Influenza in long‐term care facilities

Abstract

Long‐term care facility environments and the vulnerability of their residents provide a setting conducive to the rapid spread of influenza virus and other respiratory pathogens. Infections may be introduced by staff, visitors or new or transferred residents, and outbreaks of influenza in such settings can have devastating consequences for individuals, as well as placing extra strain on health services. As the population ages over the coming decades, increased provision of such facilities seems likely. The need for robust infection prevention and control practices will therefore remain of paramount importance if the impact of outbreaks is to be minimised. In this review, we discuss the nature of the problem of influenza in long‐term care facilities, and approaches to preventive and control measures, including vaccination of residents and staff, and the use of antiviral drugs for treatment and prophylaxis, based on currently available evidence.

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

“…19 Advantages of notifying PHUs may include receiving expert advice on the nuances of infection control, facilitating laboratory testing/chasing results, promotion of immunisation and moral support in the face of resistance to social distancing/visitor restriction. 1,25,26 Of relevance to our current findings, a meta-analysis by Darvishian demonstrated the efficacy of influenza vaccination for the elderly in the setting of an epidemic season and even in the face of poor vaccine match. Furthermore, in our LHDs, PHUs can facilitate access to anti-viral medication.…”

“…1,11 One example is that different facility layouts might facilitate outbreak propagation or control, but it is difficult to obtain and analyse meaningful information on this qualitative factor. Studies in this area are subject to confounding effects from multiple covariates, not all of which can be easily measured.…”

“…1 Residents may be at heightened risk of contracting influenza due to close living quarters, shared carers and exposure to other elderly residents who may shed virus for longer than others. Influenza can spread rapidly within facilities, impacting both residents and staff.…”

“…PHUs support RACFs in providing advice on the management and prevention of outbreaks, using a multifaceted approach based upon the CDNA guidelines. 1,[11][12][13][14] The aim of this study was to explore the relative efficacy of each element of the 'influenza package' implemented by PHUs and to determine whether PHU involvement per se mitigates the impact of RACF outbreaks, measured through three key outbreak outcomes. Outbreak prevention measures include vaccination, influenza awareness/ education and preparation activities, while outbreak management activities include the use of antiviral therapy for treatment and prophylaxis (chemoproprophylaxis) and non-pharmaceutical interventions such as infection control measures.…”

Combining Procalcitonin and Rapid Multiplex Respiratory Virus Testing for Antibiotic Stewardship in Older Adult Patients With Severe Acute Respiratory Infection

“…Acute respiratory virus infection outbreaks are a common problem in NHs. 28,29 A recent systematic review reported a 1.21% to 85.2% annual incidence of influenza or RSV infection in long-term care facilities. 28 Other than influenza and RSV, human metapneumovirus is the third most common causative pathogen for NH respiratory infection outbreaks.…”