The Virus You’ve Never Heard Of: RSV

 In recent years, respiratory viruses have become household concerns. Yet one silent and surprisingly common threat continues to be misunderstood: Respiratory Syncytial Virus, or RSV.

Often brushed off as just another seasonal cold, RSV is actually one of the leading causes of serious respiratory illness, hospitalisation, and death among infants under six months and older adults aged 60 and above.

Globally, RSV is responsible for over 33 million lower respiratory tract infections in children under five each year. Of these, 3.6 million cases require hospitalisation, and nearly 100,000 results in death. Among older adults, particularly those living with diabetes, asthma, or heart conditions, RSV can worsen existing health problems and cause severe complications that mimic or intensify pneumonia and chronic lung disease.

Despite its global burden, RSV often flies under the radar. Most parents and caregivers have never even heard of it – until their loved one ends up in the hospital.

“We’ve seen previously healthy newborns end up in the intensive care unit within days due to RSV,” says Dr. Gan Chin Seng, Consultant Paediatrician and Paediatric Intensivist. “One of the hardest things I’ve ever had to do is watch a baby fight to breathe while their parents stand by, unable to do anything. It’s heartbreaking, and I’ve witnessed this far too many times.”

In Malaysia, RSV infections occur throughout the year but tend to peak during the monsoon season, between August and January. Each year during the rainy season, Dr. Gan and his team at the Paediatric ICU Care for waves of young patients struggling to breathe. Many of them are just weeks old and require mechanical ventilation for survival. 

Protecting Babies Before Their First Breath

For Dr. Gayathri Mariappa, the danger of RSV became painfully personal when her own son fell ill at just four months old.

“I still remember the fear in my heart,” says Dr. Gayathri, a Consultant in Obstetrics and Gynaecology specialising in Maternal Fetal Medicine. “Despite being a doctor, nothing prepares you for the helplessness of seeing your child experience difficulty breathing, requiring oxygen support and nebulisation. That moment forever changed how I speak to my patients about prevention.”

Since then, Dr. Gayathri has made it a mission to raise awareness among expecting mothers about RSV and how early protection begins with maternal care. She explains that certain vaccines administered during pregnancy help pass protective antibodies to the baby. This natural transfer offers critical protection during the first few months of life, when babies are most vulnerable and too young for their own vaccinations.

“Maternal immunisation creates a protective shield for your baby,” she says. “It is like handing them an invisible blanket that guards them from life-threatening infections before they’ve even taken their first breath.”

In Malaysia, expectant mothers are already encouraged to receive vaccines such as tetanus, influenza, and pertussis. These vaccines are known to protect both mother and child. Although RSV-specific maternal immunisation is not yet routine here, global health experts are actively studying its potential.

“Every mother wants to give her child the best start in life,” says Dr. Gayathri. “And in many cases, that start begins with disease prevention.”

The Emotional and Financial Cost of RSV

Beyond the clinical statistics, RSV takes a heavy emotional and financial toll on families.

The Netherlands’ BRICK Study, one of the most comprehensive international RSV research efforts, found that nearly 30 percent of parents whose infants were hospitalised for RSV showed signs of post-traumatic stress. Families also face lost income from time off work, high hospital bills, and the emotional strain of seeing a child or elderly loved one on life support.

In Malaysia, the situation is similar. Many parents spend anxious days at their child’s bedside, struggling to understand how a virus they’ve never heard of could turn their world upside down.

“If we can prevent even one family from going through what mine went through, it’s worth everything,” says Dr. Gayathri, reflecting on her own experience as a mother and a doctor.

From Grandchildren to Grandparents: A Shared Risk

While RSV is often associated with children, its impact on older adults is just as alarming. Seniors with underlying conditions such as diabetes, heart disease, or chronic lung conditions are especially vulnerable. The concern is particularly significant in Malaysia, where more than half a million adults live with four or more chronic health conditions, according to the 2023 National Health and Morbidity Survey (NHMS). For this group, even a mild RSV infection can trigger severe complications and hospitalisation.

Many elderly patients infected with RSV may not even realise they are seriously ill. Symptoms such as fatigue, low-grade fever, and confusion often resemble those of other common illnesses or may simply be chalked up to old age. As a result, RSV often goes undiagnosed until the condition worsens and complications like pneumonia or heart failure occur.

“Older adults tend to dismiss early symptoms,” says Dr. Gan. “Unfortunately, by the time they come to us, they are often in much more serious condition than they realise.”

The problem is compounded in multigenerational homes, a common arrangement in Malaysia. When babies and grandparents live under the same roof, the potential for transmission increases. During confinement periods or festive gatherings, even a mild cough from one family member could trigger a chain of illness affecting the most fragile members of the household.

“This is why we talk about RSV protection as a family issue,” explains Dr. Gayathri. “When a pregnant mother is protected, she shields her baby. When an elderly grandparent is protected, they help safeguard the entire home. It’s about caring for one another, across generations.”

Healthcare professionals are encouraging expectant mothers to speak with their doctors about immunisation during pregnancy. These conversations during routine antenatal visits can make all the difference. Meanwhile, adult children are urged to ensure that their elderly parents are up to date with their respiratory-related vaccinations, particularly during the rainy season.

Recognising RSV early is equally important. Symptoms in both infants and the elderly include coughing, wheezing, difficulty breathing, fatigue, and poor appetite. In older adults, signs such as confusion or unusual tiredness should also be taken seriously.

As Malaysia moves through another RSV season, the medical community is united in its call to action: Let’s not wait until another baby ends up in the ICU or another grandparent is struggling to breathe. Every breath matters – from your child’s first to your parent’s next.

“Vaccination is not just for those who are sick,” says Dr. Gan. “It is for those who are healthy and want to stay that way. Especially for the most vulnerable, prevention is peace of mind.”