Researchers Evaluate Infection Control Challenges During an RSV Outbreak in a Cognitively Impaired Population

Respiratory syncytial virus (RSV) is a significant threat to vulnerable adults, often causing severe illness and death. This risk is particularly high in long-term care facilities, where infections can spread rapidly. In a new report assessing an RSV outbreak in the memory care unit of a Veterans Affairs-affiliated long-term care facility, researchers aimed to evaluate the unique challenges of controlling outbreaks in this setting among a cognitively impaired population and outline strategies that can be used to manage it.¹

Image credit: jarun011 | stock.adobe.com

RSV in Vulnerable Patient Populations

According to the CDC, RSV can be severe for older adults, adults with certain medical conditions, adults who are elderly or frail, or adults who live in a nursing home. Annually, an estimated 110,000 to 180,000 individuals 50 years and older are hospitalized due to RSV in the US. While RSV symptoms typically present as mild and cold-like, some individuals could develop more severe symptoms like pneumonia. RSV could worsen conditions like asthma, chronic obstructive pulmonary disease, or heart failure, leading to hospitalization or fatal outcomes.²

Currently, the CDC recommends a single dose of any of the 3 FDA-approved RSV vaccines—RSVPreF3 (Arexvy; GSK), RSVpreF (Abrysvo; Pfizer), and mRNA-1345 (mRESVIA; Moderna)—for all adults 75 years and older, along with individuals aged 60 to 74 years who are at increased risk of severe illness.³

However, before 2023, there was no approved RSV vaccine for adults, making infection control measures critical for preventing outbreaks, especially in medical facilities. This included the use of personal protective equipment, such as masks, rigorous hand hygiene, isolating infected patients, and cleaning contaminated surfaces.¹

RSV Outbreak in Long-Term Care Facility

Researchers assessed the RSV outbreak that occurred in a long-term care facility in 2022 to identify successful strategies that other facilities can apply in similar situations.¹

The 230-bed facility had 4 separate units that included 1 memory care unit, all occupied by male residents, with 30 single-bed rooms that were infected. All the infected individuals had cognitive impairment or dementia, and all had free range to walk in the unit. However, the residents were reported to have little understanding of hand hygiene or preventive measures to limit infection.¹

The outbreak lasted 21 days, with a total of 20 positive RSV cases out of a total of 29 residents on the unit. The results demonstrated that of the 20 residents who contracted RSV, 8 were asymptomatic, whereas 12 experienced at least 1 respiratory symptom, and 2 residents were hospitalized during the outbreak. The first individual was admitted on day 13 with pneumonia and was discharged after 6 days, and the second was hospitalized on day 18 for 4 days following a fall and was reported to have malaise, wheezing, and hypoxia. Additionally, 1 mildly symptomatic resident died from a stroke 23 days following RSV diagnosis; however, it was unclear if the infection contributed to his death.¹

After gathering the results, the researchers conducted a case-control study to assess the potential risk factors for developing RSV. However, no significant risk factors were found, but this could be due to the small patient population that was assessed.¹

In the future, to mitigate an outbreak, the study authors suggested implementing strict infection control measures, such as using rapid RSV tests for early detection, increasing cleaning measures, emphasizing hand hygiene, and ensuring RSV-positive residents remain in single rooms.¹

REFERENCES

1. Ritter AS, Manderville D, Netardus L, Vittor AY. Management of a respiratory syncytial virus outbreak in a memory care unit at a long-term care facility. Antimicrobial Stewardship & Healthcare Epidemiology. 2025;5(1):e150. doi:10.1017/ash.2025.10048

2. RSV in Adults. CDC. News release. Updated July 8, 2025. Accessed August 7, 2025. https://www.cdc.gov/rsv/adults/index.html

3. RSV Vaccines. CDC. News release. August 30, 2024. Accessed April 17, 2025. https://www.cdc.gov/rsv/vaccines/index.html