Most of us know the winter line-up by now: flu, COVID-19, and the endless round of coughs and colds that arrive with the darker evenings. There is a fourth name on that list that far fewer people in Ireland would recognise, and it quietly puts people in hospital every winter. It is called RSV, and while it has a reputation as a baby’s illness, the Irish data tells a different story once you pass your mid-seventies. With the season typically running from October to March, late summer is the right moment to work out whether you or someone you care for is at higher risk, and what Ireland’s vaccine advice actually says.
TL;DR
- RSV (respiratory syncytial virus) is a common winter respiratory infection, best known in infants but heaviest in adults aged 75 and over.
- Winter 2024/25 in Ireland: over 90 RSV-associated hospitalisations per 100,000 people aged 75 to 79, and over 185 per 100,000 in those aged 80+. RSV was a primary cause of 28 deaths that winter and 38 the winter before.
- Ireland’s National Immunisation Advisory Committee (NIAC) recommends RSV vaccination for everyone aged 75+, for people aged 60 to 74 with risk factors, and for anyone 60+ in long-term residential care: a single dose, ideally just before the season.
- It is not currently part of the State-funded vaccination programme for older adults. HIQA’s April 2026 assessment found the vaccines safe and effective but not cost effective at current prices, so the vaccine is a private purchase for now.
- Symptoms overlap with flu and COVID-19, and RSV often shows up in older adults as a flare-up of an existing heart or lung condition rather than a classic fever.
What RSV actually is
Respiratory syncytial virus is a seasonal virus that infects the airways. Almost everyone catches it in early childhood and repeatedly afterwards, usually experiencing nothing worse than a heavy cold, because immunity from a previous infection is partial and short-lived.
It has been a notifiable disease in Ireland since 2012, so confirmed cases are reported to the Health Protection Surveillance Centre. The catch is that testing has historically concentrated on young children. Older adults are tested less often and carry lower amounts of virus in airway samples, which makes the infection harder to detect. The recorded numbers are almost certainly an undercount, and NIAC has said as much.
Why it matters more after 75
The pattern in the Irish surveillance data is consistent: the older the age group, the heavier the burden. Winter 2024/25 saw more than 90 RSV-associated hospitalisations per 100,000 people aged 75 to 79, roughly doubling to more than 185 per 100,000 among people aged 80 and over. RSV was recorded as a primary cause of 28 deaths that winter and 38 the winter before, overwhelmingly in people aged 75 and older. Outbreaks in nursing homes, community hospitals and other residential settings are common too, which is why NIAC treats living in long-term care as a risk category in its own right from age 60.
The symptoms that get mistaken for something else
In a younger adult, RSV usually looks like a bad cold: blocked nose, sore throat, cough, tiredness. In older adults it can be less obvious and more serious. Watch for shortness of breath, wheeze, a cough that will not settle, unusual fatigue, confusion, or a sudden worsening of a condition you already manage, such as COPD, asthma or heart failure. Fever is often mild or absent, which is part of why it slips past unnoticed. There is no way to tell RSV apart from flu or COVID-19 by symptoms alone, so if you are unwell enough to wonder, that is reason enough to ring your GP.
Who is considered higher risk
NIAC lists these as risk factors that may raise the chance of severe RSV disease in adults aged 60 to 74:
- Chronic cardiovascular disease, for example congestive heart failure or coronary artery disease
- Chronic respiratory conditions, for example COPD or asthma
- Chronic metabolic disorders, for example diabetes
- Immunocompromising conditions or treatments
- Chronic kidney disease
- Chronic liver disease
- Chronic neurological conditions
- Obesity
The list is indicative rather than exhaustive, so a long-term condition that is not named here is still worth raising with your GP.
The vaccine question in Ireland: recommended, but not funded
Three RSV vaccines are authorised in the EU for adults aged 60 and over: Arexvy, Abrysvo and mResvia. In October 2025, NIAC issued updated advice recommending any of the three for adults aged 75 and over, for adults aged 60 to 74 with risk factors, and for adults aged 60 and over in long-term residential care. A single dose, with no booster schedule established yet. They can be given at any time of year, though the benefit is greatest just before the season, and at the same visit as flu, COVID-19, shingles or pneumococcal vaccines.
Real-world data from the 2023/24 season in the United States estimated roughly a 75 to 80 per cent reduction in RSV infection, emergency department visits and hospitalisations in adults aged 60 and over. All three vaccines have been well tolerated, though regulators are monitoring a very rare signal for Guillain-Barré syndrome, estimated internationally at roughly 3 to 25 cases per million doses, and have concluded that for people aged 75 and over the benefits outweigh that risk.
So why is it not simply offered alongside the flu jab? Cost. HIQA published a full health technology assessment on 28 April 2026 which found RSV immunisation safe and effective, but not cost effective at current vaccine prices. Even a narrow strategy limited to adults aged 80 and over was estimated at around €70 million over five years, and HIQA calculated it would only become cost effective at roughly €20 or less per dose excluding VAT, an 88 per cent cut on current pricing. The policy decision now rests with the Department of Health.
In practical terms: if you fall into a NIAC-recommended group, the vaccine is available privately through some pharmacies and clinics at an unsubsidised price. That is a real cost, and it deserves a conversation with your GP or pharmacist about your own risk profile rather than a decision made from a headline.
What you can do this autumn
- Book your flu and COVID-19 vaccines when the HSE programme opens. These are State-funded for older adults and people with qualifying conditions, and cover two of the three main winter threats.
- Ask about RSV at the same appointment. Your GP or pharmacist can tell you whether NIAC’s advice applies to you and what a private dose costs locally.
- Review your long-term conditions before winter. Well-controlled COPD, asthma, diabetes and heart failure withstand a respiratory infection far better than poorly controlled ones.
- Keep hand hygiene and ventilation going, and stay away from others while you are actively unwell. The same measures that blunt flu blunt RSV.
- Have a plan for getting sick. Know your GP’s out-of-hours number, and know which symptoms mean you ring rather than wait it out.
When to seek help
Contact your GP if a cough or breathlessness is worsening rather than settling, if you cannot keep fluids down, or if a long-term condition is flaring. Seek urgent care for severe breathing difficulty, chest pain, blue-tinged lips, or new confusion. Trust the instinct that says this is not a normal cold.
RSV is not a reason to spend the winter worrying. It is a reason to have one extra conversation before the season starts, while there is still time for it to make a difference.
Críonna Health publishes evidence-informed guidance on ageing well in Ireland. This article is general information, not a substitute for advice from your GP, pharmacist or treating clinician.
📷 Photo by Chulho Choi on Unsplash
