, fluid intake, breathing rate and symptoms day by day. Track your history
Digital medication plan — all medications and vaccinations clearly organized for the pediatrician or GP. Go to medication plan
For most children and adults, no — RSV usually runs its course like a cold. But in babies in the first months of life, premature infants and older adults, RSV can lead to severe respiratory illness. RSV is the most common cause of hospital admissions in babies in Germany.⁶
A monoclonal antibody for passive immunization — a single dose usually protects babies against severe RSV illness over the RSV season. The STIKO recommends nirsevimab for all newborns and infants in their first RSV season. It is covered by statutory insurance and is not a classic vaccination — the baby receives the antibodies ready-made and does not form its own.¹
The STIKO recommends nirsevimab for all babies in their first RSV season — regardless of risk factors. In studies it was able to considerably reduce RSV-related hospital admissions. Tolerability is considered good. It is covered by statutory insurance.¹
Yes. The STIKO recommends a single RSV vaccination as a standard vaccination from age 75 and as an indication-based vaccination for people between 60 and 74 with a severe underlying condition or in care facilities. In Germany, two protein-based and one mRNA-based vaccine are available. The vaccination can usually be given at the same time as the flu vaccination.²
The most important measures: nirsevimab (STIKO-recommended and covered by statutory insurance), thorough hand washing before contact with the baby, adults with a cold should not kiss babies on the face, a smoke-free environment and — where possible — breastfeeding as an additional protective factor.¹
Yes — natural immunity after an RSV infection only protects partially and temporarily. Reinfections are common but usually run a milder course than the first infection. The highest risk of a severe course is with the first infection in the first year of life.
No — RSV is a virus, and antibiotics only work against bacteria. Antibiotics are only used when a secondary bacterial infection (e.g. a middle ear infection or bacterial pneumonia) is added.
A medical visit or hospital admission should take place with marked poor feeding, breathing difficulty (rapid breathing, retractions, nasal flaring), pauses in breathing, bluish lips or fingernails, and fever in the first months of life. When in doubt, it is usually better to have one check-up too many than one too few.⁶
An inflammation of the small bronchi (bronchioles) — the typical RSV complication in babies. Viscous mucus blocks the still-narrow airways, which can lead to wheezing breath sounds and breathing difficulty. Bronchiolitis is the most common clinical picture in an RSV-related hospital admission in infancy.⁶
Cochrane Review: RSV-Impfung bei Senioren (2025). cochrane.de
gesundheitsinformation.de (IQWiG): RSV-Infektion bei Babys und Kleinkindern. gesundheitsinformation.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. With breathing difficulty, refusal to drink, pauses in breathing or bluish lips in a baby, the emergency number 112 should be called immediately or a pediatric emergency department visited. RSV in babies in the first months of life should usually be taken seriously. The decision about vaccinations and immunizations is always made by the treating doctor. Last updated: April 2026.
