Apr 29

RSV in Aged Care

A Critical Guide for Infection Control Teams

Respiratory Syncytial Virus (RSV) has long been overshadowed by influenza and COVID 19 in aged care, yet it remains a significant threat to the health and longevity of older adults. For infection control teams in residential settings, understanding the nuances of RSV is not just a clinical requirement – it is a cornerstone of resident safety. This guide provides a comprehensive overview of management and prevention strategies tailored to the aged care environment.

The Clinical Threat of RSV

Respiratory Syncytial Virus (RSV) is a highly contagious, single-stranded RNA virus in the Pneumoviridae family. It primarily infects the respiratory tract, including the nose, throat, and lungs. Although historically considered a paediatric concern, it is now recognised as a leading cause of morbidity and mortality among older adults.

1. Characteristics of the Infection:

  • Mechanism: The virus triggers significant inflammation and mucus build-up in the respiratory lining, obstructing clear airways.
  • Seasonality: In many regions, infections follow a seasonal pattern, peaking in late autumn, winter and continuing into spring.
  • Incubation: Symptoms typically appear between 2 and 8 days after exposure.
  • Shedding: While healthy adults typically shed the virus for 3 to 8 days, immunocompromised residents can remain infectious for several weeks, necessitating extended isolation protocols.

2. Diagnosis and Recognition in Residential Settings

Early detection is the primary defence against a facility-wide outbreak. Because RSV symptoms often mimic other respiratory illnesses, clinical vigilance is essential.

  • Clinical Presentation: Common symptoms include a runny nose, persistent cough, sore throat, and a low-grade fever.
  • Atypical Presentation in the Elderly: Infection control teams should be alert to non-respiratory signs. Older residents may not always develop a fever; instead, they may present with increased confusion, lethargy, or reduced appetite/ oral intake
  • PCR Testing: This is the gold standard for diagnosis. It is highly sensitive for detecting the virus in nasal or throat swabs and should be prioritised over other methods.
  • Rapid Antigen Tests (RATs): While convenient, RATs often have lower sensitivity in adults than PCR tests, leading to false negatives in aged care settings.
  • Imaging: Chest X-rays may be necessary to identify secondary complications, such as pneumonia or significant pulmonary oedema.

Clinical Management and Treatment

As of early 2026 an RSV vaccine was approved and available in Australia for older adults. This is not technically an “antiviral” (which treats active infection) but rather a vaccine and passive immunisation. Currently there are no RSV vaccines funded through the National Immunisation Program for older people, (except for Victorian residents aged 60 years and over in public and Aboriginal community-controlled aged care services), so if prescribed, RSV vaccines need to be purchased privately.

So, management is focused on supportive care.

  • Hydration: Maintaining adequate fluid intake is vital. If fever or poor intake leads to dehydration, IV fluids or subcutaneous hydration may be required.
  • Oxygen Therapy: Supplemental oxygen is a critical intervention for residents with hypoxia, respiratory distress, or dyspnoea.
  • Medication: Antipyretics such as paracetamol or ibuprofen are used to manage fever and pain. Bronchodilators may be prescribed if significant wheezing is present.
  • Antibiotic Stewardship: It is essential to remember that antibiotics are ineffective against RSV. They should be used only if a secondary bacterial infection (such as bacterial pneumonia) is clinically confirmed.

Why RSV is a Significant Risk for Aged Care Residents

The impact of RSV on the elderly is often underestimated, yet it is a major driver of hospitalisation and permanent functional decline.

  • Immunosenescence: Older adults experience an age-related decline in immune function, making it harder for the body to clear the virus before it moves from the upper to the lower respiratory tract.
  • Reduced Respiratory Reserve: Age-related declines in lung capacity mean that even minor viral inflammation can lead to severe respiratory failure.
  • Exacerbation of Chronic Conditions: RSV often triggers severe "flares" in underlying diseases, including Congestive Heart Failure (CHF), COPD, and asthma.
  • Cardiac Events: The systemic stress from the infection increases the immediate risk of acute cardiac events, such as heart attacks or strokes.
  • Mortality Rates: Among hospitalised elderly patients, mortality ranges from 2% to 13%, but can be as high as 36% for those requiring intensive care.
  • Long-Term Decline: Many residents do not regain their baseline level of independence after infection. Up to one-third of residents aged 75+ may die within a year of a severe RSV infection due to a subsequent decline in overall health.

Infection Control Strategies for Facilities

Aged care facilities are high-risk environments due to shared communal spaces and frequent close contact between staff and residents.

1. Transmission Dynamics:
  • Droplets: Spread through the air when an infected resident talks, coughs, or sneezes.
  • Fomites: The virus is resilient and can survive on hard surfaces (such as bed rails) for several hours.
  • Direct Contact: The primary transmission route is physical contact with an infected individual
2. Operational Prevention and Management:

  • Standard and Transmission-Based Precautions: Staff must implement both contact and droplet precautions, including wearing gloves, gowns, and surgical masks when caring for symptomatic residents.
  • Outbreak Definition: In many jurisdictions, two or more cases among residents within a 72-hour period constitute an outbreak.
  • Cohorting: Where possible, symptomatic residents should be cohorted or isolated to minimise spread to the general population.
  • Environmental Cleaning: Rigorous cleaning of "high-touch" surfaces, including door handles and shared medical equipment, is essential.
  • Hand Hygiene: Frequent handwashing remains the cornerstone of prevention.
  • Staff and Visitor Stewardship: Staff with any respiratory symptoms must stay home. Visitors should be screened, and those with cold symptoms should be restricted from entering high-risk areas.

The Role of Vaccination in Aged Care

The recent development and approval of RSV vaccines mark a major shift in facility protection strategies.

  • Available Vaccines: Products such as Arexvy or Abryso have been approved for adults aged 60 and over.
  • Efficacy: These recombinant subunit vaccines have demonstrated significant efficacy in clinical trials against lower respiratory tract disease.
  • Facility Advocacy: Infection control teams should keep vaccination records up to date and encourage uptake among residents to reduce the risk of severe outbreaks.

Conclusion

For aged care infection control teams, RSV must be treated with the same level of clinical suspicion as influenza. The combination of resident vulnerability and the high density environment of residential care make RSV a clinical threat. By prioritising timely PCR testing, maintaining strict droplet precautions, and advocating for vaccination, facilities can significantly reduce the impact of this virus and preserve residents' functional independence.

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