Do individuals with rhinovirus infection need to isolate?

Isolation for Rhinovirus Infection

For most healthy individuals with rhinovirus infection, formal isolation is not required, but basic respiratory hygiene and hand hygiene measures should be strictly followed to prevent transmission. However, specific populations require more stringent precautions.

General Population Recommendations

Basic Infection Control Measures (Not Formal Isolation)

For otherwise healthy individuals with rhinovirus infection in community settings:

• Practice strict hand hygiene by washing hands with soap and water for at least 20 seconds, especially after coughing, sneezing, or blowing the nose 1
• Cover mouth and nose with tissues when coughing or sneezing, or cough into the elbow 1
• Avoid touching eyes, nose, or mouth with unwashed hands 1
• Use alcohol-based hand sanitizer with greater than 60% ethanol when handwashing is unavailable 1
• Maintain physical distance of at least 2 meters from others when symptomatic 1
• Stay home when feeling sick and limit social contacts 1

The evidence shows that rhinoviruses are transmitted primarily through aerosol and respiratory secretions, but they are surprisingly inefficient transmitters, infecting only about 50% of susceptible contacts in family settings 2. Transmission can be interrupted completely with careful respiratory hygiene measures 2.

High-Risk Settings Requiring Enhanced Precautions

Healthcare Settings with Vulnerable Populations

Contact isolation precautions ARE required when rhinovirus-infected individuals interact with high-risk patients 3:

• Healthcare workers with acute upper respiratory symptoms (sneezing, coughing) must be restricted from caring for high-risk patients including infants, immunocompromised patients, children with severe cardiopulmonary conditions, children receiving chemotherapy, and premature infants 3
• Visitors with respiratory symptoms should not be allowed to visit uninfected pediatric, immunosuppressed, or cardiac patients 3
• Young children should be restricted from visiting patient wards due to higher risk of viral transmission and prolonged shedding 3

Hospital Infection Control for Infected Patients

When rhinovirus-infected patients are hospitalized or in healthcare facilities:

• Apply contact isolation measures including use of gloves, gowns, masks, and eye protection for healthcare workers and visitors 3
• Use isolation rooms when available for symptomatic patients 3
• Separate symptomatic patients from well patients in waiting areas 4
• Implement strict hand hygiene regardless of glove use, washing hands after contact with patients or contaminated fomites 3
• Change gloves between patients and after handling respiratory secretions 3
• Wear gowns if clothing could be soiled by respiratory secretions, changing before caring for another patient 3

Special Populations Requiring Stricter Measures

Immunocompromised Patients and Transplant Recipients

For leukemia patients, hematopoietic stem cell transplant (HSCT) recipients, and other immunocompromised individuals:

• These patients should avoid contact with individuals who have respiratory tract infections both in hospital and community settings 3
• Outpatients with respiratory infections should be seen in facilities and rooms separated from other HSCT and leukemia patients 3
• Inside care facilities, apply isolation rooms and strict protection measures for immunocompromised patients with respiratory infections 3

The rationale is that rhinovirus can cause severe lower respiratory tract disease, including bronchiolitis and pneumonia, particularly in immunocompromised hosts 5.

Pediatric Considerations

Rhinovirus causes serious illness requiring hospitalization in young infants, with 86% of hospitalized cases occurring in children less than 12 months of age 6:

• Bronchiolitis is the most common presentation in hospitalized infants with rhinovirus 6
• Clinical severity in young infants is similar to respiratory syncytial virus (RSV) infection 6
• Most rhinovirus infections in young children are symptomatic, while secondary infections in adults are often asymptomatic 7

Household Transmission Dynamics

In family settings with a rhinovirus-positive child:

• Transmission rates are high: 1.00 cases per sibling and 0.50 cases per parent when the index child is rhinovirus-positive 7
• Contact with school-aged children is the primary risk factor for both infection and symptomatic illness 8
• Multiple virus types can circulate simultaneously in families 7

Critical Pitfalls to Avoid

• Do not assume rhinovirus is always mild: It causes serious lower respiratory tract disease in infants and immunocompromised patients requiring hospitalization 6
• Do not neglect hand hygiene: This is the single most important measure to prevent transmission 3
• Do not allow symptomatic healthcare workers to care for vulnerable populations, even if symptoms seem minor 3
• Do not underestimate transmission risk in households with young children, where attack rates approach 100% among siblings 7

Duration of Precautions

• Maintain precautions while symptomatic, particularly during the acute phase when sneezing and coughing are present 3
• Young children may have prolonged viral shedding compared to adults 3
• Asymptomatic infections in adults are common but still capable of transmission 7