Americans are spreading more than holiday cheer this winter as the flu and other respiratory viruses are increasing across the country.
“Americans gathered for Thanksgiving last week amid a flu season that’s worse than any has been in more than a decade, and experts continue to urge caution as multiple respiratory viruses circulate at high levels nationwide,” reported CNN. “A growing number of US states – now 33 – are experiencing “high” or “very high” respiratory virus activity, and seasonal flu activity continues to be “elevated across the country,” according to the US Centers for Disease Control and Prevention (CDC).”
Influenza-positive tests reported to the CDC by U.S. clinical laboratories have skyrocketed from 2.68 percent positivity rate two months ago to 25.06 percent.
“Seasonal influenza activity is high and continues to increase across the country,” says the CDC, estimating that so far this season there have been at least 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths from flu.
The number of long-term facilities nationwide reporting at least one confirmed influenza-positive test among residents increased from 50 at the start of October to 364 at the end of November.
“Influenza can be introduced into a long-term care facility by newly admitted residents, healthcare personnel, and visitors. The spread of influenza can occur between and among residents, healthcare personnel, and visitors. Residents of long-term care facilities can experience severe and fatal illness during influenza outbreaks,” says the CDC.
The CDC says that preventing the transmission of influenza viruses and other infectious agents within long-term care facilities requires a multi-faceted approach that includes the following:
The CDC says that preparing nursing homes and long-term care facilities prior to flu outbreaks is important with vaccination, surveillance, and testing all crucial.
CDC guide on vaccinations for residents and healthcare personnel of long-term care facilities includes:
Typically, influenza vaccines will become available to long-term care facilities beginning in September, and influenza vaccination should be offered by the end of October.
Although vaccination by the end of October is recommended, influenza vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in most influenza seasons because the duration of the season is variable, and influenza activity might not occur in certain communities until February or March.
The next two steps in preparing long-term care facilities for flu outbreaks are surveillance and testing:
The CDC says that if one laboratory-confirmed influenza-positive case is identified along with other cases of acute respiratory illness in a unit of a long-term care facility, an influenza outbreak might be occurring.
“Active surveillance for additional cases should be implemented as soon as possible once one case of laboratory-confirmed influenza is identified in a facility,” says the CDC. “When 2 cases of laboratory-confirmed influenza are identified within 72 hours of each other in residents on the same unit, outbreak control measures should be implemented as soon as possible.”
Implementation of outbreak control measures can also be considered as soon as possible when one or more residents have an acute respiratory illness with suspected influenza and the results of influenza molecular tests are not available on the same day of specimen collection.
The following steps should be taken:
o Molecular assays, including rapid molecular assays
o Other molecular tests
o Or reverse transcription polymerase chain reaction (RT-PCR)
Daily active surveillance for acute respiratory illnesses among all residents, healthcare personnel, and visitors to the facility should be implemented including:
o Ill persons who are in the affected units as well as previously unaffected units in the facility
o Persons who develop acute respiratory illness symptoms after beginning antiviral chemoprophylaxis
o Ensure that the laboratory performing influenza testing notifies the facility of tests results promptly
The CDC says that long-term care facilities should be implementing standard precautions, regardless of suspected or confirmed infections, including:
“Droplet Precautions should be implemented for residents with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer, while a resident is in a healthcare facility,” says the CDC.
Examples of Droplet Precautions include:
The CDC says that all long-term care facility residents who have confirmed or suspected influenza should receive antiviral treatment immediately – initiation of this treatment should not wait for laboratory confirmation of influenza.
“Antiviral treatment works best when started within the first 2 days of symptoms. However, these medications can still help when given after 48 hours to those that are very sick, such as those who are hospitalized, or those who have a progressive illness,” says the CDC.
The recommended dosing and duration of antiviral treatment is twice daily for 5 days for neuraminidase inhibitors (oseltamivir and zanamivir), and one dose for intravenous peramivir.
Exposed residents on units or wards with influenza cases in the long-term care facility (currently impacted wards) should receive antiviral chemoprophylaxis as soon as an influenza outbreak is determined.
“When at least 2 patients are ill within 72 hours of each other and at least one resident has laboratory-confirmed influenza, the facility should promptly initiate antiviral chemoprophylaxis with oral oseltamivir to all non-ill residents living on the same unit as the resident with laboratory-confirmed influenza (outbreak affected units), regardless of whether they received influenza vaccination during the current season,” says the CDC.
Antiviral chemoprophylaxis is meant for residents who are not exhibiting influenza-like illness but who may be exposed or who may have been exposed to an ill person with influenza, to prevent transmission.
CDC recommends antiviral chemoprophylaxis with oseltamivir for a minimum of 2 weeks and continuing for at least 7 days after the last known laboratory-confirmed influenza case was identified on affected units.
Antiviral chemoprophylaxis can be considered or offered to unvaccinated personnel who provide care to persons at higher risk of influenza complications.
The CDC says that long-term care facilities should consider these 7 steps to curb the flu: