Influenza Update for Iowa Long-Term Care Facilities Iowa Department of Public Health Center for Acute Disease Epidemiology
Webinar Information All participants will be muted during the presentation. Questions can be submitted directly to the facilitator via the question feature located on your control panel All questions submitted will be answered at the end of the presentation This session will be recorded and made available for reviewing When available, you will receive a follow-up-email on how to access this recording
Discussion Points Influenza Virus Influenza Activity Nationally and in Iowa Outbreak Management Review of Antiviral Treatment and Prophylaxis Recommendations
Presenters (In order of presentation) Ann Garvey, DVM, MPH, MA, Deputy State Epidemiologist Kemi Oni, MPH, Influenza Surveillance Coordinator, IDPH Chris Galeazzi, MPH, Field Epidemiologist Unit Lead, IDPH Patricia Quinlisk, MD, MPH, Medical Director, IDPH
Influenza Virus
Influenza Virus Viral infection that mostly affects the respiratory system your nose, throat and lungs Symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea (they will also have fever & respiratory symptoms) Outbreaks of diarrhea and vomiting alone are frequently caused by Noroviruses (sometimes called Stomach flu)
Persons at Higher Risk for Severe Complications Children <5 years (especially <2 years) Adults >65 years Pregnant women American Indians & Alaskan Natives And people with medical conditions like: Asthma Neurological conditions Chronic lung disease Heart disease Blood disorders Endocrine disorders Kidney disorders Liver disorders Metabolic disorders Weakened immune system
Influenza in persons > 65 years Greatest risk of serious complications 90% of influenza-related deaths 50% to 60% of influenza-related hospitalizations
How Influenza Spreads Droplets when people cough, sneeze, or talk Droplets land in the mouths or noses of people who are nearby Also by touching surfaces with the virus on it and then touching your own mouth, eyes, or nose Usually spread from 1- day before symptoms start through 5-7days after becoming sick
Influenza Activity Update
National Estimates Average of 300,000 Iowans get the flu every year Flu and its complication of pneumonia cause an average of 1,000 deaths yearly in Iowa Peak Month of Flu Activity 1982-83 through 2013-14
Flu Activity Update - Iowa Widespread Activity All three strains of influenza circulating Flu A(H3N2) 92% Flu A(H1N1)pdm09 1% Flu B(both Yamagata and Victoria lineage) 4% Hospitalization rate increasing (especially > 65 yrs) This graph was generated using data collected from sentinel hospitals
Flu Activity Update - Nationally 46 states reporting widespread activity Flu A(H3N2) viruses most common (>99% of all subtyped flu A viruses) H3N2-predominiated seasons associated with more severe illness and mortality, especially in children and older persons Hospitalization rates in >65 increasing steeply More than 2/3 of flu A(H3N2) viruses circulating are not well matched to this years vaccine
LTC Outbreaks Reported to IDPH IDPH continues to receive reports of influenza-related outbreaks in long term care facilities There have been 46 reported influenza outbreaks (since October 1, 2014) Region # of outbreaks Region 1 (Central) 12 Region 2 (NE) 8 Region 3 (NW) 7 Region 4 (SW) 9 Region 5 (SE) 3 Region 6 (Eastern) 7 Total 46
Weekly Influenza Report Posted weekly at IDPH website www.idph.state.ia.us/idpharchive/ar chive.aspx?channel=flureports To learn more about our Influenza surveillance, please contact Kemi Oni, MPH 515-725-2136 Oluwakemi.oni@idph.iowa.gov
Outbreak Management
Public Health defines an outbreak as One laboratory confirmed case of influenza + Another symptomatic patient (within 72 hours)
Report to Public Health Review national recommendations Arranging specimen transportation Provide additional consultation/support
Confirm the Cause of Illness While Positive Rapid Test Results can help guide outbreak decisions Negative Rapid Test Results do not exclude influenza as the cause of the outbreak (limited sensitivity) Confirmatory testing at SHL is recommended
Implement Standard & Droplet Precautions All residents with suspected or confirmed influenza Standard Precautions Examples Gloves with hand contact with respiratory secretions or contaminated surfaces Gown if soiling of clothes with respiratory secretions anticipated Changing gloves and gowns after each encounter and performing hand hygiene Droplet Precautions In place for 7-days after onset or 24-hours after fever and symptoms resolve- whichever is longer Examples Ill patients in private room, if possible Wear facemask when enter room
CDC Antiviral Recommendations All long-term care facility residents who have confirmed or suspected influenza should receive antiviral treatment Antiviral chemoprophylaxis is recommended for all non-ill residents, regardless of whether they received influenza vaccination during the previous fall
Methods to Decrease Transmission Restrict common activities Limit large group activities Consider serving meals in rooms Avoid new admissions Or transfers to wards with symptomatic residents Limit visitation Exclude ill persons from visiting Post notices Monitor personnel absenteeism due to respiratory illness Exclude those with ILI for at least 24 hours after fever resolves Restrict personnel movement from areas having illness to those not affected by outbreak
Vaccination Routinely (every year) influenza vaccination should be provided to long term care residents and personnel During outbreaks administer influenza vaccine to unvaccinated residents and personnel
Daily Surveillance Conduct daily active surveillance for respiratory illness among ill residents, health care personnel and visitors to the facility Until at least 1 week after the last confirmed influenza case occurred
Antiviral Treatment and Prophylaxis
Antiviral Agents for Influenza Neuraminidase inhibitors (primary agents for A and B influenza) Oseltamivir (Tamiflu ) Zanamivir (Relenza ) Adamantanes (most A s resistant - not used) Amantadines Rimantanes Peramivir (Rapivab ) IV administration only
General Treatment Efficacy of Neuraminidase Inhibitors Reduces uncomplicated illness by 1 day when given within 48 hours of onset of illness In young children, reduced illness by 3.5 days if given within 24 hours of onset of illness No or minimal effect in healthy people if started after 48 hours after onset of illness Secondary pneumonia decreased by 50% in adults with lab confirmed flu if treated Risk of death reduced after treatment Children studies showed variable but reduced secondary infections after treatment, less asthma impact
CDC Antiviral Treatment Recommendations All long-term care facility residents with confirmed or suspected influenza should receive antiviral treatment immediately 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 progressive illness.
Antiviral Treatment Dosage Duration for antiviral treatment is 5 days Zanamivir (Relenza inhaled powder) 2 inhalations of 10 mg twice daily, dose varies by child s weight Treatment not approved in <7 years of age Oseltamivir (Tamiflu tablet) Children (under 40 Kg) dose varies by weight Adults (older children 40+ kg) 75 mg twice daily
CDC Antiviral Prophylaxis Recommendations All eligible residents in the entire long-term care facility (not just currently impacted wards) should receive antiviral chemoprophylaxis as soon as an influenza outbreak is determined Regardless of whether they received influenza vaccination Priority should be given to residents living in the same unit or floor as an ill resident However, since staff and residents may spread influenza to residents on other units, floors, or buildings of the same facility, all non-ill residents are recommended to receive antiviral chemoprophylaxis to control influenza outbreaks
Antiviral Prophylaxis Dosage Zanamivir (Relenza inhaled powder) 2 inhalations (10 mg) once daily Not approved for children <5 years of age Oseltamivir (Tamiflu tablet) Children one year and older (<40 kg) dose varies by weight Older children and adult (40+ kg) 75 mg once daily CDC recommends antiviral chemoprophylaxis for a minimum of 2 weeks, and continuing for at least 7 days after the last known case was identified. See Influenza Antiviral Drugs at www.cdc.gov/flu/professionals/antivirals/index.htm
Antiviral Medications are Especially Important this Season H3N2-predominant flu seasons have been associated with more hospitalizations and deaths in older people and young children in the past High hospitalization rates are being observed Hospitalization rates are especially high among people 65 years and older 2/3 of the H3N2 viruses that have been tested at CDC are not well matched to this years vaccine, suggesting vaccine effectiveness may be reduced this season
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