(and what you can do about them)

Transcription

1 (and what you can do about them)

2 What s an outbreak? In general, more cases than expected (baseline) More cases clustered in a specific unit or facility than you d expect at a particular time of year Some disease-specific definitions: One confirmed case of influenza in an LTC 2 or more cases (staff or residents) with vomiting, diarrhea or both clustered by time and place

3 Outbreak investigation Start a line list to track ill residents and staff Include: name, symptoms, onset of illness, resolution of illness and any lab testing/results Notify Epidemiology ( ) of suspected outbreak Review cases and symptoms from line list Coordinate specimen (NP swab or stool) collection for lab testing Implement infection control measures Includes education of staff and visitors Line list follow-up Monitor daily, confirm your cases Check each one with your case definition

4 What s a line list?

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6 Norovirus-general The most common cause of cases of acute gastroenteritis and gastroenteritis outbreaks Can affect nearly everyone in the population (from children to the elderly and everyone in between!) particularly because there is no long term immunity to the virus Causes acute but self-limited diarrhea, often with vomiting, abdominal cramping, fever, and fatigue Most individuals recover from acute symptoms with 2-3 days, but can be more severe in vulnerable populations

7 Burden of Norovirus Infection #1 cause of acute gastroenteritis in U.S. 21 million cases annually 21 million cases annually 1 in 14 Americans become ill each year 71,000 hospitalized annually in U.S. 91,000 emergency room visits overall in the U.S. 80 deaths annually in UK (global disease) Occurs year round with peak activity during the winter months Scallan et al EID. 17(1): 7-15.; Patel et al EID. 14(8); ; Harris et al EID. 14(10);

8 Norovirus Infectious dose: viral particles Viral shedding is mostly in stool (can be in vomit) Shedding peaks in 4 days after exposure Incubation period: hours Acute-onset vomiting and/or diarrhea Watery, non-bloody stools Abdominal cramps, nausea, low-grade fever 30% infections asymptomatic Most recover after hours More severe illness and death possible in elderly

9 Norovirus Transmission Highly contagious (as low as 18 virus particles) Survives freezing and heat (140 F) Direct person to person Fecal-oral Vomitus Indirect via fomites or contaminated environment Food or water Infected by food handlers Point source (e.g. food-raw, served multiple days) Well contamination or chlorination insufficient In healthcare, the most likely and common modes of transmission are through direct contact with infected persons or contaminated equipment

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11 What should I do for suspected cases of norovirus? Rapid identification and isolation of suspected cases Communicate and coordinate efforts with your infection prevention team Call SOE ( ) Review norovirus guidelines (CDC, Alaska, Oregon) Implement control measures as soon as possible; don t wait for lab results!

12 Summary Detect and confirm suspected norovirus cases rapidly During outbreaks, implement Contact Precautions, enhanced hand hygiene, environmental infection control measures, exclusion of ill staff from work for a minimum of 48 hrs after symptom resolution surveillance for new and resolving cases, Develop a communication plan during outbreaks to include key departments and services Consult with and report outbreak to state health department ( )

13 Influenza Be aware of influenza activity in your area Outbreaks of flu in long-term care facilities are COMMON have a plan! One confirmed case of influenza in an LTC is an outbreak Give antivirals and chemoprophylaxis to residents

14 Influenza in the Elderly Adults > 65 years higher risk for developing complications Pneumonia, bronchitis, sinus infections and ear infections are flu-related complications that can result in hospitalization or death Annual influenza vaccination is recommended, no preference from CDC on which type of vaccine A few studies that have shown improved immune response to the high-dose versus standard dose influenza vaccine DiazGranados, CA et.al Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults NEJM 2014; 371:

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16 How Flu Spreads People with flu can spread to others-about 6 ft away Spread by droplets made when people with flu cough, sneeze or talk Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose Most adults may infect others 1 day before symptoms develop and 5 to 7 days after becoming sick

17 Influenza Vaccinations for Health Care Providers (HCP) HCP can acquire flu and transmit flu to patients or other workers Vaccination is still the most effective intervention People infected with flu can spread it one day before they feel sick through five to seven days after *Higher vaccination rates among staff are associated with lower rates of flu in residents (LTC) and patients (hospital)

18 Fundamentals to Prevent Flu Have a facility plan (include your pharmacist)! Promote and give influenza vaccine Minimize exposure-use respiratory hygiene and cough etiquette Management of ill HCP Adhere to infection control precautions for all patientcare activities and aerosol-generating procedures Implement environmental infection control measures

19 Outbreak Prevention and Prep Vaccinate residents, patients and staff! Influenza (annual) Don t forget other VPDs: Chickenpox/varicella, MMR Shingles (residents in LTC) Have records of vaccination/immunity status for everyone Have standing orders for antivirals/antibiotics in case of an outbreak (especially for Long Term Care)

20 Summary Detect and confirm suspected influenza cases rapidly During outbreaks, implement Droplet Precautions, enhanced hand hygiene, environmental infection control measures, exclusion of ill staff from work for a minimum of 24 hrs after they no longer have a fever surveillance for new and resolving cases, Develop a communication plan during outbreaks to include key departments and services Consult with and report outbreak to state health department ( )

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22 Resources Centers for Disease Control and Prevention Alaska DHSS, Epidemiology Infectious Diseases Society of America (IDSA)

23 Alaska Conditions Reportable to Public Health Condition Timeframe Public Health Emergencies Immediate Phone* Infectious diseases Sexually transmitted diseases or HIV All other infectious diseases Within 5 days Acceptable report methods Phone*, Fax, Mail Firearm injuries Within 5 days Phone*, Fax Occupational disease and injury Within 5 days Phone, Fax Blood lead levels (link p14) >5 ug/dl in persons < 18 years old Within 1 week Phone*, Fax, Mail >10 ug/dl in persons >18 years old Toxic or hazardous exposures Within 1 day Phone*, Fax Healthcare associated infections required to be reported to federal authorities Follow NHSN practice NHSN

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