Nov 2022

Increased Respiratory Illnesses in the Community

Remember to get your vaccinations, test for influenza in addition to COVID, and stay home when sick. 

Quick Guide for Long Term Care Facilities Dealing with an Influenza Outbreak

Incubation Period

1-4 days (avg. 2 days)

Period of Communicability

1 day before symptoms start up to 10 days after symptom onset

Symptoms

Fever, fatigue, headache, cough, sore throat, runny or stuffy nose, chills, and muscle aches Elderly patients may experience more subtle symptoms, including anorexia, mental status changes, pneumonia, low-grade or no fever, worsening of chronic respiratory conditions or congestive heart failure.
Familiarize yourself with signs and symptoms of influenza-like illness in the elderly.
Even if influenza activity is low in the community, influenza testing should occur when any resident has signs and symptoms that could be due to influenza, and especially when two residents or more develop respiratory illness within 72 hours of each other.

Treatment

Oseltamivir 75mg twice daily for 5 days

Prophylaxis

Oseltamivir 75mg once daily for a minimum of 2 weeks, continuing for at least 7 days after identification of last known case

Lab Testing

Rapid influenza diagnostic test; Viral cell culture; RT-PCR *negative test does not rule out influenza

Report to Public Health

Within 1 day of one lab-confirmed case of influenza of = cases of like illness. Influenza- associated deaths are reportable within 3 days. To report an outbreak or consult with a Public Health Nurse call 360-778-6100 or leave a message on our report line at 360-778-6150

Key Points During an Influenza Outbreak

1. Limit large group activities and consider serving all meals to residents in their rooms if the outbreak is widespread.
2. Ill residents should stay in their rooms and limit time spent in common areas; all meals should be served in their rooms if possible.
3. As long as appropriate infection control measures are maintained, facilities can admit new residents. It is important to inform potential new residents of the outbreak so they may choose whether to postpone their admission.
4. Designate staff to care for ill residents and minimize staff movement between areas in the facility with illness and areas not affected by the outbreak. Consider setting up a separate break room for staff caring for ill residents, and disinfect surfaces used by all staff (such as time clocks) or set up an interim system to avoid contamination of shared surfaces.
5. Limit visitation and exclude anyone with influenza-like illness from visiting the facility.
6. Monitor staff absenteeism for respiratory illness and exclude ill staff for at least 24 hours after fever is gone without use of fever-reducing medications. (Regularly monitor the health of staff and residents and report updates to your LHJ.)
7. Place signs around facility indicating that an outbreak is occurring.

Antiviral Treatment

Give antiviral medication to all residents and staff with confirmed or suspected influenza-like illness. Antiviral treatment can shorten the duration of fever, illness symptoms, and hospitalizations, and may reduce the risk of complications such as pneumonia and respiratory failure or death. Do not wait for laboratory results to initiate treatment.

Chemoprophylaxis

After influenza has been confirmed in your facility, give preventative antiviral medication to non-ill residents (ill residents should be treated with antivirals) and consider for non-ill, unvaccinated staff. Priority can be placed on residents in the same area of the facility as the cases. However, since staff and residents may spread influenza to residents on other units, floors, or buildings of the same facility, all non-ill residents are recommended to receive antiviral chemoprophylaxis to control influenza outbreaks.

Influenza Vaccination

Vaccinations can decrease likelihood of an outbreak, and in the event of an outbreak, can decrease hospitalizations and deaths among residents. The Centers for Disease Control and Prevention (CDC) recommends annual influenza vaccination for everyone 6 months and older, especially for residents and staff of long term care facilities. Vaccinate newly admitted residents and newly hired staff throughout the flu season. Keep a record of vaccination status of residents and staff.

End of Outbreak

An influenza outbreak can generally be considered over 7 days from the last onset (the clock starts again with each new onset).