Control of Influenza Outbreaks in the Nursing Home: Guidelines for Diagnosis and Management

Abstract

A well coordinated plan that includes a mechanism for surveillance, rapid antigen detection testing and viral culture, infection control techniques and chemoprophylaxis is effective for aborting outbreaks of influenza A in the nursing home. Amantadine has been better studied in this situation, and experience with rimantadine is limited. The safety and efficacy of our dose guidelines for nursing home residents need to be studied and directly compared with rimantadine dose guidelines. Except for chemoprophylaxis, these guidelines can be applied to outbreaks of influenza B as well.

Duration of Antiviral Prophylaxis During Nursing Home Outbreaks of Influenza A

“…Both of these observations underscore that if chemoprophylaxis is initiated in the face of a "suspected" outbreak, continued antiviral chemoprophylaxis should be confirmed by culture. 7 Our experiences described here are similar to those of Nicholson et al, 8 who performed prospective surveillance of 515 residents of English homes for the elderly. Persons with a new onset of respiratory tract symptoms were identified, and viral cultures and serologic studies were performed.…”

Seasonal Influenza in Adults and Children—Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management: Clinical Practice Guidelines of the Infectious Diseases Society of America

“…Little disagreement exists regarding whether residents in institutional settings should receive influenza antiviral chemoprophylaxis in the context of an institutional influenza outbreak. Observational data [151,195,197,198,[217][218][219][220][221] evidence from randomized trials [219,222] and recommendations from influenza experts and medical societies [5,94,188,206,211,223,224] support the use of influenza antivirals for residents in this setting. Instituting chemoprophylaxis also demonstrates economic benefit for the affected facility [225].…”

“…Considering the high attack rate associated with influenza outbreaks in institutional settings [209], during influenza season, it is prudent to consider a single case of laboratory-confirmed disease in the context of у2 cases of influenza-like illness occurring within 72 h of each other as an outbreak in the institutional setting, leading to prompt implementation of control measures, including vaccination and use of antivirals [94,195,[210][211][212][213]. Because of the lower sensitivity of rapid influenza tests, negative results from such tests should prompt further testing with RT-PCR and/or viral culture to confirm that the outbreak is not due to influenza.…”

Approach to the problem of pneumonia in long-term care facilities

“…77,81 All patients should receive the current influenza vaccine in the Fall. Newly admitted residents who have not been immunized should receive the vaccine throughout the influenza season.…”