- Three influenza outbreaks have been reported to the Fairfax County Health Department (FCHD) in long-term care facilities (LTCFs) within the past two weeks and five during the current influenza season. The recent increase in LTCF outbreaks is coincident with widespread influenza activity in the region.
- Influenza A(H3N2) viruses are predominating so far this season. Influenza A(H3N2) virus-predominant seasons have been associated with more hospitalizations and deaths in persons aged 65 years and older compared with seasons with A(H1N1) or influenza B predominance.
- Influenza vaccine effectiveness in general has been lower against A(H3N2) viruses than against other strains. No vaccine effectiveness data are available yet for this season; however, last season, vaccine effectiveness against circulating influenza A(H3N2) viruses was estimated to be 32% in the U.S and the CDC expects it to be similar this season.
- All LTCFs should take action to prevent influenza outbreaks including exclusion of ill visitors and staff, rigorous hand hygiene and cough etiquette, vaccination, and appropriate diagnosis and case management.
- Reduce introduction of influenza into the facility by restricting entry of ill visitors. Post signs at entrances and have a receptionist actively screen visitors for fever or respiratory symptoms. Exclude ill visitors until they are symptom free without medications for 48 hours.
- Advise all staff to not report for work if they have fever and respiratory symptoms or to immediately don a facemask, stop patient care activities and report to a supervisor if they become ill during work. Exclude ill staff until they are fever free without medications for 24 hours. Because vaccination is not always effective, this recommendation applies to both vaccinated and unvaccinated staff.
- Consider masking for unvaccinated staff members at all times when in a patient care area while local influenza activity is widespread or for the remainder of the influenza season. Viral shedding and disease transmission can occur for 24 hours before symptoms occur and some influenza infections are asymptomatic, thus, masking will reduce risk to residents.
- Post signs and educate staff, residents and visitors about hand hygiene and respiratory hygiene/cough etiquette. Ensure availability of soap or hand sanitizer throughout the facility. Consider providing hand sanitizer to all visitors on entering the facility. CDC posters and patient information can be downloaded at https://www.fairfaxcounty.gov/health/food/operators/training.
- Begin antiviral therapy for residents with influenza-like illness who are at higher risk for influenza complications. Treatment should be started as soon as possible after illness onset and should not be delayed while waiting for the results of diagnostic testing. See https://emergency.cdc.gov/han/han00409.asp for CDC recommendations on antiviral drug treatment and influenza testing.
- Review records of influenza vaccination for residents and staff. Recommend and facilitate vaccination for anyone who is not vaccinated and does not have a contraindication to vaccination. CDC guidance on healthcare worker vaccination for LTCFs can be found at https://www.cdc.gov/flu/toolkit/long-term-care/index.htm.
- Contact the Fairfax County Health Department Communicable Disease Unit at 703-246-2433 if your facility becomes aware of an increased number of residents or staff with influenza-like illness or for consultation on influenza prevention, detection or management.
- Each long-term care facility should have a standing orders program that would allow for the rapid administration of antiviral medications to residents and staff if an influenza outbreak were to occur.
- On January 16, 2018, CDC reported that of 12,400 laboratory confirmed influenza infections during the current season, 90% were influenza A and 78% influenza A(H3N2). Rates of influenza-like illness are tracking similarly to pervious severe influenza seasons. While vaccine effectiveness studies have not yet been reported this season, in general, effectiveness for A(H3N2) is lower than for other influenza types.
- Virginia Department of Health (VDH) releases weekly influenza activity reports for the state. These reports are available at http://www.vdh.virginia.gov/epidemiology/influenza-flu-in-virginia/influenza-surveillance.
- Information on vaccination, antiviral use, diagnostic testing, infection control and patient education can be found on the Centers for Disease Control and Prevention’s (CDC) “Seasonal Influenza” website: www.cdc.gov/flu.
- Virginia Regulations for Disease Reporting and Control, requires physicians and directors of medical care facilities to report influenza by number of cases per week to the local health department. Please report weekly case counts of influenza online to the Fairfax County Health Department at http://bit.ly/2f5rz94 or https://www.fairfaxcounty.gov/health/flu (see Report Flu Cases box in middle of the page).
Blast Fax ID# 18-01