Unusual RSV Rates Increased in Early 2026, Decreasing in May

The traditional calendar for respiratory viruses has been significantly disrupted in 2026, as respiratory syncytial virus (RSV) demonstrated unseasonal growth well into the spring months.

“Respiratory syncytial virus season typically starts in the fall and peaks in the winter,” Gretchen Garofoli, PharmD, BCACP, clinical professor in the School of Pharmacy at West Virginia University, said. “Cases also started later this season, which could be the reason that the peak occurred later, and cases continued later than expected.”

By late February 2026, national data from the CDC revealed a test positivity rate of 9.1%, the highest recorded for the entire season at that point. This spike was notably higher than the 6.1% rate observed during the same period in the previous year, which had already begun its seasonal decline.¹ However, as of May 1, 2026, cases are declining throughout most of the US.

This late-season surge had a direct impact on health care systems and pediatric populations. Nationwide, confirmed pediatric hospital admissions for RSV reached 2810 during the final week of February, representing a 9% increase compared to the same timeframe in 2025. Since the start of the season last fall, more than 38,000 pediatric admissions have been recorded, with the vast majority involving children under the age of 5 years.¹

“Almost all infants in the United States contract RSV by 2 years of age. Most have a mild respiratory illness with typical symptoms that we see for respiratory illnesses such as cough, runny nose, fever, and fatigue,” Garofoli said. “Illnesses tend to be milder if the infant is older at the time of first infection. Parents should pay special attention to the progression of a respiratory illness if their infant was born prematurely or has other lung diseases at baseline.”

Of note, the 2025-2026 season both started and peaked later than the year prior, which explains why cases continued to climb during months when they would typically be expected to fall.

For community pharmacists, this unseasonal trend shifts the clinical focus toward managing secondary complications and ensuring proper diagnostic testing.

“I am unsure as to the impact it will have on pharmacies, as patients usually present to pharmacies for prescriptions for secondary infections due to RSV, such as an ear infection in a child after having RSV,” Garofoli said.

She added that patients may also receive inhalers and nebulizers with medication for respiratory symptoms.

“I do not think that the late season will overwhelm community pharmacies,” she added. “I think the biggest impact will be on providers identifying the possibility that a patient is presenting with RSV and to test appropriately since they may not normally think of an RSV diagnosis during this time of year.”

Prevention strategies have also required a longer tail of implementation this year. The American Academy of Pediatrics (AAP) and other health officials recommended continuing immunizations for eligible infants and toddlers through the end of March in most of the continental United States, with the caveat that activity levels should guide local decisions into late spring.¹

For infants under 8 months old whose parents were not vaccinated during pregnancy, the monoclonal antibodies nirsevimab or clesrovimab remain the primary defense. Although maternal vaccination with Pfizer’s Abrysvo is typically restricted to the September through January window, infants born in the spring remain candidates for monoclonal antibody protection if they were not protected in utero.¹

“RSV vaccination is recommended for all adults 75 years of age and older and adults 50 through 74 years of age who are at an increased [risk] of severe disease from RSV. These patients could technically be vaccinated now, but I would recommend waiting until fall since the vaccine takes 2 weeks to be fully effective,” Garofoli said.

She added that older adults should continue to practice good hand hygiene and avoid being near those who are sick. If they are sick, Garofoli said they should stay home.

As of May 2026, the national trend has finally begun to show a decline in most regions, with wastewater activity levels for RSV reported as very low across much of the country. However, some regional anomalies persist, with wastewater data from late April showing moderate activity in West Virginia and high activity in Nebraska. Furthermore, while most states are seeing declining epidemic trends, Arizona was recently categorized as "likely growing" in its RSV activity.²

READ MORE: Infectious Diseases Resource Center

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REFERENCES

1. Jenco M. RSV rates rising instead of winding down in some states. March 6, 2026. Accessed May 7, 2026. https://publications.aap.org/aapnews/news/34606/RSV-rates-rising-instead-of-winding-down-in-some

2. CDC. Respiratory virus activity levels. May 1, 2026. Accessed May 7, 2026. https://www.cdc.gov/respiratory-viruses/data/activity-levels.html