Ask AI
Back Back
Why RSV Diagnosis Matters
The Underestimated Burden of RSV: Why Accurate Diagnosis Matters for Patients and Public Health

Released: September 26, 2025

Carina Marquez
Carina Marquez, MD, MPH
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • RSV is not just a childhood illness. It causes severe disease, hospitalizations, and deaths in older adults and vulnerable populations, with a burden comparable to influenza.
  • Accurate diagnosis matters—molecular testing improves patient management, reduces inappropriate antibiotic use, and strengthens public health efforts such as surveillance, vaccine uptake, and infection prevention.

Respiratory syncytial virus (RSV) has long been viewed primarily as a childhood illness. Parents, pediatricians, and public health professionals alike recognize its role in bronchiolitis and hospitalizations among infants.

Yet this perception hides a larger truth: RSV is not just a pediatric concern. Adults—especially older adults, those with chronic cardiopulmonary disease, and immunocompromised patients—face significant risks from RSV, and the true burden of disease across the lifespan remains underestimated. 

Recent evidence, combined with advances in diagnostic tools, highlights why healthcare professionals (HCPs) must reassess their approach to RSV. Accurate diagnosis has implications not only for individual patients but also for antibiotic stewardship, infection control, vaccine uptake, and broader public health policy.

The Overlooked Burden of RSV
For decades, influenza has dominated discussions of viral respiratory disease in adults. However, studies now show that RSV can be just as serious, if not more so, in certain populations. In a prospective global study, patients hospitalized with RSV were more likely to require supplemental oxygen, suffer complications, and need intensive care than those hospitalized with influenza. Among older adults, RSV causes tens of thousands of hospitalizations annually in the US, with mortality rates comparable to influenza.

RSV’s burden also extends to exacerbations of chronic diseases. Patients with chronic obstructive pulmonary disease, asthma, or heart failure often experience worsening symptoms when infected. Indeed, RSV is now linked to myocardial injury and hospitalizations for heart failure. Taken together, the virus accounts for billions of dollars in healthcare costs annually.

Yet despite these data, RSV is consistently underestimated. Why? The answer lies largely in diagnostic practices.

Why Diagnosis Is Difficult—and Essential
The symptoms of RSV—fever, cough, congestion, fatigue—overlap with those of influenza, COVID-19, and the common cold. Its seasonality is also similar, making it impossible for HCPs to distinguish RSV from other respiratory pathogens without laboratory testing.

The gold standard today is molecular testing, particularly reverse transcription polymerase chain reaction (RT-PCR), which offers sensitivities above 80%. Point-of-care (POC) molecular tests now allow HCPs to obtain rapid, accurate results in outpatient settings. This represents a transformative shift: HCPs can confirm RSV in real time, shaping treatment decisions and public health responses.

Rapid antigen tests may be used in settings without access to molecular testing or alongside molecular testing. However, their accuracy is lower than RT-PCR, particularly in older adults. Culture and serology are too cumbersome or unreliable.

The Consequences of Missed Diagnoses
Failing to diagnose RSV carries real consequences. Diagnostic uncertainty often leads to unnecessary antibiotic prescriptions. Approximately half of all outpatient antibiotics for acute respiratory infections are estimated to be inappropriate, fueling antimicrobial resistance—a global health crisis. Confirming RSV helps HCPs provide appropriate supportive care while avoiding unnecessary antibiotics.

At the community level, knowing who has RSV can reduce transmission to vulnerable populations such as infants, older adults, and immunocompromised individuals. Accurate diagnosis also contributes to surveillance data that guide vaccine recommendations and preparedness planning. Without widespread testing, the true prevalence of RSV remains hidden, hindering both awareness and prevention efforts. 

Barriers to Implementation in Practice
Despite the clear benefits, barriers exist. HCPs may question the value of testing when no specific antiviral therapy for RSV is yet available. Many are unfamiliar with testing options, leading to inappropriate reliance on antigen tests in adults. Others cite challenges related to workflow, time, and reimbursement.

Studies confirm these knowledge and practice gaps. In surveys, fewer than one third of HCPs recognized that antigen tests are less sensitive in adults compared to children. Many also reported rarely considering RSV in older patients, often because they perceived no treatment benefit.

Cost and logistics are additional hurdles. Molecular testing devices require investment, and reimbursement policies vary. To successfully implement POC testing, clinics must determine which patient groups to test, train staff, and clarify billing procedures.

The Public Health Value of Accurate Diagnosis
Even without a specific antiviral, RSV testing matters. Accurate diagnosis supports:

  • Surveillance and epidemiology: More testing improves estimates of RSV’s true burden, informing public health policies and vaccine strategies.
  • Infection prevention: Patients with confirmed RSV can take precautions to protect those at highest risk.
  • Vaccine uptake: Awareness of RSV’s prevalence can improve acceptance of new vaccines among older adults and parents. Misconceptions that RSV is “just a childhood disease” remain a barrier to vaccination campaigns. 
  • Antibiotic stewardship: Confirming viral etiology reduces inappropriate antibiotic use, slowing the spread of antimicrobial resistance.
  • Treatment in Immunocompromised Patients: Confirming viral etiology can guide treatment considerations in patients with transplants and hematologic malignancies.

With new RSV vaccines for older adults and maternal and infant immunization strategies now available, awareness of the disease is especially critical. Expanding diagnostic practices will amplify the impact of these preventive tools.

Moving Forward
RSV should no longer be dismissed as a minor pediatric illness. It is a serious respiratory pathogen across the lifespan, responsible for hospitalizations, exacerbations of chronic disease, and thousands of deaths annually. HCPs who embrace accurate diagnostic practices can improve patient care, reduce inappropriate prescribing, and strengthen public health surveillance.

The future may bring RSV antivirals, but even now, testing carries significant benefits. By recognizing the underestimated burden of RSV and implementing effective diagnostic strategies, HCPs can help shift the narrative and ultimately improve outcomes for both patients and communities.

Your Thoughts
Share your thoughts, stories, or questions below. Together, we can close knowledge gaps and protect more patients across the lifespan.

Continue