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RSV: Symptoms, Protection for Babies & Vaccination for Seniors
At a glance
Who's affectedAlmost every child is infected with RSV at least once in the first years of life
Risk groupsBabies in the first months of life, premature babies, older adults, people with COPD or heart failure
SeasonUsually October to March (Northern Hemisphere), peaking around January/February
Protection for babiesNirsevimab (passive immunization) — STIKO recommends it for all newborns and infants in their 1st RSV season; covered by statutory health insurance
Protection for seniorsRSV vaccination: standard vaccination from age 75, risk-based vaccination at 60–74 with a serious underlying condition or in a care facility
Respiratory syncytial virus (RSV) is one of the most common causes of respiratory infections — and the most common cause of hospital admissions in babies. Almost every child is 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 babies and older adults, RSV can lead to serious 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 vaccine for older adults — both recommended by STIKO.¹˒²
2. Symptoms: babies vs. adults
BabiesOften more severe — risk of bronchiolitis
Runny nose, cough, mild fever — often like a normal cold at first
Poor feeding — the child drinks markedly less than usual
Pauses in breathing (apnea) — especially in premature babies, 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 airways (bronchioles), in which thick mucus can block the still-narrow airways. It is the most common diagnosis behind an RSV-related hospital admission in infancy.⁶
AdultsOften like a cold — underestimated in seniors
In older adults and people with chronic illness: shortness of breath, worsening of existing COPD or heart failure, pneumonia
RSV often goes unrecognized in adults — it's frequently dismissed as "just a cold" and usually isn't tested for
3. When to see a doctor? When to call 112?
See a doctor immediately or call 112 if there is:
Marked poor feeding (drinking much less than usual) · Rapid breathing, visible breathing difficulty, chest retractions · 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, unusual floppiness · A change in consciousness¹˒⁶
When in doubt: get it checked once too often
RSV in babies in the first months of life should usually be taken seriously. Premature babies and babies with a congenital heart defect or chronic lung disease are especially at risk.
4. Causes and transmission
Droplet transmission — when coughing, sneezing or talking
Contact (surface) transmission — the virus can survive on surfaces (door handles, toys) for several hours
Incubation period: usually a few days
Contagiousness: usually for a few days after symptoms start (possibly longer in people with weakened immune systems)
Reinfection is possible — natural immunity protects only partially and temporarily
Important: Adults with a seemingly harmless cold can unknowingly pass RSV on to babies
RSV vs. cold vs. flu vs. COVID
The symptoms usually overlap heavily — reliably telling them apart without a test is mostly not possible. Hospitals and pediatric practices often use multiplex tests that can detect several pathogens at once. Learn more: Respiratory infections — cold, flu, COVID.
5. Diagnosis
RSV rapid test: A nasal swab with a result within a few minutes. Available in hospitals and many pediatric practices. RSV infections have been notifiable in Germany since 2023.
PCR: The most accurate test — usually used in hospital for severe cases.
Multiplex test: Simultaneous detection of RSV, influenza and SARS-CoV-2 — helps tell them apart.
6. Treatment
Based on 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)
Saline nose drops — keep the nose clear, especially before feeding
Position the upper body slightly raised
If needed: fever reduction as advised by a doctor — no aspirin in children
Humidify the room air
Severe cases (hospital)
Oxygen (e.g. nasal cannula, high-flow)
Suctioning of nasal mucus
Feeding via a feeding tube in case of marked refusal to drink
In rare cases: breathing support (CPAP or mechanical ventilation)
Antibiotics don't work against RSV
RSV is a virus — antibiotics only work against bacteria. They are used only if a secondary bacterial infection (e.g. a middle ear infection or bacterial pneumonia) develops.
Possible long-term effects
In some children who have had RSV bronchiolitis, recurrent wheezing and a possibly increased risk of asthma can occur in the following years. Children who had severe RSV bronchiolitis should be monitored for respiratory symptoms in the years afterward.⁶
7. Protection for babies: nirsevimab
Nirsevimab — passive immunization for all infants
What it is: A monoclonal antibody (not a classic vaccine). A single dose usually protects against severe RSV illness over the RSV season. The baby doesn't make 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 the autumn before the RSV season begins. Newborns during the RSV season (October to March): as soon as possible after birth. Effectiveness: In studies, nirsevimab significantly reduced RSV-related hospital admissions in infants. Tolerability: Most common side effect: a mild, temporary rash at the injection site. Fever is rare and usually mild. Cost: Covered by statutory health insurance for all infants with statutory insurance.
Second RSV season
For children in their second RSV season, nirsevimab is usually recommended only in certain high-risk situations (e.g. premature babies with bronchopulmonary dysplasia, hemodynamically significant heart defects, severe immunodeficiencies). In these cases, palivizumab is an alternative option (an older antibody given monthly).¹
8. RSV vaccination for older adults
STIKO recommends an RSV vaccination for older adults:²
From 75Standard vaccination — one-time
A single RSV vaccination, ideally in September or early October before the RSV season.
60–74Risk-based vaccination — for a serious underlying condition or care facility
For 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 for adults are currently approved. STIKO does not express a preference for any particular vaccine. Studies have shown high effectiveness against severe disease.²˒⁵ Co-administration: The protein-based RSV vaccines can usually be given at the same time as the seasonal flu shot (in different arms).² Booster: Based on current data, STIKO cannot yet conclusively say whether and when a booster is needed.
9. Everyday life and prevention
Hand washing: The single most important measure. Always wash thoroughly with soap before contact with babies.
Adults with a cold: Don't kiss babies on the face, cough or sneeze on them. Adults with a cold can pass RSV on to babies — often without knowing it.
Breastfeeding: Breast milk contains antibodies that can provide some additional protection. However, breastfeeding alone usually does not reliably protect against RSV.
Room hygiene: Clean toys, pacifiers and bottles regularly. Air the room regularly.
Daycare and nursery: Common places to catch it. Children with clear RSV symptoms should usually stay home.
Tobacco smoke: Secondhand smoke can significantly increase the risk and 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, log vaccination dates — brite supports you and your family.
Reminders — Nirsevimab appointment, fever-reducing medicines, vaccination dates: brite reminds you reliably. Set up a reminder
Health tracking — Log fever, amount drunk, breathing rate and symptoms day by day. Track your history
Digital medication plan — all medications and vaccinations clearly laid out for your pediatrician or GP. Go to medication plan
For most children and adults, no — RSV usually runs its course like a cold. In babies in the first months of life, premature babies and older adults, however, RSV can lead to serious respiratory illness. RSV is the most common cause of hospital admissions in babies.⁶
A monoclonal antibody for passive immunization — a single dose usually protects babies against severe RSV illness over the RSV season. STIKO recommends nirsevimab for all newborns and infants in their first RSV season. It is covered by statutory health insurance and is not a classic vaccine — the baby receives the antibodies ready-made and doesn't make its own.¹
STIKO recommends nirsevimab for all babies in their first RSV season — regardless of risk factors. In studies it significantly reduced RSV-related hospital admissions. It is considered well tolerated. It is covered by statutory health insurance.¹
Yes. STIKO recommends a single RSV vaccination as a standard vaccination from age 75 and as a risk-based vaccination for people aged 60 to 74 with a serious 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 shot.²
The most important measures: nirsevimab (STIKO-recommended and covered by statutory health insurance), thorough hand washing before contact with the baby, adults with a cold not kissing 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 protects only partially and temporarily. Reinfections are common, but usually run a milder course than the first infection. The highest risk of a severe course is during the first infection in the first year of life.
No — RSV is a virus, and antibiotics only work against bacteria. Antibiotics are used only if a secondary bacterial infection (e.g. a middle ear infection or bacterial pneumonia) develops.
A medical visit or hospital admission is warranted with marked poor feeding, breathing difficulties (rapid breathing, retractions, nasal flaring), pauses in breathing, bluish lips or fingernails, and with fever in the first months of life. When in doubt, it's usually better to get your child checked once too often than once too little.⁶
An inflammation of the small airways (bronchioles) — the typical RSV complication in babies. Thick mucus blocks the still-narrow airways, which can lead to wheezing and breathing difficulties. Bronchiolitis is the most common diagnosis behind an RSV-related hospital admission in infancy.⁶
Cochrane Review: RSV Vaccination in Older Adults (2025). cochrane.de
gesundheitsinformation.de (IQWiG): RSV Infection in Babies and Young Children. gesundheitsinformation.de
Medical disclaimer: This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. If a baby has breathing difficulties, refuses to drink, has pauses in breathing or bluish lips, call the emergency number 112 immediately or go to a pediatric emergency department. RSV in babies in the first months of life should usually be taken seriously. Decisions about vaccinations and immunizations are always made by your treating doctor. Last updated: April 2026.
