Respiratory infections can be caused by different viruses and bacteria and can cause illness along the respiratory tract (e.g., nose, mouth, airways and lungs). They include viruses like influenza, respiratory syncytial virus (RSV), and COVID-19, and bacteria like pertussis. Respiratory infections can cause illness beyond the respiratory system, and can make people very sick, especially those with weakened immune systems and seniors, infants and young children, and people who are pregnant. They can spread easily and their spread often follows seasonal patterns, with more people becoming sick with respiratory infections in the fall and winter.  

Everyone has a role to play to reduce the spread of respiratory infections. The actions you take will protect you, loved ones and those most vulnerable in our community. The following guide provides strategies that can be used to reduce the spread of all respiratory illnesses 

To learn more about specific respiratory infections, see the following disease fact sheets: 

Each year, cases of RSV and influenza rise during the fall. COVID-19 also increases in the fall, though it can surge at other times throughout the year as well. In Toronto, fall 2024 has also seen a notable rise in pertussis (whooping cough) cases, with infection rates significantly higher than the five-year average.

The best way to protect yourself and your loved ones from respiratory infections each fall is to get vaccinated. Learn more about vaccines that are available for each of these respiratory infections:

Flu vaccines are usually available in October/November available for everyone 6 months of age and older. Get yours through a health care provider, pharmacist, or, for eligible people, at a TPH vaccination clinic.

For more information about flu vaccines, see the flu vaccine fact sheet.  

RSV vaccines are available for people aged 60 or older and for infants. For more information about RSV vaccines, see the RSV fact sheet.

RSV vaccine for older adults

In fall 2023, Ontario introduced its first publicly-funded high-risk older adult RSV vaccine program.

Ontario will continue this program with expanded eligibility in 2024–25. This includes adults aged 60 years and older who are also:

  • Residents of long-term care homes, elder care lodges, or retirement homes
  • Patients in hospital receiving alternate level of care (ALC) including similar settings (for example, complex continuing care, hospital transitional programs)
  • Patients receiving hemodialysis or peritoneal dialysis
  • Recipients of solid organ or hematopoietic stem cell transplants
  • Those experiencing homelessness
  • Those who identify as First Nations, Inuit, or Métis

RSV vaccine for infants and young children

For the 2024/2025 fall respiratory season, the Ministry of Health will expand the Ontario publicly funded infant RSV prevention program to include new products and increase eligibility.

Increased eligibility to Ontario infants and high-risk children that includes:

  • All infants born during and outside of the RSV season
  • Children under two years of age with high-risk medical conditions

New Products to prevent RSV infections in infants and young children:

  • Nirsevimab (BeyfortusTM): a monoclonal antibody (mAb) immunizing agent given to infants just prior to or during RSV season. Given as a single dose and will replace palivizumab (Synagis). It is the recommended product for infants as per NACI due to its effectiveness, long-lasting protection, and positive safety profile.
  • AbrysvoTM: a vaccine administered to pregnant individuals between 32 to 36 weeks gestational age. It provides antibody transfer in utero to protect newborns. It is available on a case-by-case basis in consultation with the pregnant individual and their health care provider.

Eligibility for Beyfortus®:

Any infant less than eight months old who also meets any of the following criteria:

  • Born in 2024 prior to the RSV season
  • Born during the 2024/25 RSV season
  • High-risk children up to 24 months of age who remain vulnerable from severe RSV disease through their second RSV season, with:
    • Chronic lung disease of prematurity (CLD), including bronchopulmonary dysplasia/chronic lung disease
    • Hemodynamically significant congenital heart disease (CHD)
    • Severe immunodeficiency
    • Down syndrome/Trisomy 21
    • Cystic fibrosis with respiratory involvement and/or growth delay
    • Neuromuscular disease
    • Severe congenital airway anomalies impairing clearing of respiratory secretions

Eligibility for AbrysvoTM:

  • Pregnant individuals from 32 to 36 weeks gestational age if they will deliver prior to or during RSV season (generally from November to April, peaking in December), in consultation with their health care provider. If the vaccine is given in pregnancy, the monoclonal antibody does not need to be given to the infant (except under specific circumstances such as a high-risk infant born to a pregnant person who received the vaccine).

Ask a health care provider about your child’s eligibility for RSV vaccination.

Pertussis vaccinations are routinely provided as part of Ontario’s Publicly Funded Routine Immunization Schedule. Doses include:

  • Vaccination against pertussis is provided in one combined vaccine  at 2, 4, 6, and 18 months and 4-6 years of age. Adolescents get a booster at 14 to 16 years of age.
  • One adult booster of pertussis-containing vaccine is provided to adults aged 18 years old and older.
  • A pertussis vaccine booster is recommended in every pregnancy, between 27 and 32 weeks of gestation, to provide antibodies through the womb and protect the newborn.

If you or your child missed a vaccine or are due for the next dose, these vaccines are available from your health care provider’s office. Students can book an appointment at a TPH clinic

There will be no COVID-19 vaccines in Canada beginning September 1, 2024. An updated COVID-19 vaccine is licensed by Health Canada and will become available in Fall 2024.

When updated COVID-19 vaccines are available, it is recommended that all individuals 6 months of age and older consider getting vaccinated, especially if they are at higher risk. See NACI guidance for further information and check back here or on our COVID-19 vaccines web page for updates.

Layers of Protection

We can layer our protection against respiratory infections with some simple steps, which can be used any time, but are especially recommended when there is a higher risk of getting and spreading respiratory infections. 

Layers of protection include the following, and work better when used together. Further details about physical distancing, masking, and keeping public settings and high touch areas clean, can be found below:

  • Stay up-to-date with your vaccinations for the best protection against getting very sick.
  • Consider wearing a high quality, well-fitting mask crowded indoor public settings with poor ventilation, especially if you or people around you are at higher risk (such as seniors, those with a weak immune system, or young children).
  • Stay home if you are sick or have symptoms of illness, even if they are mild, and wear a mask for 10 days after the start of symptoms. Take appropriate action if you are sick. See the “What to do if you are sick” tab.  
  • Wash or sanitize your hands often.
  • Cover your cough or sneeze with your elbow or a tissue.
  • Clean and disinfect frequently touched surfaces.
  • Choose well ventilated spaces (see “Ventilation” tab) when possible.
  • During times of higher spread of infections or if you are at higher risk of getting very sick,
    • Reduce or limit the number of people you have close contact with, especially in crowded indoors spaces with poor ventilation.
    • Socialize outdoors when possible – outdoors is lower risk than being indoors.
    • Keep a physical distance of 2 metres from other people when possible, especially indoors.

People at Higher Risk of Infection and Serious Illness

Knowing if you are at higher risk of getting sick from a respiratory infection can help you make informed decisions about your health and when to use layers of protection. 

Some people are at higher risk of getting very sick or being hospitalized with a respiratory infection, including: 

  • Seniors 
  • People with a weak immune system 
  • Pregnant people 
  • Young children 

Some settings and situations can put you at higher risk of getting and spreading respiratory infections, including: 

  • Congregate settings such as long-term care homes or shelters 
  • Crowded indoor public settings with poor ventilation 
  • During respiratory virus illness season, which usually happens during the fall and winter months: 

More Information:

Physical Distancing

Respiratory illnesses are spread mainly from person-to-person through respiratory droplets that can travel up to two metres. Keeping a physical distance from others, where possible, is an extra measure that can be taken to reduce the risk of respiratory illnesses, especially for those at greater risk of serious illness.  

Here are some ways to practice physical distancing:  

  • Greet others from a distance with a smile, nod or wave  
  • Avoid trips during peak times, to limit contact with large crowds  
  • Avoid crowded stores and return when it is less busy  
  • Consider curbside pick-up, if available  
  • Connect with others online, by phone or outdoors

Face Masks & Respirators

Consider wearing a well-fitting, high-quality mask in crowded indoor public settings with poor ventilation, especially if you or people around you are at higher risk of getting very sick from a respiratory illness.  

If you are sick or have symptoms of illness, it is recommended to wear a mask for 10 days after the start of symptoms.  

Masking continues to be an important layer of protection to keep you, your loved ones, and the most vulnerable in our community safe. Wearing a mask, in addition to other public health measures, can reduce the spread of these viruses and is an important measure we can use to protect ourselves and one another.  

Masks may still be expected or required in certain settings or situations, including: 

  • In healthcare settings such as long-term care homes, retirement homes, hospitals and clinics 
  • In congregate care settings, such as shelters, group homes, 24-hour respite and drop-in sites 
  • At businesses and organizations that have put in place their own masking policies 
  • As personal protective equipment 
  • On some public transportation 

Check with individual organizations to learn more about their specific policies. 

Masks are recommended for anyone who: 

  • Has tested positive for, or has symptoms of COVID-19, flu, or RSV for10 days after the start of symptoms or the positive test result. This means: 
    • Has tested positive for, or has symptoms of pertussis until 5 days of antibiotic treatment have been completed or after 21 days since the start of symptoms. 
    • Is caring for someone, is a close contact of, or lives with someone who has tested positive for, or has symptoms of COVID-19, flu, RSV, or pertussis. 

Masks should not be worn by: 

  • Children under the age of two 
  • People who have trouble breathing or who cannot remove the mask without assistance 

Tips on Wearing a Mask

  • Wear a high-quality, well-fitted, comfortable mask: 
    • A medical mask or respirator (such as an N95 mask) can provide better protection 
    • Cloth masks should be made of at least three layers of tightly woven fabric (such as cotton or linen), or two layers with a filter layer for extra protection 
  • Well-fitted: 
    • A mask should fit your face, covering your nose, mouth and chin without gaping. 
    • Ties/ear loops should fit securely to avoid adjusting during use. 
  • Comfortable: 
    • Your mask should be comfortable, easy to breathe through, and not limit your vision 
  • Wash or sanitize your hands before putting on and after taking off your mask 
  • Place the mask over your nose, mouth and chin 
  • Change your mask if it becomes wet or dirty 
  • Avoid touching your face or mask when wearing it 
  • Remove your mask by the ear loops without touching the front of the mask 
  • Throw away disposable medical masks or respirators after each use 
  • Wash cloth masks after each use 
  • Put your used mask in a plastic bag or directly in the garbage or laundry bin 

Communicating With People who are Deaf, Deafened or Hard of Hearing While Masking

Some people who are deaf, deafened or hard of hearing may remove their mask, or may ask others to remove their mask, because they rely on facial movements and/or lip-reading to communicate. See the below tips for communicating with people who are deaf, deafened or hard of hearing: 

  • Ask the person how they prefer to communicate 
  • Use speech-to-text mobile apps or writing paper 
  • If the person reads lips, you can remove your mask 
  • If you remove your masks, you can consider keeping a distance, wearing a face shield, or standing behind a plexiglass barrier to help reduce your risk 
  • Look at and speak directly to the person, not the ASL interpreter (if they are using one) 
  • Respect the dignity of anyone who requires accommodation 

Hand Hygiene

Learn more about practicing good hand hygiene. 

General Cleaning Tips

Common cleaners, such as soap and bleach, are effective against respiratory viruses. If using alcohol-based cleaners such as hand sanitizer, make sure it is at least 70 per cent alcohol. Always follow the product instructions. 

Clean & Disinfect High-Touch Surfaces

High-touch surfaces may include, but are not limited to: 

  • Door handles 
  • Countertops 
  • Tables 
  • Light switches 
  • Sinks and faucets 
  • Electronic devices (such as cell phones, tablets, keyboards, remote controls) 

If surfaces are visibly dirty: 

  • Use a cleaner, such as soap and water to remove the dirt first 
  • Apply a disinfectant to kill the germs and viruses 
  • Leave the disinfecting solution to dry 

You can choose a product that cleans and disinfects. Read the label to find a product that does both. 

Use disinfectant wipes that are appropriate for electronics. 

Clean & Disinfect Soft Surfaces

Soft surfaces may include, but are not limited to: 

  • Clothing 
  • Drapes 
  • Bedding (such as sheets and pillowcases) 

If soft surfaces are dirty: 

  • Launder according to the label 
  • Use regular laundry detergent and the warmest appropriate temperature setting 
  • Dry items completely in the dryer, if possible 

It is safe to wash laundry from a person who is sick with other items. 

Establishing a Cleaning Schedule for Public Settings

  • Identify high-touch surfaces, objects, and equipment that need routine cleaning as well as disinfection 
  • Indoor high-touch surfaces should be cleaned and disinfected at least once per day and when visibly dirty 
  • Check for and follow any specific cleaning and disinfection protocols for your setting 

Caution: Always check the expiry date, read the label and follow product instructions. Use a product approved in Canada (look for a DIN number). Household bleach may not have a DIN, but is an effective disinfectant. Do not mix chemicals. Wear protective gloves/eyewear and open windows for good ventilation. Never use products on your skin or food, as this can cause serious harm. Store chemicals out of reach from children and pets. 

 

Respiratory infections are spread by: 

  • Respiratory droplets that come out of your nose and mouth when you breathe, talk, cough or sneeze; 
  • Aerosols, which are tiny respiratory droplets that can stay in the air longer; 
  • Close contact with other people in crowded indoor spaces is a common way that viruses spread through respiratory droplets; 
  • Touching something with the virus or bacteria on it, then touching your mouth, nose or eyes. 

If you are sick, you should take the following measures. Details for how to do so are provided below. 

  • Stay at home and self isolate. 
  • Seek testing if you are eligible, and/or medical care if needed. 
  • Notify close contacts to self monitor for symptoms. 

Stay at home & self-isolate if you are sick

If you have symptoms of a respiratory virus, it is recommended that you stay
home (self-isolate) while you are sick, whether you have tested or not. 

This means: 

  • Staying home until you have no fever and your symptoms are improving
    for at least 24 hours (or 48 hours if you have gastrointestinal symptoms
    such as vomiting and/or diarrhea). Individuals with a weak immune
    system should isolate for at least 10 days (from symptom onset or
    positive test date). 
  • After isolating, wear a well-fitted, high quality mask when out in public for 10 days from when your symptoms started. 
  • Avoid non-essential visits to vulnerable individuals (e.g. seniors) and
    highest risk settings (e.g., hospitals, long-term care) for 10 days from
    when your symptoms started. 
  • Make sure you know if you are eligible for treatments. 

If you tested positive for a respiratory virus, but do not have any symptoms and do not have a weakened immune system, you are not required to self-isolate, but it is recommended that you wear a well-fitted, high quality mask when in public settings, especially if they are crowded or have poor ventilation. Individuals with a weak immune system should isolate for at least 10 days (from symptom onset or positive test date) regardless if you have symptoms of COVID-19. Everyone should monitor for symptoms and self-isolate if symptoms develop. 

If you live in a high-risk setting, like a long-term care home, retirement home, hospice, correctional institution, or shelter, you must self-isolate for at least 5 to10 days after your positive test for a respiratory virus or symptom onset date. 

If you work/volunteer/attend a high-risk setting you can return to work after 10 days. Speak to your employer and follow workplace instructions for your return to work. 

If you are diagnosed with pertussis or are suspected of having it you should stay home from childcare, school, or work. You should not participate in group activities, have visitors, and should avoid contact with babies, young children, and people who are pregnant until five days of antibiotic treatment have been completed or 21 days after the start of symptoms. 

Tests to show you have recovered are not required for ending self-isolation. 

Testing and Seeking Medical Care

Toronto Public Health is no longer ordering or distributing rapid antigen test kits for COVID-19. Residents continue to have access to these tests at a number of pharmacies across Toronto, and high-risk individuals will be provided kits through the Ministry of Health through existing channels.  

Tests for flu, RSV, and pertussis are available through health care providers. 

Seek medical care if your symptoms feel worse than a common cold by calling your health care provider or by calling Health811. 

If you are pregnant and have symptoms of COVID-19 or have tested positive, speak to your healthcare provider as soon as possible to find out if you are eligible for treatment.   

If you have ANY of the following signs of severe illness, you should seek immediate medical attention:  

  • Shortness of breath  
  • Chest pain  
  • Weakness  
  • Lethargy or drowsiness  
  • Dizziness  

The following infants and children should also be assessed in the emergency department:  

  • Infants under 3 months of age with fever or trouble breathing or appear unwell  
  • Children and infants over 3 months of age with any of the following:  
  • Fever longer than 7 days  
  • Fast breathing or trouble breathing  
  • Bluish skin colour  
  • Not drinking enough fluids  
  • Not waking up or not interacting  
  • Being so irritable that the child does not want to be held  
  • Fever with a rash  
  • Constant vomiting  
  • Immune compromised with a fever 

 If you do not feel well enough to take personal transport, call 911. Before going for in-person medical care, tell them that you likely have a respiratory infection.  

Notify Close Contacts

To stop the spread of respiratory illnesses, it is important that you notify your close contacts if you get sick, so that they can self-monitor for symptoms and self-isolate if symptoms develop, especially if they are at higher risk of getting very sick. 

A close contact is anyone who you spent time with when you were infectious: 

  • If you have COVID-19 symptoms, your infectious period began 48 hours before your symptoms started. 
  • If you do not have COVID-19 symptoms, your infectious period began 48 hours before your positive COVID-19 test date. 

This may include anyone you live with, had multiple close encounters with within a 24-hour period, especially close physical contact, or anyone who was within 2 metres of you for 15 minutes or more, without a well-fitted, high quality mask. 

Respiratory illnesses can spread more easily when people gather indoors together. There are a number of things you can do to improve indoor air quality to help reduce the spread. 

How to Use Ventilation Systems Reduce the Spread from Respiratory Droplets and Aerosols

  • Improve Ventilation and Filtration:
    • Ventilation means increasing the amount of fresh air that flows into a space. Good ventilation replaces indoor air with fresh outdoor air through air exchanges. This is similar to opening windows to air out a stuffy room. 
    • Filtration means using a filter to remove viruses, bacteria, and other particles from the air. The filtered air is cleaned, and is then returned back into the room. 
    • Good ventilation and filtration help to prevent the spread of respiratory illnesses by reducing particles that have the potential to make you sick in the air. 
    • The effect of ventilation and filtration will depend on many things such as: room size, number of people, the type of activities taking place and measures used to improve ventilation. 
    • Extra attention may need to be given to ventilation and filtration in settings where aerosol generating activities take place. 
  • Use and Maintain Heating, Ventilation and Air Conditioning (HVAC) Systems 
    • HVACs can improve ventilation and reduce the amount of viral and bacterial particles in the air.
    • When using HVAC systems: 
      • The equipment should be maintained often to make sure it works well. 
      • Avoid re-circulating air, for example, adjust vents to let in as much outdoor air and as little recirculated indoor air as possible through air exchange. 
      • Keep areas near air vents free and clear from items such as furniture 
  • For Spaces Without HVAC Systems or With Poor HVAC Systems 
    • Use Portable Air Cleaners 
      • Portable air cleaners filter and clean the air. 
      • Make sure that the air cleaner keeps running and does not blow directly at anyone. 
      • Use proper filters that can filter out small particles from the air, such as HEPA filters, and change the filter often. 
    • Promote Natural Fresh Air Flow 
      • All indoor spaces can benefit from natural fresh air flow. 
      • Open windows, if it is safe to do so. 
      • Use portable fans, ceiling fans and single unit air conditioners to improve natural air flow. 
      • When using a window air conditioner unit or fan, make sure it does not blow directly toward anyone. 
        • Place fans near an open window or door to help bring outdoor air into the space. 
        • When using ceiling fans, use the setting that moves the air up toward the ceiling. 

Other Resources:

For information in French about respiratory viruses, please visit the Government of Ontario’s website and Public Health Ontario portal