Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

Tennant, Elaine; Fletcher-Lartey, Stephanie; Kakar, Sheena; Najjar, Zeina; Lord, Heidi; Clark, P. M. S.; Gupta, Leena

doi:10.1111/1753-6405.12933

Cited by 12 publications

(19 citation statements)

References 33 publications

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“…This increase is clinically and statistically significant, and demonstrates that early public health involvement along with OP use has the potential to contain an outbreak promptly. This finding is in keeping with findings from other studies conducted in metropolitan NSW [19]. These results also support the need for mandatory reporting of influenza outbreaks by ACFs to PHUs to prevent unnecessary morbidity and mortality.…”

Section: Discussionsupporting

confidence: 90%

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Dronavalli,

Lord,

Alexander

et al. 2020

JEGH

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Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08–0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34–0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05–0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.

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Section: Discussionsupporting

confidence: 90%

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Dronavalli,

Lord,

Alexander

et al. 2020

JEGH

Self Cite

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“…This is better than another recent study in NSW where the median time ranged from 5.4 to seven days 3 . Earlier public health support, can ensure the timely intervention of effective infection prevention control measures that include antiviral therapies, and adequate personal protective equipment Many factors influence the notification of ILI outbreaks, in ACFs to PHU, such as delays in outbreak recognition, non‐typical ILI symptoms and the gap between education and clinical practice 3 . Our findings highlight the timely use of POCT as an additional measure in ACFs that enables timely prescription of antivirals, which in turn may prevent hospitalisation.…”

Section: Discussioncontrasting

confidence: 64%

“…Additionally, the study found that ACFs conducting POCT notified the PHU within a median of two days from the first onset of symptoms, in comparison to the ACFs that conducted only routine laboratory testing (median four days). This is better than another recent study in NSW where the median time ranged from 5.4 to seven days 3 . Earlier public health support, can ensure the timely intervention of effective infection prevention control measures that include antiviral therapies, and adequate personal protective equipment Many factors influence the notification of ILI outbreaks, in ACFs to PHU, such as delays in outbreak recognition, non‐typical ILI symptoms and the gap between education and clinical practice 3 .…”

Section: Discussionmentioning

confidence: 89%

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Rapid on‐site molecular Point of Care Testing during influenza outbreaks in aged care facilities improves antiviral use and reduces hospitalisation

Escarate

Jones

Clarke

et al. 2022

Australian and New Zealand Journal of Public Health

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Objective: Western Sydney Local Health District (WSLHD) measured the utility and validity of rapid molecular point-of-care testing (POCT) in aged care facilities (ACFs) experiencing influenza-like illness (ILI) outbreaks against routine laboratory testing. Methods:A descriptive epidemiological study into 82 respiratory outbreaks reported across 63 ACFs within WSLHD supporting approximately 6,500 residents aged ≥65 years and staffed by ~6,500 employees, from 1 August 2018 to 31 December 2019.Results: WSLHD Public Health Unit performed on-site testing at 27 ACF outbreaks (34%), while 53(66%) ACFs conducted only routine laboratory testing. The Xpert®Xpress Flu/RSV molecular PCR provided a sensitivity and specificity of 100%. Those with on-site testing, antiviral prophylaxis was prescribed at 75% of facilities within 24 hours of testing, as opposed to 32% of those using laboratory testing (p<0.01). There were 24 of 181 ACF residents hospitalised in the POCT group compared to 76 of 357 in the laboratory-only group (OR=0.57; p=0.02).Conclusions: On-site ACF testing is reliable and practical for early identification of influenza, enabling timely use of antiviral treatment and prophylaxis, and was associated with decreased hospitalisation.Public health implications: Enhanced respiratory surveillance and on-site testing should be strongly considered as part of routine management of respiratory outbreaks in ACFs and may reduce outbreak severity.

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“…While some RACFs notify the PHU of outbreaks early and provided daily updates via email and phone, delayed contact with facilities renders timely public health intervention a signi cant challenge. (30)(31) Relationships between RACFs and PHUs have likely been strained throughout 2022, particularly when public health advice differed from facility outbreak guidelines. A goal for PHUs work towards rebuilding relationships with RACFs for ongoing engagement in not only COVID-19 outbreak management, but all communicable disease control and health promotion.…”

Section: Discussionmentioning

confidence: 99%

Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective

Hodge

Oversby

McClure

et al. 2022

Preprint

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Background: From a Public Health Unit (PHU) perspective, this review aimed to examine factors associated with adverse outbreak outcomes, to identify evidence based focal strategies of managing COVID-19 outbreaks in aged care settings. Methods: A retrospective review of PHU documentation identified 55 COVID-19 outbreaks in aged care facilities in Wide Bay during 2022. Results: Thematic analysis using the framework approach identified several themes and subthemes associated with COVID-19 outbreaks in aged care. These were analysed for statistical significance against outbreak outcomes including duration, attack rate and case fatality rate. There was a significant relationship between memory support unit (MSU) involvement and adverse outbreak outcomes. Attack rate was significantly affected by communication efficiency, case detection and staff cohorting. Staff shortages were also significantly associated with adverse outcomes regarding attack rate and duration. Conclusions: This emphasises the importance of frequent communication between PHUs and RACFs during an active outbreak, as well as the need for prompt case detection, to minimise viral transmission, staff shortages and cohorting are also crucial factors to be addressed during outbreak management. Implications for Public Health: This review adds to the evidence basis of COVID-19 outbreak management strategies to improve PHU advice to RACFs during future periods of viral transmission, to ultimately reduce the associated burden of disease.

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Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

Cited by 12 publications

References 33 publications

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Rapid on‐site molecular Point of Care Testing during influenza outbreaks in aged care facilities improves antiviral use and reduces hospitalisation

Why are some outbreaks worse than others? COVID-19 outbreak management strategies from a PHU perspective

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