Commentary: Parents, Take Note: Leading Cause of Infant Hospitalisation Is RSV, Not the Common Cold

By Dr Li Jiahui, Head and Senior Consultant, Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital.

By Dr Li Jiahui, Head and Senior Consultant, Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital

Respiratory Syncytial Virus, or RSV, has long been mistaken for the common cold, yet studies across the world show it can lead to severe respiratory illness requiring oxygen therapy and hospital care, even in healthy, full-term babies.^1,2,3,4

This renewed attention to RSV comes at a crucial time. As Singapore’s healthcare community steps up efforts to improve respiratory health awareness, it is becoming clear that RSV deserves the same vigilance families already apply to influenza or COVID-19.

A Virus More Common than Many Realise

RSV is not a new threat, but most people will be unaware that they’re infected with RSV, which is why it can easily be spread to others. RSV can survive on hard surfaces, such as toys, cribs, and utensils, for many hours. It can then spread to babies if they touch these surfaces before touching their eyes, nose, or mouth.⁵

Nearly every child will be infected by the age of two⁶, and while many experience only mild cold-like symptoms, RSV can cause more serious illnesses such as bronchiolitis and pneumonia⁷.

From June to October 2025, RSV has consistently ranked among the top three paediatric viruses detected at local polyclinics in children treated for acute respiratory infections, according to the Communicable Diseases Agency (CDA)⁸. In some weeks, RSV cases have even surpassed influenza.⁹

Parents should take note that RSV is not rare, nor is it confined to children with existing health problems¹⁰. In fact, most RSV-related hospitalisations in Singapore occur in otherwise healthy, full-term infants¹¹.

Why RSV Is Especially Dangerous for Infants

Babies have small, developing lungs and immature immune systems. This makes them more vulnerable to breathing difficulties when RSV infects the lower airways¹². In severe cases, babies may require oxygen therapy, intensive care, or even mechanical ventilation.

For parents, the experience is harrowing. What begins as a mild cough or runny nose can rapidly progress to wheezing, grunting, or chest retractions – signs of respiratory distress that demand urgent medical care. Many parents are caught off-guard, as RSV infections can seem mild in its early stages.

Globally, RSV is recognised as a major cause of infant hospitalisations and deaths. According to The Lancet (2022), RSV was responsible for more than 3 million hospitalisations and over 100,000 deaths in children under five worldwide in 2019, with the majority occurring in infants under six months.¹³

A Hidden Burden on Families and Healthcare

For healthcare systems, RSV hospitalisations increase strain on paediatric wards. Beyond the immediate health risks, RSV places a significant emotional and financial burden on families¹⁴. Parents often need to take extended leave from work, juggle care for other children in the family, and cope with the anxiety of seeing their baby struggle to breathe.

Research has also shown a clear link between RSV infection in early life and a higher risk of developing asthma and wheezing episodes in later childhood.^15,16,17Preventing RSV in infancy is not just about avoiding short-term illness, but also about protecting children’s respiratory health well into the future.

Prevention and Awareness Are Key

Despite the scale of the problem, public awareness of RSV remains low compared to influenza or COVID-19. Many parents are simply unaware of how common RSV is, how serious it can become, or what preventive measures are available.

Preventive options have advanced in recent years, including infant and maternal immunisation strategies now being implemented in countries such as Spain, the United States, United Kingdom¹⁸ and Chile. These efforts have already shown promising results in reducing infant hospitalisations.¹⁹

Singapore has an opportunity to build on this momentum by strengthening RSV education and exploring preventive strategies suited to our local context.

RSV in Singapore

What Parents and Healthcare Professionals Can Do

For now, vigilance remains critical. Parents should:

Learn to recognise early symptoms of RSV: persistent cough, wheezing, rapid breathing, poor feeding, or irritability.
Practise good hygiene: frequent handwashing, disinfecting toys and surfaces, and avoiding close contact with sick individuals.²⁰
Seek medical care promptly if a baby shows signs of difficulty breathing, dehydration, or worsening symptoms.

Healthcare professionals play a vital role too. By proactively discussing RSV during routine check-ups, obstetricians, paediatricians, and family physicians can equip parents with the knowledge to respond quickly and appropriately.

A Collective Effort in 2026

Beyond awareness of RSV, protecting infant health requires long-term commitment and concrete steps that include education, clinical readiness, and preventive care.

Awareness campaigns, educational resources, and national health initiatives all play a part in helping families understand RSV and make informed decisions. However, awareness alone is not enough; it must be coupled with practical steps that reduce RSV’s impact on families and our healthcare system.

In Singapore, experts have also highlighted the need for greater protection. A panel of paediatricians recently published an expert consensus²¹ underscoring the urgency of safeguarding all infants against RSV. They recommend that immunisation be considered for inclusion under the National Immunisation Programme to help reduce the RSV burden on the healthcare system.

As a paediatrician, I have seen how quickly RSV can overwhelm a baby’s fragile body and a family’s peace of mind. Awareness is only the first step. Singapore now has an opportunity to strengthen its public health response through education, prevention, and access to protection, so that no family faces this struggle alone.

[1] Leader S and Kohlhase K. Pediatr Infect Dis J 2002; 21(7): 629–632.

[2] Demont C et al. BMC Infect Dis 2021; 21(1): 730.

[3] Suh M et al. J Infect Dis 2022; 226(Supp 2): S154–Sl63.

[4] SGH Media Release: Not just a common cold: Singapore studies show RSV’s severity and impact on long-term health: 5 November 2025

[5] Coultas JA et al. Thorax 2019; 74(10): 986–993.

[6] Walsh, EE. Respiratory Syncytial Virus Infection: An Illness for All Ages. Clinics in Chest Medicine. 2017;38(1):29-36.

[7] Pickles RJ and De Vincenzo JP. J Pathol 2015; 235(2): 266–276.

[8] Communicable Diseases Agency. Weekly Infectious Diseases Bulletin 2025 [Internet]. Singapore: CDA; Retrieved September 3, 2025

[9] Communicable Diseases Agency. (2025). Weekly Infectious Diseases Bulletin, Epidemiological Week 23: June 1–7, 2025. Ministry of Health, Singapore. Retrieved September 3, 2025

[10] Lee MW. Singapore Med J. 2021 Dec;62(12):642-646. doi: 10.11622/smedj.2020075. Epub 2020 May 27.

[11] Tam CC, Yeo KT, Tee N, et al. Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore. Emerg Infect Dis. 2020;26(7):1489-1496. doi:10.3201/eid2607.190539

[12] Hussain M et al. Biochim Biophys Acta Mol Basis Dis 2017; 1863(12): 3226–3242.

[13] Li Y, Wang X, Blau DM, Caballero MT, Feikin DR, Gill CJ, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399(10340):2047–64. doi:10.1016/S0140-6736(22)00478-0.

[14] Tam CC, Yeo KT, Tee N, Lin R, Mak TM, Thoon KC, Jit M, Yung CF. Burden and cost of hospitalization for respiratory syncytial virus in young children, Singapore. Emerg Infect Dis. 2020 Jul;26(7):1489–96. doi:10.3201/eid2607.190539. PMID:32568036; PMCID:PMC7323550.

[15] Zar HJ, Nduru P, Stadler JAM, et al. Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health. Lancet Glob Health 2020; 8: e1316–25.

[16] Abreo A, Wu P, Donovan BM, et al. Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilisation. Clin Infect Dis 2020; 71: 211–14.

[17] McCready C, Haider S, Little F, et al. Early childhood wheezing phenotypes and determinants in a South African birth cohort: longitudinal analysis of the Drakenstein Child Health Study. Lancet Child Adolesc Health 2023; 7: 127–35.

[18] Williams TC, Marlow R, Cunningham S, et al. Bivalent prefusion F vaccination in pregnancy and respiratory syncytial virus hospitalisation in infants in the UK: results of a multicentre, test-negative, case-control study. Lancet Child Adolesc Health. 2025;9(9):655-662. doi:10.1016/S2352-4642(25)00155-5

[19] Goh, D.Y.T., Goh, A., Chen, C.K. et al. Expert consensus on the burden of respiratory syncytial virus disease and the utility of nirsevimab for disease prevention and protection of infants. World J Pediatr 21, 552–565 (2025). doi.org/10.1007/s12519-025-00926-2

[20] Welsh Government. Respiratory syncytial virus (RSV) and bronchiolitis. [Online] Available at: gov.wales/sites/default/files/publications/2021-10/respiratory-syncytial-virus-rsv-and-bronchiolitis-leaflet.pdf [Accessed November 2023]

[21] Goh DYT, Goh A, Chen CK, Chan SM, Khoo PC, Thoon KC, Li J, Lee BW, Yung CF. World J Pediatr. 2025 Jun. doi: 10.1007/s12519-025-00926-2 MAT-SG-2500313-1.0-09/2025

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