After what feels like years of advocating for updated guidance, the Centers for Disease Control and Prevention (CDC) has finally released updated guidance for viral respiratory infections in healthcare personnel. This guidance includes viruses such as SARS-CoV-2 (COVID-19), influenza viruses, respiratory syncytial virus (RSV), parainfluenza viruses, rhinoviruses, human metapneumovirus, additional adenoviruses, endemic coronaviruses, and enteroviruses. This guidance doesn’t reduce isolation times for residents but LeadingAge National reported that the CDC is also working on updating this guidance. However, we are uncertain when updated resident guidance will be released. For Illinois members, this information aligns with guidance released by the Illinois Department of Public Health in 2025. LeadingAge Midwest will work on updating associated resources which will be posted to our website when available.

Exposures:

For asymptomatic healthcare personnel (HCP) who have a known or suspected exposure to a respiratory virus:

• Work restrictions are not necessary
• Wear source control from the day of first exposure through at least the 5^th day after last exposure.
• Monitor for development of signs or symptoms of a viral respiratory infection for at least 5 days after the last exposure.
• HCP who develop signs or symptoms of a viral respiratory infection should be restricted from work.
• Note that this does not apply to viral respiratory pathogens with specific guidance such as measles, mumps, rubella, varicella, cytomegalovirus, parvovirus B19, and viral conjunctivitis
• Exposure to a respiratory virus can be generally defined as being within close proximity of an infectious source person while unprotected (not wearing recommended personal protective equipment) or having mucous membrane contact with their secretions. In general, for most viral respiratory pathogens, transient contact with an infectious person (such as walking past them in the hallway) is not considered an exposure.

For HCP with a suspected or confirmed viral respiratory infection:

• Restrict from work until:
  • At least 3 days have passed from symptom onset (or from their first positive respiratory virus test if asymptomatic throughout their infection) and
  • They are fever free for at least 24 hours without the use of antipyretics, and
  • Symptoms are improving, and
  • They feel well enough to return to work.
• Wear source control upon return to work until at least the end of day 7, where the day of symptom onset (or first positive test if asymptomatic throughout their infection is day 0).

Respiratory viral infection symptoms:

Respiratory viral infections can typically cause similar signs and symptoms, which in general, may include, but are not limited to, the acute onset of any of the following:

• Fever
• Chills
• Fatigue
• Cough
• Runny or stuffy nose
• Decrease in appetite
• Sore throat
• Vomiting
• New loss of taste or smell
• Headache, muscle, or body aches
• Diarrhea
• Weakness

Testing and diagnosis:

HCP with mild symptoms of a viral respiratory infection may not be tested to confirm which pathogen is the causative agent, whereas testing may more likely be performed for those with severe illness or immunocompromise. Ultimately, how to test for a specific viral pathogen varies by virus, and information on recommended viral pathogen-specific tests can be found on the CDC website and are linked here:

• Overview of Testing for SARS-CoV-2 – COVID-19
• Laboratory Information for Collection of Respiratory Specimens for Influenza Virus Testing
• Diagnostic Testing for RSV

Special return to work instructions:

Individuals who are severely to critically ill and immunocompromised individuals with a viral respiratory infection may be contagious to others for longer than those with milder illness. Return to work decisions for these HCP are typically made by occupational health on a case-by-case basis. Strategies to inform the duration of work restrictions for these individuals include:

• Consultation with an expert in pathogen transmission/immunosuppression (such as infectious disease specialist) and
• Considerations for using pathogen-specific testing to inform ongoing risk for transmission