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Influenza and the Nursing Home Population

This presentation discusses the provisiona data from the 2010-2011 influenza season in nursing homes, the definition of outbreak, and the importance of laboratory testing in this population.

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Influenza and the Nursing Home Population

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  1. Influenza and the Nursing Home Population Julie L. Freshwater, PhD MPH Influenza Surveillance Coordinator

  2. Objectives • Present provisional data from the 2010-2011 influenza season in the nursing home population • Understand the term outbreak in the nursing home setting • Understand the importance of laboratory testing in this population

  3. Testing for Influenza* • Rapid tests • Sensitivities are approximately 50-70% • Specificities are approximately 90-95% • Serology • 2 weeks or more • DFA/IFA • 2 – 4 hours • Viral Culture • 3 – 10 days • PCR • 2 – 4 hours *CDC Influenza Diagnostic Table

  4. OLS Testing for Influenza • PCR for: • Influenza • AH3 • AH1N1 (SO) • B • When negative for influenza: • Culture for: • Parainfluenza • Adenovirus • RSV

  5. Definition of Influenza-like Illness Temperature ≥ 100◦ F AND Cough and/or Sore throat In absence of any other known cause

  6. LTCF Outbreak Definition • One (1) positive laboratory test for influenza in conjunction with other similar illnesses on the unit indicates an outbreak is occurring OR • Three cases of influenza-like illness within 72 hours

  7. Importance of Laboratory Testing • Starting or stopping antiviral treatments • Chemoprophylaxis for residents and staff • Mitigating morbidity and mortality • Reducing costs

  8. If positive for influenza • Begin prophylaxis on ALL residents • Treatment should continue for 14 days or for 7 days after onset of symptoms of last person infected • Unvaccinated staff should receive antiviral treatment

  9. Importance of positive lab • Place ill residents in private rooms or cohort with other ill residents • Ill staff should stay off work until 24 hours without fever • Keep staff from floating between floors/units • Implement control measures

  10. LTCF Outbreak Control Measures • Use standard and droplet precautions • Attention to hand hygiene

  11. Additional control measures • Consider • Limiting new admissions • Limiting or stopping visitation to the facility until no new cases for 48 hours • Stopping or limiting group activities • Serve meals in residents’ rooms

  12. Specimens for Influenza Testing • Nasopharyngeal swabs • Obtain 8-10 from recently ill • Ship to OLS for sub-typing

  13. Respiratory Outbreaks January-September 2011 • 51 respiratory outbreaks or clusters • 30 in long term care facilities • Clinical Syndrome/Diagnosis: • Influenza • Influenza/Pneumonia • Upper or Lower Respiratory Tract Infection • Pneumonia • 14 counties

  14. LTCF Influenza Outbreaks January – September 2011 (Provisional Data) • 19 of 30 (63%) respiratory outbreaks were attributed to influenza • 15 of 19 (79% ) lab confirmed • 4 of 19 (21% ) were rapid test positive with no confirmatory testing • Only influenza AH3 , no AH1N1 in residents

  15. Nursing Home Case #1 • Started January 31, 2011 with one rapid test (+) • Two more residents on February 12 • Vaccination status of 44 of 73 (60%) staff members unknown • 2 staff members tested positive for influenza, specifics were not available

  16. Nursing Home #1 Final Count • 5 out 6 specimens sent to OLS for testing were positive for AH3 • 14 of 55 (25%) residents met the case definition of ILI • 25 of 73 (34%) staff met case definition

  17. Nursing Home #2 • Illness started February 28, 2011 • 19 residents with ILI, 1 rapid test (+) • 8 staff with ILI, 2 rapid test (+) • 46 of 71 (65%) staff members immunized against influenza

  18. Nursing Home Case #2 Final Count • 16/125 residents met case definition • Instead of 19 originally on line list • 14/171 staff met case definition • Additional 6 staff members ill from original 8

  19. Nursing Home #3 • Illness started March 30, 2011 • 10 of 56 residents • 0 of 35 staff members • 5 were rapid test (+) • Doctor wanted to just provide anti-virals for those that were ill

  20. Nursing Home #3 • April 4, 2011 • 26 of 56 (46%) residents were ill • 5 residents were sent to the hospital • 13 of 35 (37%) staff reported illness • 6 specimens were sent to OLS in saline • Antivirals administered to everyone at this time • Last onset April 10, 2011

  21. Nursing Home #3 Final Count • 3 specimens sent to OLS were AH3 (+) • Five residents hospitalized, two residents died • 15 of 56 (27%) residents met case definition • 14 of 35 (40%) staff met case definition

  22. Conclusion • Influenza symptoms are very similar to other respiratory diseases • Laboratory testing is essential in determining etiologic agent • Results can guide treatment • Antivirals? • Antibiotics? • Results can guide control measures • Respiratory and cough etiquette • Restriction of activities enforced or lifted

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