Public worry about RSV has faded, unlike flu and COVID-19

More than 100,000 older adults are hospitalized on average yearly in the United States with RSV (respiratory syncytial virus), as are 58,000 or more infants and young children under the age of 5, according to the Centers for Disease Control and Prevention (CDC). The CDC says 6,000 or more older adults and 100 or more young children die annually of RSV.

Yet public worry about contracting RSV has dropped significantly in the past year, though not worry about contracting COVID-19 or the seasonal flu, according to a new Annenberg Public Policy Center health survey conducted in September 2024.

The survey finds that 1 in 4 people (26%) surveyed are worried about getting or having a family member get RSV over the next three months, significantly less than 1 in 3 (35%) who were worried in October 2023, at the onset of last year’s RSV season. By contrast, 33% are worried about getting or having a member get COVID-19 in the next three months, and 37% are worried about the flu, neither one significantly changed from October 2023.

“It is possible that memories of last year’s winter holiday surge in respiratory illnesses and of the 2022–23 ‘tripledemic’ of COVID-19, flu, and RSV respiratory viruses have faded,” says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania and director of the survey.

The findings come from APPC’s latest nationally representative Annenberg Science and Public Health Knowledge (ASAPH) survey, conducted with a panel of more than 1,700 U.S. adults in September 2024.

RSV: A common virus, but potentially severe for the old and young

According to the CDC, RSV is very common and usually causes mild, cold-like symptoms. Most infections go away on their own, so most people are unaware that they have had an RSV infection. But RSV can be more severe, especially for babies, some young children, and older adults. In fact, RSV hospitalizes 100,000 to 200,000 Americans each year. Increasing awareness and immunization rates among these populations have the potential to dramatically reduce hospitalizations.

RSV vaccines for older adults entered the U.S. market in May 2023. A year later, in June 2024, the CDC updated recommendations to protect older adults at the greatest risk for severe RSV, saying that everyone 75 and older should receive a single dose of the vaccine and those 60 to 74 years old who are at increased risk should as well. New CDC evidence finds that older adults getting vaccinated against RSV reduces hospitalization with severe illness.

In the summer of 2023, two immunization options to protect infants from severe RSV also became available. In August 2023, the CDC recommended an RSV vaccine for pregnant individuals to be given during weeks 32 to 36 of pregnancy to protect their babies born during the RSV season.

The CDC also recommended an injection to be administered to infants 8 months and younger, providing an additional option for protecting very young children. Most babies do not need both.

These options protect very young infants from severe RSV, the primary reason children that young are hospitalized. Child hospitalization rates from RSV are the highest for those six months and younger, with a peak at one month old.

“We are seeing increased awareness of RSV vaccines to protect the very young,” says Laura A. Gibson, the senior data analyst at APPC who analyzed the RSV data. “If this translates into increased immunization rates, we could reduce their hospitalization rates.”

Nearly half of those surveyed (46%) in September 2024 know that there is a Food and Drug Administration-approved vaccine against RSV for those who are pregnant to benefit their newborns, while 4% say there is no such vaccine.

This is a significant increase in awareness of the vaccine from 12% in August 2023, when the survey was last fielded and just as the RSV vaccine for pregnant people was approved by the FDA. There was also a corresponding decrease in the proportion who were unsure from 70% in August 2023 to 50% in September 2024.

CDC recommendations on vaccination against RSV

To maximize protection during the fall and winter RSV season, the CDC recommends that pregnant people get the RSV vaccine between September and January if weeks 32–36 of their pregnancy fall during that time. Protection for their infant will last for approximately six months after birth. If parents choose the RSV antibody for infants less than eight months old, that should be administered between October and March and will last at least five months after immunization.

For older adults, the CDC recommends all adults 75 years and older get an RSV vaccine. Adults 60–74 years old should get vaccinated against RSV if they are at increased risk of severe RSV. Some conditions that increase risk include living in a nursing home or having a weakened immune system.

This is an update as of June 26, 2024 from the previous CDC RSV recommendations for older adults (which was for adults 60 years and older to get the RSV vaccine after consulting with their health care providers). For maximum protection during the fall and winter RSV season, older adults should be vaccinated between August and October.

Support for preventive measures against RSV

The survey on RSV and the vaccines found about half of respondents support RSV preventives:

• The vaccine during pregnancy: Fewer people are unwilling to recommend the RSV vaccine to a pregnant friend or family member. Told that the CDC recommended this new vaccine against RSV for pregnant individuals to protect their infants: 40% would not recommend it, a significant decrease from 45% not recommending it in October 2023. In contrast 46% would recommend it, about the same as the 43% who recommended it in October 2023.
• The monoclonal antibody injection for infants: 46% say they would be likely to recommend a friend or family member get the monoclonal antibody injection for their infant and 30% would not. When asked about this injection in October 2023, in a question that was worded slightly differently, 42% said they were likely to recommend that a friend or family member ask their health care provider to give their infant the monoclonal antibody injection, while 35% were not likely to do so. This shift in support of a preventive measure to protect the infant resembles the shift in support of the vaccine during pregnancy described above.
• Preference for vaccine during pregnancy: Given the choice between protecting an infant against RSV by a vaccine for pregnant individuals or an injection for infants, more respondents chose the vaccine (40%) than the infant injection (11%)—a significant increase in preference for the vaccine from 31% in October 2023. Also, a third of people were not sure (32%, down from 37% in August 2023) and 16% selected neither (down from 21% in August 2023).
• The vaccine for older adults: Over half of those surveyed (54%) either got the RSV vaccine (3%) or say they would be likely to recommend that a friend or family member age 75 or older or 60–74 and at increased risk get the RSV vaccine (51%). A previous question in February 2024 asked about recommending that adults 60 years or older talk to their health care provider about this preventative health care, but the rates were very similar (56% got it or would recommend talking about getting it with their health care provider).

Great uncertainty about RSV

Only small segments of the American public correctly answer questions about RSV. Most people say they are not sure. The survey found that:

• Symptoms: One in 5 people (20%) know it’s more accurate to say that RSV usually produces mild, cold-like symptoms than serious difficulties in breathing (44%), while 36% are not sure. The percentage who believes that RSV produces serious difficulties in breathing has increased significantly from October 2023, when 38% believed that.
• Persistence: One in 4 people (25%) know it’s more accurate to say that RSV can survive for many hours on hard surfaces such as table or crib rails than to say RSV can’t survive for many hours on these hard surfaces (7%). Over two-thirds of people (68%) say they are not sure. But there’s been a significant shift from not sure to the accurate belief since June 2023, when 74% were not sure and just 17% knew it could survive on hard surfaces.
• Reoccurrence: About 4 in 10 people (42%) know it’s more accurate to say that once a person contracts RSV, they can get it again. Only 3% incorrectly believe it’s more accurate to say that you can’t get RSV again, but 55% say they are not sure. There’s been a significant increase in uncertainty since October 2023 when 50% were not sure and 48% knew the more accurate response.
• Spreading the virus while asymptomatic: Just over 4 in 10 people (43%) know it’s more accurate to say it is possible to have and spread RSV before showing symptoms than to say it is not possible (3%). But over half of those surveyed (54%) are not sure.
• Typical season for RSV: During the height of the coronavirus pandemic, RSV infection patterns were disrupted. But starting in fall 2022, RSV infections returned to their typical fall/winter seasonality. About half of respondents (51%) knew people are most likely to get RSV in the fall and winter, while 1 in 3 people (32%) were not sure. This was a significant decrease in knowing that fall and winter is the most likely time of year to get RSV, from 63% in October 2023, and an increase in uncertainty from 21%.
• Unaware of how common it is: Although RSV is very common, people are unaware that they have had it. Most respondents (85%) think they have never had RSV. The CDC states that “Nearly every child will get RSV by the time they are 2 years old.” Asked how many children contract RSV before the age of two, only 3% of our survey respondents correctly say, “virtually all.” Although 3% is a statistical increase from 2% in August 2023, it is clear that respondents do not realize RSV is very common.
• More familiar with severe cases: Although RSV is typically not severe, severe cases are more memorable. Also, people with more severe cases of RSV are more likely to undergo diagnostic testing to confirm that it is RSV. Only 18% in the current survey say they know children who had RSV, but most of those cases (63%) were somewhat or very serious. Similarly, only 6% say they know someone age 60 or older who had RSV, but again most of those cases (69%) were somewhat or very serious.

Less than half recognize the symptoms for infants

Less than half of those surveyed recognized some of the most common symptoms of RSV in an infant (respondents were asked to select all that applied):

• Wheezing: 48% know this is a symptom
• Decreased activity: 39% know this is a symptom (a significant increase from 32% in June 2023)
• Runny nose: 37% know this is a symptom
• Pauses in breathing: 35% know this is a symptom
• Decreased appetite: 33% know this is a symptom

Very few people incorrectly selected non-respiratory symptoms as associated with RSV (these are not symptoms of RSV):

• Jaundiced skin: 6% incorrectly say this is a symptom
• Spontaneous bruising: 2% incorrectly say this is a symptom
• Bleeding gums: 2% incorrectly say this is a symptom

APPC’s Annenberg Science and Public Health knowledge survey

The survey data come from the 21st wave of a nationally representative panel of 1,744 U.S. adults conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. Most have been empaneled since April 2021. To account for attrition, small replenishment samples have been added over time using a random probability sampling design.

The most recent replenishment, in September 2024, added 360 respondents to the sample. This wave of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded Sept. 13–22 and Sept. 26–30, 2024. The margin of sampling error (MOE) is ± 3.5 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.

The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, COVID-19, flu, RSV, and other consequential health issues through this survey panel over the past two-and-a-half years.

In addition to Jamieson and Gibson, APPC’s team on the survey includes research analyst Shawn Patterson Jr., Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute, and Ken Winneg, managing director of survey research.