During an outbreak, once a single laboratory-confirmed case of influenza has been identified in a resident, it is likely there are other cases among exposed persons. *Patients with illness associated with influenza virus infection often have fever or feverishness with cough, chills, headache, myalgias, sore throat, or runny nose. Added information on patient group direction (PGD) templates. When a higher-than-average number of people who live and work in a health care facility are sick with similar symptoms. The outbreaks have sickened hundreds of staff members and patients and led to scores of deaths. As well, five staff cases were employed in other acute and long-term care homes. Peters PH Jr, Gravenstein S, Norwood P, et al. 2. An emphasis on close monitoring and early initiation of antiviral treatment is an alternative to chemoprophylaxis in managing certain persons who have had a suspected exposure to influenza virus. CCDR 2005;31(ACS-6):1-32. Setting: The Jewish Home and Hospital for Aged, a skilled-care nursing facility. Post-acute and LTCFs provide rehabilitative, restorative, and/or ongoing skilled nursing care to patients or residents in need of assistance with activities of daily living. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Guidelines for Suspected Influenza Outbreaks in Nursing Homes/Long Term Care Facilities Division of Infectious Disease Epidemiology 350 Capitol Street, Room 125, Charleston, WV 25301-3715 Phone: 304.558.5358 Fax: 304.558.6335 Updated January 2015 Page 1 of 1 Before an Outbreak … Wearing gloves if hand contact with respiratory secretions or potentially contaminated surfaces is anticipated. Intern Med 2002; 41:366–70. Over 60 residents and dozens of staff members at a nursing home in Old Saybrook have tested positive for COVID-19 and three residents have died during the outbreak, according to the facility. Fifteen residents of the Marco Polo Aged Care Services in Unanderra, just outside Wollongong, were suffering with flu symptoms after the June long weekend. Health Care Facility Outbreaks. A Guide to the Control of Respiratory Infection Outbreaks in Long Term Care Homes 2004. Murti M, Fung CK, Chan K, Bigham M. Duration of influenza outbreaks in long-term care facilities after antiviral prophylaxis initiation: Fraser Health, British Columbia, 2014-2017. Rainwater-Lovett K, Chun K, Lessler J. Public Health Agency of Canada. •The City of Laredo Health Department investigated the initial report via laboratory reports received by fax and Saving Lives, Protecting People, When there is a confirmed or suspected influenza outbreak, Testing and Management Considerations for Nursing Home Residents with Acute Respiratory Illness Symptoms when SARS-CoV-2 and Influenza Viruses are Co-circulating, Recommendations of the Advisory Committee on Immunization Practices – United States, 2020-2021 Season, Antiviral Drugs: Information for Healthcare Professionals. Four influenza antiviral drugs approved by the U.S. Food and Drug Administration are recommended for treatment of uncomplicated influenza in the United States: neuraminidase inhibitors: oral oseltamivir (available as a generic version or under the trade name Tamiflu®), as a pill or suspension; zanamivir (trade name Relenza®), available as an inhaled powder using a disk inhaler device; and intravenous peramivir (trade name Rapivab®); and a cap-dependent endonuclease inhibitor: baloxavir marboxil (trade name Xofluza®). (https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm). Define the outbreak… A nursing home in southern New South Wales is in lockdown following a flu outbreak which has left four people dead. Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999–2000. This will also reduce transmission of viruses that may have become resistant to antiviral drugs during therapy. Have symptomatic residents stay in their own rooms as much as possible, including restricting them from common activities, and have their meals served in their rooms when possible. Consideration may be given for extending antiviral chemoprophylaxis to residents on other unaffected units or wards in the long-term care facility based upon other factors (e.g. Flu outbreak kills two at Qld nursing home MORE than a dozen residents at a Queensland nursing home where two people died from the flu have tested positive to Influenza A. AAP March 28, 2013 11:22am Even if it’s not influenza season, influenza testing should occur when any resident has signs and symptoms of acute respiratory illness or influenza-like illness. Flu Watch Report February 13 to February 19, 2005. Information about influenza testing is available at: https://www.cdc.gov/flu/professionals/diagnosis/index.htm, https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935, influenza diagnostic testing is available online, those who are at high risk for complications of influenza, https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. mirror.co.uk - Care homes have yet again become the epicentre of Covid outbreaks, heartbreaking new data shows. Offer flu vaccinations to nursing home patients and staff. Drinka PJ, Gravenstein S, Schilling M, Krause P, Miller BA, Shult P. Duration of antiviral prophylaxis during nursing home outbreaks of influenza A: a comparison of 2 protocols. Fifteen residents of the Marco Polo Aged Care Services in Unanderra, south … Flu outbreaks in nursing homes can lead to pneumonia, stroke and heart attacks among elderly residents. Limit the number of large group activities in the facility and consider serving all meals in resident rooms if possible when the outbreak is widespread (involving multiple units of the facility). Consider restricting visitation by children during community outbreaks of influenza. A facility called Shimizu Funai no … A team from the Public Health Unit at Sydney Local Health District has developed an application to help staff at 2019 Aug 5;19(1):210. doi: 10.1186/s12877-019-1236-6. Outbreak ID Institution Setting Outbreak Type Causative Agent Date Reported Date Ended ; 2268-2021-31 : Chartwell Royal Marquis Retirement Residence - Facility 590 Grand Marais Rd E Windsor, ON N8X 3H4 : Retirement Home : Respiratory : COVID-19: January 7, 2021 CDC’s influenza antiviral medication page for health professionals. Eastside Center for Health and Rehabilitation, which provides both long-term and short-term care, is the latest congregate living setting to face an outbreak. 15 October 2018. Flu Prevention in Nursing Homes Elder care facilities have always worked hard to prevent and control flu outbreaks, and COVID-19 has only heightened … An outbreak of influenza A occurred in an elderly population in a Maryland nursing home between December 8, 1980 and January 13, 1981 and involved 76 of the 170 residents. Neither routine infection control measures nor vaccination prevented illness, complications, or death in a nursing home outbreak of influenza A. Influenza can be introduced into a long-term care facility by newly admitted residents, healthcare personnel and by visitors. According to outbreak data published by the state, there are 118 nursing home and 137 assisted living outbreaks. Ensure that the laboratory performing influenza testing notifies the facility of tests results promptly. Oseltamivir prophylaxis in controlling influenza outbreak in nursing homes: a comparison between three different approaches. While unusual, an influenza outbreak can occur outside of the normal influenza season; therefore, testing for influenza viruses and other respiratory pathogens should also be performed during non-influenza season periods. Influenza transmission may have been mediated by staff via either contaminated hands or fomites. The recommended dosing and duration of antiviral treatment is twice daily for 5 days for neuraminidase inhibitors (oseltamivir and zanamivir), and one dose for intravenous peramivir. Influenza Surveillance Report (FluView), Past Flu Seasons Flu Forecasting Accuracy Results, Tools to Prepare Your Practice for Flu Season, Multiplex Assays Authorized for Simultaneous Detection of Influenza Viruses and SARS-CoV-2, Information on Collection of Respiratory Specimens for Influenza Virus Testing, Information for Clinicians on Rapid Diagnostic Testing for Influenza, Algorithm: Interpreting Influenza Testing Results When Influenza is Circulating, Algorithm: Interpreting Influenza Testing Results When Influenza is NOT Circulating, Guide: Influenza Diagnostic Testing in Closed Setting Outbreaks, Guidance: Standard-Based Electronic Laboratory Reporting, Guidance: Antiviral and Obstetric Health Care, Guidance: Outbreak Management in Long-Term Care Facilities, Guidance: Use of Mask to Control Influenza Transmission, Guidance: Prevention & Control in Peri- and Postpartum Settings, Health Professional References & Resources, Responding to Problems with Purchasing Needles for Flu Vaccination, U.S. Department of Health & Human Services, Infection Prevention and Control Measures, Influenza-related illness and death, especially among people at increased risk for severe influenza complications. 19 ACTION CARD: Respiratory Illness 29 Integrated care pathway (Checklist) for Acute Respiratory Infections in care homes (including flu-like illnesses) 29 Appendix 1: Transmission, incubation and communicability of respiratory pathogens 40 Examples of standard precautions include: Droplet Precautions are intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions. Member Research and Reports January 14, 2021 Brown: Adjuvanted Vaccine Cuts Nursing Home Flu Outbreaks by 17 Percent, Researcher Reports The next update for this report will be on Tuesday, January, 19, 2021. COVID-19 Ongoing Outbreaks in Congregate Living Settings Report will be updated every Tuesday and Friday by 4 p.m. . That is supplemented by separate “strike teams” that can bolster infection control if an The manager of an aged care home at Unanderra in the midst of a flu outbreak that has killed three residents has issued a plea to the public. Current Outbreaks. Isolating and containing people with the flu is a highly effective measure for curbing an outbreak of the flu, but symptoms typically don’t appear for 2-3 days. In the event that a new patient or resident is admitted after the influenza vaccination program has concluded in the facility, the benefits of vaccination should be discussed, educational materials should be provided, and an opportunity for vaccination should be offered to the new resident as soon as possible after admission to the facility. Adjuvanted trivalent vaccine (Fluad) is significantly more protective against nursing home flu outbreaks than standard vaccines, according to a large new study. Placing ill residents in a private room. The following influenza tests are recommended: molecular assays, including rapid molecular assays, other molecular tests, or reverse transcription polymerase chain reaction (RT-PCR). Since October 2005, the Centers for Medicare and Medicaid Services (CMS) has required nursing homes participating in Medicare and Medicaid programs to offer all residents influenza and pneumococcal vaccines and to document the results. If influenza molecular assays are not available and antigen detection tests are used such as rapid influenza diagnostic tests (RIDTs) or immunofluorescence assays, false negative results can occur because RIDTs and immunofluorescence assays have lower sensitivity than molecular assays for detection of influenza viruses. CDC: Flu outbreak in two Maine prisons showed need for preparedness An influenza outbreak at a pair of neighboring state prisons in Maine last year sickened 46 inmates and staff members and killed one inmate, pointing up the need to offer flu vaccine to prison populations and take other precautions, according to the US Centers for Disease Prevention and Control (CDC) today. Sudbury's health unit says it may take a while to clear two active Effectiveness of post-exposition prophylaxis with oseltamivir in nursing homes: a randomised controlled trial over four seasons. nasopharyngeal swab, nasal swabs, nasopharyngeal or nasal aspirates, or combined nasal and throat swabs) of ill residents with recent onset of signs and symptoms suggestive of influenza or acute respiratory illness. Clinicians should consult the manufacturers’ package insert for approved ages, recommended drug dosing adjustments and contraindications. Because residents with influenza may continue to shed influenza viruses while on antiviral treatment, infection control measures to reduce transmission, including following Standard and Droplet Precautions, should continue while the resident is taking antiviral therapy. Amid an outbreak of influenza, the nation has seen a spate of deaths in recent days following mass infections at nursing care facilities. J Am Geriatr Soc 2002; 50:608–16. Implementation of outbreak control measures can also be considered as soon as possible when one or more residents have acute respiratory illness with suspected influenza and the results of influenza molecular tests are not available the same day of specimen collection. Childs A, Zullo AR, Joyce NR et al. Antiviral prophylaxis in the management of an influenza outbreak in an aged care facility. According to public health officials, 151 people tested positive during a recent However, these medications can still help when given after 48 hours to those that are very sick, such as those who are hospitalized, or those who have progressive illness, or those who are at high risk for complications of influenza. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Baloxavir is not recommended for pregnant women, severely immunosuppressed persons, those with severe disease, or hospitalized influenza patients. If infection with an antiviral-resistant influenza virus is suspected, the local or state public health department should be notified promptly. Perform hand hygiene before and after touching the resident, after touching the resident’s environment, or after touching the resident’s respiratory secretions, whether or not gloves are worn. PLoS One 2012; 7:e46509. An outbreak of COVID-19 at a Bangor rehabilitation and skilled nursing facility is being investigated by the Maine Center for Disease Control and Prevention. Administer the current season’s influenza vaccine to unvaccinated residents and healthcare personnel as per current vaccination recommendations. Residents receiving antiviral medications who do not respond to treatment or who become sick with influenza after starting chemoprophylaxis might have an infection with an antiviral-resistant influenza virus. *Note that older adults and other long-term care residents, including those who are medically fragile and those with neurological or neurocognitive conditions, may manifest atypical signs and symptoms of influenza virus infection (e.g. 11 October 2018. Obtain standing orders to enable influenza laboratory testing and administration of antiviral agents in the event of an influenza outbreak. Influenza outbreak control practices and the effectiveness of interventions in long-term care facilities: a systematic review. The local public health and state health departments should be notified of every suspected or confirmed influenza outbreak in a long-term care facility, especially if a resident develops influenza while on or after receiving antiviral chemoprophylaxis. This care may represent custodial or chronic care management or short-term rehabilitative services. Please also refer to the Infectious Diseases Society of America (IDSA) 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.external icon. Having preapproved orders from physicians or plans to obtain orders for antiviral medications on short notice can substantially expedite administration of antiviral medications. Hospitalizations and Mortality Associated With Norovirus Outbreaks in Nursing Homes, 2009-2010 external icon; Outbreaks of Human Metapneumovirus in Two Skilled Nursing Facilities – West Virginia and Idaho, 2011–2012; Mycoplasma pneumoniae Outbreak in a Long-Term Care Facility – Nebraska, 2014; Outbreaks of 2009 Pandemic Influenza A (H1N1) among Long-Term Care Facility … For newly vaccinated healthcare personnel, antiviral chemoprophylaxis can be considered for up to 2 weeks following inactivated influenza vaccination until vaccine-induced immunity is acquired. These researchers conducted a pragmatic cluster-randomized trial comparing adjuvanted trivalent influenza vaccine (aTIV) versus trivalent influenza vaccine (TIV). Saving Lives, Protecting People, Nursing Home COVID-19 Infection Control Assessment and Response (ICAR) Tool, Applying COVID-19 Infection Control Strategies in Nursing Homes, Nursing Home Infection Preventionist Training Course (CDC TRAIN), Use Personal Protective Equipment Correctly for COVID-19, Sparkling Surfaces: Stop COVID-19’s Spread, CMS Emergency Preparedness & Response Operations, Supporting Your Loved One in a Long-Term Care Facility, Applying COVID-19 Infection Prevention and Control Strategies in Nursing Homes (Recorded Webinar), National Center for Immunization and Respiratory Diseases (NCIRD), Duration of Isolation & Precautions for Adults, Nursing Homes & Long-Term Care Facilities, SARS-CoV-2 Antigen Testing in Nursing Homes, Post Vaccine Considerations for Healthcare Personnel, Decontamination & Reuse of N95 Respirators, Purchasing N95 Respirators from Another Country, Powered Air Purifying Respirators (PAPRs), Operational Considerations for Non-US Settings, Responding to SARS-CoV-2 Infections in Acute Care Facilities, U.S. Department of Health & Human Services, Sample Notification Letter to Residents and Families: COVID-19 Transmission Identified. 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