What is the burden of respiratory syncytial virus outbreaks in care homes? An enhanced surveillance study in England, winter 2024/25

Care homes are vulnerable to respiratory syncytial virus (RSV) outbreaks, with residents at risk of severe disease outcomes, though surveillance studies are lacking. In September 2024, RSV vaccination was introduced for adults in England aged 75–79 years, excluding most residents (median age 86 years). Between October 2024 and March 2025, we prospectively extracted information on RSV outbreaks in English care homes reported to UK Health Security Agency (UKHSA). Enhanced surveillance questionnaires (ESQs) were completed for a sample of outbreaks, including information on symptomatic residents, testing, and outcomes. Acute respiratory infection (ARI) cases were defined symptomatically, RSV cases based on test-positive RSV (≤5 residents tested per home), and RSV outbreaks as ARI outbreaks including ≥1 RSV case. We described outbreak trends, attack rates, hospitalizations, and deaths. Of 2419 ARI outbreaks in care homes, 222 (9%) were RSV outbreaks, with additional respiratory viruses identified in 69 (31%). Among 48 (22%) RSV outbreaks completing ESQs, the median ARI attack rate was 15% (IQR 10%–24%). Of 350 ARI cases, 32% (112) were confirmed RSV cases on routine testing, 20% (71) were hospitalized, and 6% (20) died. These findings demonstrate the vulnerability of care home residents to RSV infection, hospitalization, and death, which are potentially preventable through vaccination.