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Outbreak control measures for non-influenza respiratory viral illnesses in residential care facilities

Non-influenza respiratory virus outbreaks in residential care facilities (RCF) can lead to hospitalisations and cause significant morbidity and mortality.

This document was prepared to assist Public Health recommendations for RCF with non-influenza respiratory virus outbreaks and should be read in conjunction with CDNA guidelines for Prevention and Management of Influenza Outbreaks in RCFs 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

Testing residents or staff with influenza-like illness (ILI) for influenza and other respiratory illnesses is critical for establishing a diagnosis so the RCF can plan an appropriate response. In an outbreak, several people meeting the clinical case definition of ILI should be tested for influenza and other respiratory illnesses (4–6 cases, up to 10). Nose or throat swabs should be collected for nucleic acid amplification tests for influenza and respiratory viruses.

Control Measures

  • ŸInitial management of non-influenza viral respiratory illness outbreaks in RCFs is identical to influenza outbreak management. Managers of the RCF are responsible for implementing outbreak control measures in line with those set out in the CDNA Prevention and Management of Influenza Outbreaks in RCFs in Australia, (with the exception of antiviral medication which is not indicated for outbreaks other than confirmed influenza outbreaks). Antibiotics are not indicated unless bacterial superinfection is diagnosed.
  • ŸThese measures include (but are not limited to) hand hygiene, personal protective equipment, isolating ill residents, placing residents who are infected with the same pathogen in the same room, excluding ill staff, restricting visitation and ongoing surveillance.
  • ŸOnce 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.
  • ŸRhinovirus and adenovirus rarely cause severe disease. However, severe outcomes may be observed in elderly residents of RCFs.
  • ŸHuman metapneumovirus (HMPV), Respiratory Syncytial Virus (RSV) and Parainfluenza Virus: In frail elderly patients, patients with pulmonary or cardiovascular disease and immunocompromised patients, infection can be severe.

Visitation during and 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, whichever is longer. This “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 two 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.

Table: Helpful information about non-influenza viral respiratory illnesses

Disease

Incubation period (range)

Infectious period

Exclusion of ill staff

Human Metapneumovirus

4–9 days

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

Parainfluenza

2–7 days

3–10 days during initial infection, shedding rates are lower for subsequent infections

Until asymptomatic

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

Adenovirus

2–14 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”

Until asymptomatic

The institutional outbreak summary report should be completed for each ILI outbreak and forwarded to EPI@health.qld.gov.au.

Last updated: 25 July 2017