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Outbreak Management in Institutions, Childcare, and other Congregate Settings

Outbreak Management in Institutions, Childcare, and other Congregate Settings

Update: criteria for molecular respiratory virus testing

Please note effective October 02, 2025, Public Health Ontario (PHO) has updated its eligibility criteria for molecular respiratory virus testing. Respiratory virus testing (including COVID-19) requests should now be submitted using PHO’s General Test Requisition Form (external PDF) with patient setting and symptoms clearly indicated.

Early identification of outbreaks

Conduct surveillance

  • Entry Screening for Symptoms and exposures in staff, visitors, and returning residents
  • Daily Resident/ Children and/ Staff screening for symptoms
    • Respiratory symptoms: runny nose, sneezing, stuffy nose, cough, congestion, fever, sore throat or hoarseness or difficulty swallowing, chills, difficulty breathing, loss of appetite, malaise, muscle pain or headache
    • Gastrointestinal symptoms: at least two unexpected episodes of diarrhea (loose/ watery bowl movements) and/or vomiting within 24 hours.

Report the outbreak

Contact Halton Region Public Health immediately if you suspect or have confirmation of an outbreak.

  • Respiratory: Two patient/resident cases of Acute Respiratory Infection (ARI) with symptom onset within 48 hours with an epidemiological link (for example, same unit/floor/service area) suggestive of transmission in the setting and testing is not available or all negative.
  • Gastrointestinal: Symptoms of gastrointestinal illness occurring in two or more residents/ children/ staff within 48 hours, with a common epidemiological link (such as same unit or floor).
  • Timely reporting of outbreaks is essential for their control and to prevent further spread of infectious diseases.
  • Facilities must report suspected outbreaks and/or reportable diseases (Disease of Public Health Significance) to Halton Region Public Health as outlined in the Health Protection and Promotion Act, R.S.O. 1990, c.H.7, Regulation 135/18 (external link).
    • During regular business hours, Monday to Friday from 8:30 a.m. to 4:30 p.m., call (905) 825-6000 for both respiratory or enteric outbreaks; OR email PublicHealthOM@halton.ca for respiratory outbreaks.
    • Outside of regular business hours, contact the Halton Region Public Health by calling 311.

Outbreak management

  • An outbreak investigator from public health will follow-up to conduct an outbreak investigation. The outbreak investigator will assess the outbreak to see if criteria has been met, then review public health recommendations and IPAC Measures to implement to reduce further transmission of illness.
  • Start line lists for the residents and staff for each affected home area (line lists are found in the (outbreak resources below).
  • Submit outbreak line lists daily to Halton Public Health by 10 a.m.
  • Consult with Halton Region Public Health before collecting outbreak specimens for laboratory testing. The Outbreak Investigator will assess the plan for collection and transportation of specimens. The Outbreak investigator will interpret laboratory reports.
  • Maintain daily contact with Public Health to review the outbreak status (new cases, hospitalizations, deaths, activity in new home areas). The Outbreak Investigator will review outbreak control measures and declare the outbreak over when appropriate.

Outbreak management resources for LTCH/RR/CCC

Halton Region Public Health

Halton IPAC Hub

Ministry of Health

Public Health Ontario

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