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. RFCs need to have systems in place for early detection of influenza-like illness affecting both staff and residents.
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. While many different respiratory viruses can cause the common cold, rhinoviruses are the most frequent cause. Rhinovirus and adenovirus rarely cause severe disease, but adverse outcomes have been observed in residents of RCF.
The following information has been developed to assist RCFs with non-influenza respiratory virus outbreaks and should be read in conjunction with the Communicable Diseases Network Australia (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 implement 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 infection is diagnosed.
Outbreak precautions should be considered for RCF 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.
Outbreak control measures include, but are not limited to:
- hand and respiratory hygiene
- personal protective equipment for staff (and visitors/residents where indicated)
- isolating ill residents in single rooms, or placing those infected with the same pathogen in the same room
- excluding ill staff from work while they are infectious
- limiting 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.
Visitation during an outbreak
Limit visitation during outbreaks. Exceptions may be considered on a case-by-case basis. Visitors with any signs or symptoms of influenza-like illness should be made aware of risks and take appropriate precautions to prevent the spread of the condition, this may include being excluded from visiting the facility.
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.
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.
(Average duration of illness 9.5 days)
Variable: Asymptomatic carriage can persist for weeks or months. “Infection can be by reactivation of the virus, exposure to infected individuals or acquisition from an exogenous source.”
Variable: from the onset of symptoms until symptoms resolve, usually 7–14 days.
*Please note: It is important to refer to the Australian Guidelines for the Prevention and Control of Infection in Healthcare (nhmrc.gov.au) for additional information