Skip to content

Respiratory Infection Outbreaks in Institutions and Public Hospitals

Reportable Disease Toolkit Badge

Reporting Obligations

All confirmed or suspect outbreaks of respiratory infection shall be reported to the local Health Unit. Notification should be done by phone.


Aetiologic Agent

Outbreaks of respiratory infections in institutions are caused by a variety of respiratory viruses such as influenza A and B, respiratory syncytial virus (RSV), parainfluenza, rhinovirus, human metapneumovirus, coronaviruses and adenovirus. Bacteria that occasionally cause respiratory outbreaks in institutions are Chlamydophila pneumoniae, Legionella spp. and Mycoplasma pneumoniae (Atypical Pneumonia).

Clinical Presentation

These viruses often cause similar acute respiratory symptoms: common cold, pharyngitis, runny nose or sneezing, congestion, sore throat, hoarseness or difficulty swallowing, dry cough, swollen or tender glands in the neck, fever/abnormal temperature, malaise, myalgia, loss of appetite, headache and chills.

Modes of Transmission

Person to person, droplet transmission as well as contact with fomites may also occur.

Incubation Period

Varies depending on the causative agent.

Period of Communicability

Varies depending on the causative agent.

Risk Factors/Susceptibility

All persons are susceptible, however susceptibility is greater in the very young and the institutionalized elderly. Residents/patients and HCW’s who have not received current influenza vaccination are more susceptible to influenza.

Diagnosis and Laboratory Testing

Refer to Public Health Ontario, Respiratory Virus Testing Algorithm Labstract for the testing available for winter and summer seasons.

Testing Information and Requisition Button

Treatment and Case Management

Treatment of individual cases is under the direction of the attending health care provider. Refer to the Control of Respiratory Infection Outbreaks in Long-Term Care Homes to manage the outbreak.

Whenever there are two cases of acute respiratory infections (ARI) within 48 hours on one unit, or one lab-confirmed case of influenza, an outbreak should be suspected. Early recognition of case, timely specimen collection, communicating to staff and the implementing appropriate control measures with contact/droplet precautions can have a positive impact on the course of the outbreak.

If influenza is suspected, refer to Antiviral Medications for Influenza, Information for Health Care Providers for initiating treatment.

An outbreak can be declared at any time by the Medical Officer of Health (or their designate), the Medical Director or the Director of Care for the facility. Laboratory confirmation of an organism is not required to declare an outbreak.

Ongoing monitoring will include: surveillance of residents/patients and staff to identify new cases, monitoring the status of ill residents and staff, monitoring the use of additional precautions/control measures, and implementing control measures for visitors.

Public Health staff will collaborate with the facility and provide guidance and support to the infection control practitioner.

Additional Resources

Ministry of Health and Long-Term Care. “Control of Respiratory Infection Outbreaks in Long-Term Care Homes, November 2018.

Public Health Ontario. “Antiviral Medications for Influenza, Information for Health Care Providers, November 2017.


Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2022.

Ministry of Health and Long-Term Care. “Control of Respiratory Infection Outbreaks in Long-Term Care Homes, November 2018.