Other respiratory viruses in residential care facilities
Non-influenza respiratory virus outbreaks in residential care facilities (RCF) can lead to hospitalisations and cause significant morbidity and mortality.
The following information has been developed to assist RCF with non-influenza respiratory virus outbreaks and should be read in conjunction with the CDNA guidelines for the prevention control and public health management of influenza outbreaks in residential care facilities in Australia.
A confirmed respiratory illness outbreak in a RCF is defined as:
Three or more epidemiologically linked cases of influenza-like illness, where influenza has been excluded by laboratory testing, in residents or staff of the facility within 72 hours.
Testing residents or staff with an influenza-like illness for influenza and other respiratory viruses is critical for establishing a diagnosis so the RCF can plan an appropriate response.
Collect nose and throat swabs to test for respiratory virus pathogens. The recommended test is a nucleic acid test (NAT) also known as polymerase chain reaction (PCR). In an outbreak, several people with influenza-like illness should be tested (usually 4 to 6 cases, up to 10).
Initial management of a non-influenza respiratory virus outbreak is identical to management of an influenza outbreak. Managers of the RCF are responsible for implementing outbreak control measures in line with those set out in the CDNA guidelines, (with the exception that antiviral medication is not indicated for outbreaks other than confirmed influenza outbreaks). Antibiotics are not indicated unless bacterial superinfection is diagnosed.
Outbreak control measures include, but are not limited to:
- hand and respiratory hygiene
- personal protective equipment for staff
- isolating ill residents or placing those infected with the same pathogen in the same room
- excluding ill staff from work while they are infectious
- restricting visitation
- ongoing surveillance
Once pathology results are available, the choice of outbreak control measures may be guided by the pathogen(s) detected, severity of disease, attack rate and pattern of transmission.
Human metapneumovirus (HMPV), respiratory syncytial virus (RSV) and parainfluenza virus can cause severe infection in frail elderly residents and those with pulmonary or cardiovascular disease or weakened immune systems.
Rhinovirus and adenovirus rarely cause severe disease but adverse outcomes have been observed in residents of RCF.
Many different respiratory viruses can cause the common cold but rhinoviruses are the most common. RCF residents with confirmed rhinovirus infection should be isolated while unwell. Outbreak precautions should be considered for RCF with rhinovirus outbreaks particularly if:
- the facility meets the criteria for an influenza-like illness outbreak
- illness transmission is rapid and/or sustained
- illness is severe, resulting in hospitalisation or death.
Visitation during an outbreak
Limit visitation during outbreaks and ill persons should be excluded from visiting the facility. Exceptions may be considered on a case-by-case basis.
Declaring an outbreak over
Viral respiratory outbreaks can be declared over if no new cases have occurred in 8 days from the onset of symptoms of the last resident case or 3 days from last day of work of an ill staff member, whichever is longer.
The ‘8-day rule’ is based on the period of communicability and the incubation period for influenza and applies to many other respiratory viruses associated with respiratory infection outbreaks. Another common way to decide when to declare an outbreak over is to use 2 incubation periods for the disease. Duration of outbreak precautions may vary depending on the virus and severity of the outbreak. Refer to the table below for further information.
Incubation, infectious and exclusion periods for non-influenza respiratory viruses
Incubation period (range)
Exclusion of ill staff
Virus shedding has been reported as 3–10 days, although it can be 13 days or even longer in immunocompromised people. It is not known if the virus shedding period is related to infectivity.
48 hrs after symptoms have resolved
3–10 days during initial infection, shedding rates are lower for subsequent infections
Respiratory Syncytial Virus
Average 5 days
(range 2 – 10)
Before symptomatic until recovery (usually within 10 days)
Shedding duration 7–10 days
Exclude until well
Average duration of illness 9.5 days
Variable: Asymptomatic carriage can persist for weeks or months. “Infection can be by reactivation, exposure to infected individuals or acquisition from an exogenous source”