With the onset of the spring season, hospitalizations caused by Respiratory Syncytial Virus (RSV) have significantly increased. In Georgia, the peak of the influenza season for 2025–2026 was recorded in the last two weeks of December (361 cases per 100,000 population), after which infection rates gradually declined.
Currently, influenza is no longer the dominant respiratory infection, having been replaced by RSV. This pathogen causes inflammation of the small bronchi (bronchioles) and narrowing of their diameter, which manifests clinically through paroxysmal coughing, acute respiratory distress, fever, and tachypnea (rapid breathing). Children under the age of 3 and individuals over 60 represent particularly high-risk groups.
We spoke with infectious disease specialist Alexander Goginava regarding the current epidemiological picture, the clinical characteristics of the virus, and prevention strategies.
Why has RSV become the leading virus at this stage, and how does its transmission dynamics differ from influenza?
Respiratory Syncytial Virus is a seasonal respiratory pathogen that circulates annually, though the intensity of its spread varies significantly from year to year. The epidemiological dynamics of RSV largely coincide with the seasonality of influenza—both infections become active in late autumn and continue through the first half of spring.
Observations in recent years have revealed a trend where the number of RSV cases increases following the peak of the flu season. This phenomenon is likely related to the alternation of dominance between viruses. It is noteworthy that while RSV can circulate at other times of the year, its peak activity remains tied to the cold seasons.
When interpreting transmission dynamics, it is important to consider diagnostic patterns and healthcare-seeking behavior. In the case of influenza—especially when Type A viruses like H3N2 (the so-called “Hong Kong Flu”) are prevalent—diagnostics are more intensive. Due to the severe clinical presentation of the flu, medical consultation rates among adults are high. Consequently, the proportion of RSV cases appears lower during the flu peak. However, as the influenza wave subsides, the detection frequency of RSV rises. This is partly due to a real increase in the pathogen’s spread and partly because other respiratory infections often run a milder course and are less likely to be laboratory-confirmed. In contrast, with RSV—especially during severe clinical presentations—hospital visits and diagnostics are significantly higher, increasing its epidemiological visibility in both outpatient and inpatient services.
Is it possible to distinguish between RSV and influenza based on clinical signs?
From a clinical standpoint, differentiating between RSV and influenza based solely on symptoms is often difficult, as both pathogens are respiratory infections. However, certain distinguishing features do exist. Influenza typically begins acutely with high fever and pronounced intoxication, followed by respiratory symptoms (cough, sore throat, rhinitis). RSV infection often starts relatively mildly with a dry cough and catarrhal symptoms of the upper respiratory tract (rhinitis, nasal discharge), after which the disease may progress and damage the lower respiratory tract. Nevertheless, a definitive diagnosis still requires laboratory confirmation.
Why are children under two (especially under six months) and the elderly at particular risk? What are the most common complications in these groups?
The most significant and potentially dangerous complication of RSV infection is damage to the lower respiratory tract—specifically, inflammation of the small-caliber bronchi, known as bronchiolitis. During this process, acute inflammation develops, leading to breathing difficulties, especially in infants and the elderly. This complication is the primary reason for hospitalization, as patients often require oxygen therapy and intensive medical supervision.
The infection may also be accompanied by other respiratory complications such as sinusitis or damage to other organ systems; however, in clinical practice, such cases are relatively rare, and bronchiolitis remains the dominant complication.
Regarding risk groups, the high risk in infants under six months is due to the functional immaturity of the airways and the immune system. For similar reasons, the elderly and immunocompromised individuals are also at high risk—their immune response is diminished due to age-related factors or underlying chronic pathologies, increasing vulnerability to the pathogen and resulting in a severe clinical course.
What are the main clinical signs that indicate the necessity of hospitalization?
The decision to hospitalize is based on a complex assessment of respiratory function. Particularly noteworthy signs include acute difficulty breathing, cyanosis (bluish tint around the nose and mouth), paroxysmal coughing, noisy breathing (inspiratory and expiratory wheezing), as well as lethargy and other neurological symptoms. It is important to note that in children, oxygen saturation may remain within the normal range at certain stages; however, if clinical signs are present, inpatient monitoring is still recommended.
What preventive measures are recommended for the population during the viral season?
Prevention of respiratory infections is based on controlling their transmission mechanisms. Since they spread mainly through airborne droplets and contact, the following are crucial:
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Regular ventilation of enclosed spaces;
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Wet cleaning of surfaces;
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Strict adherence to personal hygiene (especially frequent hand washing);
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Using face masks in high-risk environments;
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Avoiding crowded places (for vulnerable groups);
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Limiting contact with infected individuals.
Additionally, I urge the population to get vaccinated against influenza, which significantly reduces the risk of developing co-infections. As for a specific RSV vaccine—although it is not available at this stage, it is critically necessary to introduce it to the country and ensure broad access. Timely immunization of risk groups will significantly reduce both hospitalization rates and the likelihood of severe complications.
