Abstract
BackgroundsInfluenza can spread rapidly in long‐term care facilities (LTCFs), and residents are usually at higher risk for influenza infections.ObjectiveOur study aimed to evaluate the effectiveness of antiviral interventions on outbreak control.MethodsTaiwan Centers for Disease Control used a syndromic surveillance system to monitor outbreaks in LTCFs. Local public health authorities verified those outbreaks and logged reports to the Epidemic Investigation Report Files Management System (EIRFMS). We conducted a retrospective cohort study by reviewing EIRFMS reports of influenza outbreaks in LTCFs during 2008‐2014. An influenza outbreak was defined as 3 or more cases of influenza‐like illness occurring within a 48‐hours period with ≥1 case of real‐time RT‐PCR‐confirmed influenza in the same LTCF. Antiviral interventions included providing antiviral treatment for patients and antiviral prophylaxis for contacts during outbreaks.ResultsOf 102 influenza outbreaks, median days from onset of the first patient to outbreak notification was 4 (range 0‐22). Median attack rate was 24% (range 2.2%‐100%). Median influenza vaccination coverage among residents was 81% (range 0%‐100%); 43% occurred during the summer months. Even though antiviral treatment was provided in 87% of the outbreaks, antiviral prophylaxis was implemented in only 40%. Starting antiviral treatment within 2 days of outbreak onset was associated with keeping attack rates at <25% (OR 0.29, 95% CI: 0.12‐0.71).ConclusionsEarly initiation of antiviral treatment may reduce the magnitude of influenza outbreaks. Clinicians should identify patients with influenza and start antiviral use early to prevent large outbreaks in LTCFs.
Highlights
Long-term care facilities (LTCFs), including board and care home, assisted living facilities and nursing homes, provide health care to individuals who cannot independently take care of themselves
Our study aimed to describe the epidemiological characteristics of influenza outbreaks in LTCFs in Taiwan and to evaluate the effectiveness of antiviral interventions on outbreak control
Influenza outbreaks in LTCFs in Taiwan mostly occurred during the summer months according to our analysis
Summary
Long-term care facilities (LTCFs), including board and care home, assisted living facilities and nursing homes, provide health care to individuals who cannot independently take care of themselves. Residents living in these facilities are usually elderly or those with chronic diseases, such as cardiovascular disease, diabetes mellitus, or dementia, making the residents at high risk for influenza infection.[1]. After the licensure of neuraminidase inhibitor, many guidelines started to recommend the use of antiviral interventions, including antiviral treatment and antiviral prophylaxis, for outbreak control.[4,5,6] findings from a modeling analysis found that antiviral prophylaxis use was effective in controlling outbreaks, other studies, mainly observational, could not quantify the effectiveness of such interventions and make definitive conclusions.[5,7]
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