Pneumonia Associated with an Influenza A H3 Outbreak at a Skilled Nursing Facility — Florida, 2014

Abstract

In December 2014, the Florida Department of Health, Bureau of Epidemiology, was notified that 18 of 95 (19%) residents at a skilled nursing facility had radiographic evidence of pneumonia and were being treated with antibiotics. Two residents were hospitalized, one of whom died. A second resident died at the facility. The Florida Department of Health conducted an outbreak investigation to ascertain all cases through active case finding, identify the etiology, provide infection control guidance, and recommend treatment or prophylaxis, if indicated.

A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control

“…Fifteen studies reported outbreaks caused by bacteria [15-17, 20, 22, 24, 27, 32-39] and 22 studies were outbreaks by viruses [14,18,19,21,23,25,26,[28][29][30][31][40][41][42][43][44][45][46][47][48][49][50]. The largest number of a single pathogen was influenza viruses [40][41][42][43][44][45], followed by group A streptococcus (GAS) [17,20,24,37,38]. The most affected site was respiratory tract (n = 12) [32, 35, 36, 39-45, 48, 50], followed by gastrointestinal (GI) tract (n = 10) [14,16,23,26,27,31,33,46,47,49].…”

“…Three studies analyzed the data of multiple outbreaks of viral gastroenteritis and influenza-like illness that occurred in multiple facilities for a certain period of time [14,46,48]. The outbreaks in 23 studies affected both the residents and HCWs [14,20,22,23,25,26,29,31,33,[35][36][37][38][39][40][41][43][44][45][46][47][48][49], and the outbreaks of 14 studies affected only the residents [15-19, 21, 24, 27, 28, 30, 32, 34, 42, 50].…”

“…Causes of transmission in the eligible studies were reported as person-to-person transmission, contaminated water and food, and problems in practice (Tables 2 and 4). The following studies (n = 12) did not report or could not identify the cause of the outbreaks: 5 studies on influenza viruses, 2 on non-typeable Haemophilus influenzae, 1 on hepatitis C virus, 1 on C. difficile, 1 on adenovirus, 1 on norovirus, and 1 on RSV and HMPV [14,27,29,30,32,36,40,42,44,45,48,50]. The most commonly reported route of transmission was person-to-person [17, 22-24, 26, 31, 33, 35, 38, 41, 43, 46, 47, 49].…”

“…The response to outbreaks also could influence the progress of outbreaks. Nine reports underlined early notification of outbreaks to public health authorities and implementation of control measures within 3 days of onset of the first case, which affected the attack rates and duration of the outbreaks [23,29,35,41,44,46,[48][49][50].…”

“…Most facilities notified public health authorities or institutions about the outbreaks and received advice and assistance to manage the outbreaks. All four studies applying limitation or cessation of group activities were recently published since 2014 [31,42,44,50].…”