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. Statement on influenza vaccination for the 2005-2006 season. David Levine Oct. 16, 2020 CDC’s guidance titled Prevention Strategies for Seasonal Influenza in Healthcare Settings contains details on the prevention strategies for all healthcare settings. Influenza Other Respir Viruses 2018; 12:287–92. Arch Intern Med 1998; 158:2155–9. For some other, rarer diseases, just 1 case can be considered an outbreak. However, no nursing homes have reported influenza outbreaks this flu … A facility called Shimizu Funai no … These researchers conducted a pragmatic cluster-randomized trial comparing adjuvanted trivalent influenza vaccine (aTIV) versus trivalent influenza vaccine (TIV). The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. The next update for this report will be on Tuesday, January, 19, 2021. According to public health officials, 151 people tested positive during a recent If you are visiting a facility during an outbreak, consider taking certain precautions. 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. 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. 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. 3. Influenza transmission may have been mediated by staff via either contaminated hands or fomites. Merritt T, Hope K, Butler M, et al. This information is to be reported as part of the CMS Minimum Data Set, which tracks nursing home health parameters. Influenza Other Respir Viruses 2014; 8:74–82. 2. Healthcare personnel, and visitors who are identified with any illness symptoms should be excluded from the facility until their illness has resolved. In some cases, facilities may choose to apply Standard Precautions and Droplet Precautions for longer periods based on clinical judgment, such as in the case of young children or severely immunocompromised residents, who may shed influenza virus for longer periods of time. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. behavior change), and may not have fever. Interim Guidance for Influenza Outbreak Management in Long-term Care Facilities pdf icon[153 KB, 7 pages]. Member Research and Reports January 14, 2021 Brown: Adjuvanted Vaccine Cuts Nursing Home Flu Outbreaks by 17 Percent, Researcher Reports Clin Infect Dis 2004; 39:459–64. Long-term care facilities may be defined as institutions, such as nursing homes and skilled nursing facilities that provide health care to people (including children) ... which tracks nursing home health parameters. Nursing home showed few signs it prepared for virus outbreak By Bernard Condon and Carla K. Johnson, Associated Press | Updated - Mar. Laboratory investigations. Longer antiviral treatment courses for hospitalized patients who remain severely ill after 5 days of treatment can be considered. Sixth death in flu outbreak nursing home. As well, five staff cases were employed in other acute and long-term care homes. COVID-19 Ongoing Clusters in Child Care and School Settings Report will be updated every Tuesday and Friday by 4 p.m. Use of oseltamivir during an outbreak of influenza A in a long-term care facility in Taiwan. "Getting any flu outbreak under control quickly is really important as it quickly spreads into the local community from bad outbreaks in nursing homes and schools," Professor Dwyer said. Abstract. The following influenza tests are recommended: molecular assays, including rapid molecular assays, other molecular tests, or reverse transcription polymerase chain reaction (RT-PCR). Fifteen residents of the Marco Polo Aged Care Services in Unanderra, south … Commun Dis Intell Q Rep 2004; 28:396–400. Updated to include COVID-19 outbreak management and algorithm. Amid an outbreak of influenza, the nation has seen a spate of deaths in recent days following mass infections at nursing care facilities. CDC recommends antiviral chemoprophylaxis for a minimum of 2 weeks and continuing for at least 7 days after the last known laboratory-confirmed influenza case was identified on affected units. 7, 2020 at 7:49 a.m. | Posted - Mar. For persons aged ≥65 years, any age-appropriate IIV formulation (standard-dose or high-dose, trivalent or quadrivalent, unadjuvanted or adjuvanted) or quadrivalent recombinant influenza vaccine are acceptable options. Persons receiving antiviral chemoprophylaxis should not receive live attenuated influenza virus vaccine (LAIV), and persons receiving LAIV should not receive antiviral treatment or chemoprophylaxis until 14 days after LAIV administration. While CDC recommends judicious use of antiviral medications for chemoprophylaxis to reduce the possibility of development and spread of antiviral resistant influenza viruses, chemoprophylaxis may be considered for healthcare personnel, regardless of their influenza vaccination status, if the outbreak is caused by a strain of influenza virus that is not well matched by the vaccine, or based upon other factors (e.g. Viral culture should be performed at a public health laboratory if additional information on influenza viruses, such as influenza A virus subtype, antigenic characterization to compare with influenza vaccine strains, or antiviral resistance data, are needed. 4 I. The outbreaks … If possible, all residents should receive inactivated influenza vaccine (IIV) annually before influenza season. A Guide to the Control of Respiratory Infection Outbreaks in Long Term Care Homes 2004. behavior change), and may not have fever (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935external icon). CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Influenza outbreaks pose a … The CDC defines an outbreak as one confirmed case of the flu in a nursing home, along with other cases of acute respiratory illness. Booy R, Lindley RI, Dwyer DE, et al. Adjuvanted trivalent vaccine (Fluad) is significantly more protective against nursing home flu outbreaks than standard vaccines, according to a large new study. Immunization of Health-Care Personnel. Placing ill residents in a private room. J Hosp Infect 2008; 68:83–7. Zanamivir should be used when persons require chemoprophylaxis as a result of exposure to influenza virus strains that are suspected or known to be oseltamivir-resistant. Infect Control Hosp Epidemiol. Current Outbreaks. Dosage adjustment may be required for children and persons with certain underlying conditions. Recommended Dosage and Duration of Treatment or Chemoprophylaxis for Influenza Antiviral Medications, CDC’s influenza antiviral drugs page for health professionals, CDC’s seasonal influenza vaccination resources for health professionals page, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2020–21 Influenza Season, Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza, Interim Guidance for Influenza Outbreak Management in Long-term Care Facilities, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD), Reconstruction of the 1918 Influenza Pandemic Virus, 2019-2020 Preliminary In-Season Burden Estimate, Who is at High Risk for Flu Complications, Who Should & Who Should NOT Get Vaccinated, Live Attenuated Influenza Vaccine (LAIV)/Nasal Spray Vaccine, Selecting Viruses for the Seasonal Influenza Vaccine, Flu Vaccine and People with Egg Allergies, Frequently Asked Questions on Vaccine Supply, Historical Reference of Vaccine Doses Distributed, Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN), How Vaccine Effectiveness and Efficacy are Measured, What People with a Staph Infection Should Know about Flu, Resources for Hosting a Vaccination Clinic, Overview of Influenza Surveillance in the United States, Influenza Hospitalization Surveillance Network (FluSurv-NET), Weekly U.S. Figure 2 summarizes staff and resident symptoms.. If a private room is not available, place (cohort) residents suspected of having influenza residents with one another; Wear a facemask (e.g., surgical or procedure mask) upon entering the resident’s room. Flu Prevention in Nursing Homes Elder care facilities have always worked hard to prevent and control flu outbreaks, and COVID-19 has only heightened their diligence. According to requirements, each resident is to be vaccinated unless contraindicated medically, the resident or legal representative refuses vaccination, or the vaccine is not available because of shortage. A sixth person has died in an outbreak of a flu virus at a nursing home, NHS Tayside said has said. 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 … MMWR 2010:59(03):74-77. Facility Outbreak Bulletin This bulletin lists ongoing and recently ended outbreaks in licensed long-term and acute care facilities throughout Vancouver Coastal Health, as of 03:08 PM, 10-Jan-2021 DISEASE LOCATION RESTRICTIONS IMPOSED RESTRICTIONS FACILITY LIFTED COVID-19 Vancouver General Hospital, LB8A 899 W 12th Ave, Vancouver 06-Jan-21 If one laboratory-confirmed influenza positive case is identified along with other cases of acute respiratory illness in a unit of a long-term care facility, an influenza outbreak might be occurring. 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. O’Neil CA, Kim L, Prill MM et al. CDC. ​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®). Determining influenza virus type or subtype of influenza A virus can help inform antiviral therapy decisions. 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. 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. The 55% case-fatality rate resulted from severe pneumonia. 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. 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. When a higher-than-average number of people who live and work in a health care facility are sick with similar symptoms. BMC Geriatr. Avoid new admissions or transfers to wards with symptomatic residents. 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 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. Changing gloves and gowns after each resident encounter and performing hand hygiene. Most outbreaks of Covid-19 reported to Public Health … •The City of Laredo Health Department investigated the initial report via laboratory reports received by fax and Initiation of antiviral treatment should not wait for laboratory confirmation of influenza. If influenza is suspected and RIDTs or immunofluorescence results are negative, perform confirmatory testing using molecular influenza assays. The outbreaks have sickened hundreds of staff members and patients and led to scores of deaths. Ye M, Jacobs A, Khan MN, et al. 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. To limit the potential transmission of antiviral drug-resistant influenza virus, whether in chronic or acute-care settings or other closed settings, measures should be taken to reduce contact between ill persons taking antiviral drugs for treatment and other persons, including those receiving antiviral chemoprophylaxis. Setting: The Jewish Home and Hospital for Aged, a skilled-care nursing facility. Use of oseltamivir in Dutch nursing homes during the 2004–2005 influenza season. If resident movement or transport is necessary, have the resident wear a facemask (e.g., surgical or procedure mask), if possible. • On March 19, 2017 two (2) more patients were rapid test positive for Influenza A. Baloxavir is approved for early treatment of uncomplicated influenza in people 12 years and older who are otherwise healthy or at high-risk for influenza complications and have been ill for no more than 2 days. Outbreaks of infectious diseases can decimate resident populations in nursing home facilities. Flu and gastro can then spread very quickly to other residents, staff and visitors. PLoS One 2012; 7:e46509. 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​. 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. BMJ Open 2016; 6:e011686. Six elderly people have died in a North-West nursing home during an influenza outbreak, director of public health Dr Mark Veitch has confirmed. Health Care Personnel . 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. Visitors entering may be at risk of getting sick or taking the illness home to others. An Oakland County nursing home is barring visitors from entering and residents from leaving because of a flu outbreak. Baloxavir is not recommended for pregnant women, severely immunosuppressed persons, those with severe disease, or hospitalized influenza patients. Define the outbreak… Test for influenza with a molecular assay in the following: Ill persons who are in the affected unit(s) as well as previously unaffected units in the facility, Persons who develop acute respiratory illness symptoms after beginning antiviral chemoprophylaxis. to reduce the risk of short staffing in facilities and units where clinical staff are limited and to reduce staff reluctance to provide care to residents with suspected or laboratory-confirmed influenza). Zapata County Influenza Outbreak •Wednesday, March 22, 2017: The City of Laredo Health Department received a telephone communication from a nursing home’s Administrator to report a possible outbreak of Influenza. 03 April, 2012. Respiratory illness outbreak at retirement home kills 2 and ... assisted living and skilled nursing ... a year in the winter and flu season. Residents of long-term care facilities can experience severe and fatal illness during influenza outbreaks. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Australia is gripped by its worst ever flu season with more than 71,000 people sick and up to 3,000 expected to die, including three nursing home residents who were caught in an outbreak. Spread of influenza can occur between and among residents, healthcare personnel and visitors. Consider restricting visitation by children during community outbreaks of influenza. 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. Childs A, Zullo AR, Joyce NR et al. Make sure there is an adequate supply of masks on hand. More information about testing is included below. In an aged care home, a flu or gastro outbreak can start with just 2 or 3 residents getting sick. Flu outbreaks in several long-term care facilities in Nebraska and Iowa have health care officials on high alert. These Precautions are part of the overall infection control strategy to protect against influenza in healthcare settings and should be used along with other infection control measures, such as isolation or cohorting of ill residents, screening employees and visitors for illness, furloughing ill healthcare personnel, and discouraging ill visitors from entering the facility. Am J Infect Control. Five residents were hospitalised and three died. INTRODUCTION Influenza, more commonly known as ^the flu, is typically caused by either a type A or type B influenza virus. van der Sande MA, Ruijs WL, Meijer A, Cools HJ, van der Plas SM. van der Sande MA, Meijer A, Sen-Kerpiclik F, et al. It should be noted that some long-term care residents may have difficulty using the inhaler device for zanamivir. Implementation of Standard Precautions constitutes the primary strategy for the prevention of healthcare-associated transmission of infectious agents among patients and healthcare personnel. Although vaccination by the end of October is recommended, influenza vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in the majority of influenza seasons because the duration of the season is variable, and influenza activity might not occur in certain communities until February or March. When at least 2 patients are ill within 72 hours of each other and at least one resident has laboratory-confirmed influenza, the facility should promptly initiate antiviral chemoprophylaxis with oral oseltamivir to all non-ill residents living on the same unit as the resident with laboratory-confirmed influenza (outbreak affected units), regardless of whether they received influenza vaccination during the current season. Specific recommendations are highlighted below. Flu Watch Report February 13 to February 19, 2005. Antiviral prophylaxis in the management of an influenza outbreak in an aged care facility. 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. 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. Health Care Facility Outbreaks. Effectiveness of post-exposition prophylaxis with oseltamivir in nursing homes: a randomised controlled trial over four seasons. It was reported that staff worked on more than one floor in the home. (For more information see Recommended Dosage and Duration of Treatment or Chemoprophylaxis for Influenza Antiviral Medications and (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy866/5251935external icon). For more information on the antiviral agents see CDC’s influenza antiviral medication page for health professionals. Informed consent is required to implement a standing order for vaccination, but this does not necessarily mean a signed consent must be present. Healthcare personnel who have occupational exposures can be counseled about the early signs and symptoms of influenza and advised to contact their health-care provider immediately for evaluation and possible early initiation of antiviral treatment if clinical signs or symptoms develop. According to outbreak data published by the state, there are 118 nursing home and 137 assisted living outbreaks. Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999–2000. Zapata County Influenza Outbreak •A nursing home, first identified through influenza rapid testing on March 18, 2017, four (4) patients and one (1) staff member (CNA) as positive for Influenza A. To receive weekly email updates about Seasonal Flu, enter your email address: Co-circulation of Influenza Viruses and SARS-CoV-2, Centers for Disease Control and Prevention. When an influenza outbreak occurs in a nursing home, several measures can be implemented by the treating physician. 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