Respiratory Illness

July 19, 2019

Dear Colleague,

Since the end of flu season, the Virginia Department of Health has received increased reports of respiratory illness across the Commonwealth, greater than observed in previous summers. Recent illnesses have mainly involved older adults or persons with chronic medical conditions in assisted living and long-term care facilities. Cases have not been associated with the same pathogen—multiple pathogens have been reported, including those causing pertussis, influenza, Haemophilus influenzae infection, Legionnaire’s disease, and pneumonia caused by rhinovirus, or human metapneumovirus. With high temperatures in the forecast, VDH is also concerned about exacerbation of lung or heart disease and other heat-related illnesses.

Certain groups are higher risk for developing severe respiratory illness, including young children, adults aged 65 years or older, those with chronic medical conditions (e.g., asthma, chronic obstructive pulmonary disease), and those with weakened immune systems. Early diagnosis and treatment are critical to minimize disease severity and further transmission. Commercial laboratories can be used to detect infectious pathogens that cause respiratory illness. For legionellosis, which occurs more frequently during the summer, both culture of respiratory specimens using specialized media and urine antigen test to detect L. pneumophila serotype I are recommended when testing patients with pneumonia.

In addition to having a heightened awareness for respiratory illnesses, VDH asks that healthcare providers consider the following:

  • Report suspected and confirmed cases of diseases listed on the Virginia Reportable Disease List to the local health department. Certain conditions and all outbreaks, regardless of the cause, require immediate reporting. For some conditions (e.g., invasive Haemophilus influenzae infection), testing of culture isolates at Virginia’s Division of Consolidated Laboratory Services is required.
  • Depending on the pathogen and its spread, infection control precautions or timely administration of postexposure prophylaxis might be required to prevent further illnesses.
  • Remind your patients to take precautions to avoid heat-related illness.

Thank you for all you do to protect all people in Virginia. I hope you and your patients have a safe, healthy summer.


M. Norman Oliver, MD, MA
State Health Commissioner