Care Home Outbreaks Research Articles

Care home managers' views on the media coverage of COVID-19 outbreaks in care homes for older adults: A case study in Stockholm.

The COVID‐19 pandemic has particularly affected older adults and resulted in high rates of infections and deaths in care homes. We have conducted a case study in which three managers of care homes for older adults in central Stockholm have shared their thoughts on the media coverage of care homes for older adults during the COVID‐19 pandemic. We analysed the data using conventional content analysis and identified three themes and five categories. The results show that the managers experienced the media coverage of care homes during the pandemic to be negative and incomplete, causing feelings of sadness and shame amongst themselves and their staff. The negative media coverage further generated added workload as they had to arrange for discussions to answer questions by staff and close relatives of the residents. Informants also thought that there is a lack of knowledge about the role of care homes and subsequently what to expect of them. Finally, informants reported that the pandemic might create an opportunity for system‐level policy changes. In light of this, we discuss possible victim blaming of staff and how greater public awareness of the care home sector could facilitate for a debate on policy changes and the low social status of caring for older adults.

The impact of organisational characteristics of staff and facility on infectious disease outbreaks in care homes: a systematic review

BackgroundInfectious disease outbreaks are common in care homes, often with substantial impact on the rates of infection and mortality of the residents, who primarily are older people vulnerable to infections. There is growing evidence that organisational characteristics of staff and facility might play a role in infectious disease outbreaks however such evidence have not previously been systematically reviewed. Therefore, this systematic review aims to examine the impact of facility and staff characteristics on the risk of infectious disease outbreaks in care homes.MethodsFive databases (MEDLINE, EMBASE, ProQuest, Web of Science, CINAHL) were searched. Studies considered for inclusion were of any design reporting on an outbreak of any infectious disease in one or more care homes providing care for primarily older people with original data on: facility size, facility location (urban/rural), facility design, use of temporary hired staff, staff compartmentalizing, residence of staff, and/or nursing aides hours per resident. Retrieved studies were screened, assessed for quality using CASP, and analysed employing a narrative synthesis.ResultsSixteen studies (8 cohort studies, 6 cross-sectional studies, 2 case-control) were included from the search which generated 10,424 unique records. COVID-19 was the most commonly reported cause of outbreak (n = 11). The other studies focused on influenza, respiratory and gastrointestinal outbreaks. Most studies reported on the impact of facility size (n = 11) followed by facility design (n = 4), use of temporary hired staff (n = 3), facility location (n = 2), staff compartmentalizing (n = 2), nurse aides hours (n = 2) and residence of staff (n = 1). Findings suggest that urban location and larger facility size may be associated with greater risks of an infectious disease outbreak. Additionally, the risk of a larger outbreak seems lower in larger facilities. Whilst staff compartmentalizing may be associated with lower risk of an outbreak, staff residing in highly infected areas may be associated with greater risk of outbreak. The influence of facility design, use of temporary staff, and nurse aides hours remains unclear.ConclusionsThis systematic review suggests that larger facilities have greater risks of infectious disease outbreaks, yet the risk of a larger outbreak seems lower in larger facilities. Due to lack of robust findings the impact of facility and staff characteristics on infectious disease outbreaks remain largely unknown.ProsperoCRD42020213585.

Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration

ObjectivesAt the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). Study designWe undertook an ecological study using routinely available national data. MethodsWe used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. We estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. ResultsCare home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553–1694) between 7 December 2020 and 28 October 2021 to an observed 501. We estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. ConclusionsThese findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.

Integrated Health and Social Care in England: Ten Years On.

Introduction:As part of major policy reforms begun in 2010, England introduced a wave of initiatives to encourage more integrated care between health and social care. These built on previous attempts which sought to achieve similar objectives through a focus on better partnership working. This article provides an overview and critical commentary on integrated care policy in England from 2010–2020 based on reviews by regulators, parliamentary committees and the national audit office.Overview of Policy:Integrated care became a priority through the work of the Future Forum, a group of leading stakeholders established due to concerns about greater competition in public health care. This led to a public statement of shared commitment to integrated care by national health and social care bodies. Early mechanisms included a pooled fund to achieve nationally set objectives, the creation of local authority led partnership boards, and high profile innovation programmes. Later in the 2010’s, new health led partnerships became more dominant vehicles to achieve integrated care at regional level.Impact of Policy:Despite progress within a few local areas, and reduction in delayed discharges from hospital the overall picture from national reviews was that expected improvements were not achieved. Emergency admissions to hospital continued to grow, patients within primary care reported being less involved in their care, and health inequalities worsened. The initial response to COVID-19 was health-centric contributing to outbreaks in care homes and inadequate supplies of protective personal equipment. The ability of leaders to look beyond their organisations’ interests was reported as vital for local progress. National government performance frameworks discouraged system based working and chronic underfunding of social care led to major capacity and workforce challenges.Conclusion:The experience of England suggests that greatest progress is made when integrated care focusses on tangible issues and when there is a clear understanding of how success will be measured. Even with considerable investment and intent progress should be expected to be slow and difficult. Layering of numerous policy initiatives provides confusion and can distract from the important work of relationship building. And ultimately, integrated care cannot by itself address major inadequacies in the underlying resources and structural inequalities.

Outbreaks in care homes may lead to substantial disease burden if not mitigated.

The number of COVID-19 outbreaks reported in UK care homes rose rapidly in early March of 2020. Owing to the increased co-morbidities and therefore worse COVID-19 outcomes for care home residents, it is important that we understand this increase and its future implications. We demonstrate the use of an SIS model where each nursing home is an infective unit capable of either being susceptible to an outbreak (S) or in an active outbreak (I). We use a generalized additive model to approximate the trend in growth rate of outbreaks in care homes and find the fit to be improved in a model where the growth rate is proportional to the number of current care home outbreaks compared with a model with a constant growth rate. Using parameters found from the outbreak-dependent growth rate, we predict a 73% prevalence of outbreaks in UK care homes without intervention as a reasonable worst-case planning assumption.This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.

An assessment of the impact of the vaccination program on coronavirus disease 2019 (COVID-19) outbreaks in care homes in Northern Ireland-A pilot study.

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Antibodies to SARS-CoV-2 protect against re-infection during outbreaks in care homes, September and October 2020.

Two London care homes experienced a second COVID-19 outbreak, with 29/209 (13.9%) SARS-CoV-2 RT-PCR-positive cases (16/103 residents, 13/106 staff). In those with prior SARS-CoV-2 exposure, 1/88 (1.1%) individuals (antibody positive: 87; RT-PCR-positive: 1) became PCR-positive compared with 22/73 (30.1%) with confirmed seronegative status. After four months protection offered by prior infection against re-infection was 96.2% (95% confidence interval (CI): 72.7–99.5%) using risk ratios from comparison of proportions and 96.1% (95% CI: 78.8–99.3%) using a penalised logistic regression model.

COVID-19 outbreaks in care homes during the first wave: are Care Quality Commission ratings a good predictor of at-risk homes?

BackgroundCOVID-19 placed a significant burden on the care home population during the first wave. Care Quality Commission’s care quality ratings are given to all English care homes and could be used to identify whether care homes are at risk of COVID-19 outbreaks.MethodsAn audit was performed, April 2020, of Liverpool care homes to identify associations between COVID-19 status and care quality ratings from the Care Quality Commission. Univariable logistic regression was performed to identify whether the Care Quality Commissions ratings were associated with a care home experiencing a COVID-19 outbreak, or a home having asymptomatic cases.FindingsOver half of the care homes (53.2%, n=41), had laboratory-confirmed clinical cases and 39 (95.1%) of these were reported as outbreaks. A small number of care homes (10.4%, n=8) had asymptomatic cases and over a third had no clinical or asymptomatic cases (36.4%, n=28). There was no significant difference between the overall Care Quality Commission rating of Liverpool and English care homes (p=0.57). There was no significant association between any of the Care Quality Commission rating domains and the presence of COVID-19 outbreaks and/or asymptomatic cases.ConclusionsDuring the first wave of the COVID-19 pandemic, Care Quality Commission ratings were not associated with COVID-19 outbreaks or asymptomatic cases in care homes. Infection prevention and control components of Care Quality Commission ratings need to be strengthened to identify care homes at a potential risk of infectious disease outbreaks that may require targeted support. Further large-scale studies will be required to test the findings from this study.

COVID-19 testing in outbreak-free care homes: what are the public health benefits?

BackgroundCOVID-19 care home outbreaks represent a significant proportion of COVID-19 morbidity and mortality in the UK. National testing initially focused on symptomatic care home residents, before extending to asymptomatic cohorts.AimThe aim was to describe the epidemiology and transmission of COVID-19 in outbreak free care homes.MethodsA two-point prevalence survey of COVID-19, in 34 Liverpool care homes, was performed in April and May 2020. Changes in prevalence were analysed. Associations between care home characteristics, reported infection, prevention and control interventions, and COVID-19 status were described and analysed.FindingsNo resident developed COVID-19 symptoms during the study. There was no significant difference between: the number of care homes containing at least one test positive resident between the first (17.6%, 95% confidence interval (CI) 6.8–34.5) and second round (14.7%, 95% CI 5.0–31.1) of testing (p>0.99); and the number of residents testing positive between the first (2.1%, 95% CI 1.2–3.4) and second round (1.0%, 95% CI 0.5–2.1) of testing (P=0.11). Care homes providing nursing care (risk ratio (RR) 7.99, 95% CI 1.1–57.3) and employing agency staff (RR 8.4, 95% CI 1.2–60.8) were more likely to contain test positive residents. Closing residents shared space was not associated with residents testing positive (RR 2.63, 95% CI 0.4–18.5).ConclusionsAsymptomatic COVID-19 care homes showed no evidence of disease transmission or development of outbreaks; suggesting that current infection prevention and control measures are effective in preventing transmission. Repeat testing at two to three weeks had limited or no public health benefits over regular daily monitoring of staff and residents for symptoms. These results should inform policies calling for regular testing of asymptomatic residents.

Epidemiological analysis of 3,219 COVID-19 outbreaks in the state of Baden-Wuerttemberg, Germany

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has emerged as an unprecedented global crisis challenging health systems. This paper aims to assess and characterise SARS-CoV-2 outbreaks in the state of Baden-Wuerttemberg to identify groups at greatest risk, to establish early measures to curb transmission. We analysed all mandatory notified (i.e. laboratory-confirmed) coronavirus disease (COVID-19) outbreaks with more than two cases in Baden-Wuerttemberg from calendar weeks 18-49 (from 27 April to 6 December 2020). We used the following classification for settings: asylum and refugee accommodation, care homes, care facilities, day care child centres, hobby-related, hospitality, hospitals, households, other, residence halls, schools, supported housing, training schools, transportation, treatment facilities and workplace (occupational). We used R program version 3.6.3 for analysis. In our analysis, 3219 outbreaks with 22 238 individuals were included. About 48% were in household and hobby-related settings. Care homes accounted for 9.5% of outbreaks and 21.6% of cases. The median age across all settings was 43 (interquartile range (IQR) 24-63). The median age of cases in care homes was 81 (IQR 56-88). Of all reported cases in care homes, 72.1% were women. Over 30% (466/1511) of hospitalisations were among cases in care homes compared to 17.7% (268/1511) in households. Overall, 70% (500/715) of all deceased persons in outbreaks in the study period were in care homes compared to 4.2% in household settings (30/715). We observed an exponential increase in the number of notified outbreaks starting around the 41st week with N = 291 outbreaks reported in week 49. The median number of cases in outbreaks in care homes and care facilities after the 40th week was 14 (IQR 5-29) and 11 (IQR 5-20), respectively, compared to 3 (IQR 3-5) in households. We observed an increase in hospitalisations, and mortality associated with COVID-19 outbreaks in care homes after the 40th week. We found the care home demographic to be at greatest risk after the 40th week, based on the exponential increase in outbreaks, the number of cases, hospitalisations and mortality trends. Our analysis highlights the necessity of targeted, setting-specific approaches to control transmission in this vulnerable population. Regular screening of staff members and visitors' using rapid antigen point-of-care-tests could be a game-changer in curbing transmission in this setting.

Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect.

In Hong Kong, about 15% of older people (aged 80 and above) live in care homes, one of the highest proportions in the world. During the spread of severe acute respiratory syndrome in 2003, the crude fatality rate for older people in care homes that were infected was 72%. After taking the advice of a team of international experts, the Hong Kong Government implemented comprehensive preventive measures to cope with the future epidemics. This commentary evaluates the effectiveness of these measures in coping with both influenza outbreaks and COVID-19 and suggests the lessons learnt are relevant to both developed and less developed countries? Lockdown in care homes is very effective under two conditions. Healthcare workers must wear surgical masks in the care home. Hospitals must adopt a strict policy to prevent virus transmission by discharged patients. Care homes situated within high-rise residential towers are particularly vulnerable to COVID-19 transmission; their residents can more easily be infected by asymptomatic carriers from the community. Airborne virus can also be transmitted more swiftly in care homes with open-plan layouts. Lockdown had been shown to significantly reduce influenza outbreaks in care homes. On the other hand, lockdown causes loneliness to residents. Care homes allow residents to move freely within the care home though with the risk of spreading the virus by resident who is an asymptomatic carrier. Finally, lockdown may cause family members to have guilty feelings. Family members can only make video call or window visit to residents.

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

BackgroundCOVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. We aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland.MethodsWe did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. We obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19-related), and we analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. We calculated excess deaths (both COVID-19-related and non-COVID-19-related), which we defined as the sum of deaths over and above the historical average in the same period over the past 5 years.FindingsBetween March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3·35, 95% CI 1·99–5·63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19-related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital.InterpretationThe effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from our findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave.FundingNone.

SWARM: A regional health system’s intervention approach to COVID-19 outbreaks in nursing and adult care homes in rural eastern North Carolina

Background: Incessant, COVID-19 outbreaks occurring in nursing and adult care homes are a serious public health concern that continues to create significant healthcare crisis management challenges. Adult care facilities often lack in-house capacity and capability to safely treat its ill residents, while hospitals are strained to balance the influx of patients, allocate scarce resources and protect healthcare workers.Objectives: This project sought to implement a regional, community engaged, intervention model to assist nursing and adult care homes in reducing or preventing outbreaks and risks associated with COVID-19 in rural eastern North Carolina (N.C.).Methods: Design/Setting: Through collaborations between Vidant Health (VH), health departments and a network of community partners, a shared intervention plan was created and implemented to monitor nursing and adult care homes for COVID-19-related outbreaks across 29 counties in rural eastern N.C. A “Strike” team or “Swarm (SWARM) approach was developed as an operationalized concept for rapidly responding to nursing and adult care home outbreaks while providing an array of services and interventions to help prevent the spread of COVID-19. Comparative analysis was conducted between the mean number of COVID-19-related cases, deaths and length of outbreak time in VH service contracted, SWARM facilities (n = 12) and all other non-service contracted, or non-SWARM facilities (n = 155) in N.C.Results: Nursing and adult care homes under service contract using our SWARM approach experienced fewer average number of COVID-19-related resident ill cases (24.4 vs 29.0), and deaths (1.2 vs. 3.9). The length of outbreak recovery time was far less among SWARM facilities than non-participating, non-SWARM facilities (17.1 vs. 25.4; p &lt; .034).Conclusions: By actively monitoring key indicators, engaging in daily communication with local partners and providing rapid response, VH’s SWARM approach provides a proactive method for preventing further spread of COVID-19 in adult care facilities and communities.

COVID-19 in care homes: ‘a scandal behind closed doors’

Nursing and Residential CareVol. 22, No. 7 News AnalysisCOVID-19 in care homes: ‘a scandal behind closed doors’Melissa McAleesMelissa McAleesFreelance journalistSearch for more papers by this authorMelissa McAleesPublished Online:18 Jun 2020https://doi.org/10.12968/nrec.2020.22.7.2aAboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Age UK. Age UK response to more care home deaths. 2020. https://tinyurl.com/y8tpkgxu (accessed 15 May 2020) Google ScholarGilroy R. New support pledged for care homes as PM confronted over ‘slow’ response. Nursing Times. 13 May 2020. https://tinyurl.com/yblj8sqf (accessed 15 May 2020) Google ScholarGov.uk. COVID-19: number of outbreaks in care homes—management information. 2020. https://tinyurl.com/ybweukot (accessed 15 May 2020) Google ScholarThe Care Home Environment. Government pledges extra £600m for care home infection control. 2020. https://tinyurl.com/yc6rkgjs (accessed 15 May 2020) Google ScholarThe National Care Association. COVID-19 testing for care services. 2020. https://tinyurl.com/yb46ajgu (accessed 15 May 2020) Google Scholar FiguresReferencesRelatedDetails 2 July 2020Volume 22Issue 7ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 18 June 2020 Published in print 2 July 2020 Information© MA Healthcare LimitedPDF download

Covid-19: Continued outbreaks in care homes risk extending pandemic, say experts.

The number of outbreaks in care homes and a lack of important public health information are still affecting the ability to manage the spread of covid-19, experts have warned. Latest figures from the Office for National Statistics (ONS) showed 100 outbreaks in care homes in England during the week of 8 June—an average of two to three deaths in each care home. At a Science Media Centre briefing to discuss the data, Carl Heneghan, director of the Centre for Evidence-Based Medicine at the University of Oxford, said that the figures were worrying. “If we are going to eradicate and reduce this outbreak we have got to get that number down to zero,” he said. He noted that care homes in some areas had been disproportionately affected, such as in Oxfordshire, where 74% of 129 care homes had had covid-19 …

The Impact of Social and Physical Distancing Measures on COVID-19 Activity in England

Background: Mandatory social and physical distancing measures (SPDM) were introduced in the UK on the 23rd March 2020. A multi-tiered surveillance system based on influenza surveillance, was adopted from the early stages of the COVID-19 Epidemic to monitor different stages of disease. We describe how the impact SPDM was detected through each surveillance system and how these systems may be applied to detect increases in COVID-19 activity as SPDM are eased. Methods: Data from national population surveys, web-based indicators, syndromic surveillance, sentinel swabbing, respiratory outbreaks, secondary care admissions, and mortality indicators from the start of the epidemic to Week 20 2020 were used to identify timing of peaks in the indicator relative to the introduction of SPDM. This was compared to median time from symptom onset to different stages of illness or interactions with healthcare services. Results: The impact of SPDM was detected within 1 week through population symptom surveys, web search indicators and through GP sentinel swabbing reported by onset date. There were detectable impacts on syndromic surveillance indicators for difficulty breathing, influenza-like illness and COVID-19 coding at 2, 7 and 12 days respectively. This was followed by hospitalisations and critical care admissions (both 12 days), laboratory positivity (14 days), deaths (17 days) and care home outbreaks (4 weeks). Interpretation: There was a clear impact of SPDM on COVID-19 activity which was detectable within 1 week through community indicators highlighting their importance in early detection of changes in activity. Community swabbing surveillance will be increasingly important as a specific indicator when circulation of seasonal respiratory viruses increases. Funding Statement: There was no specific funding for this report. Declaration of Interests: None declared. Ethics Approval Statement: The surveillance collections included here are approved as Health Protection, under Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002.

Covid-19: Experts urge strategies to prevent further outbreaks in care homes.

With data showing that covid-19 outbreaks are occurring in 38% of care homes, a concerted effort is needed to prevent outbreaks in the rest, say experts. Office for National Statistics data for the week ending 8 May 2020 showed that deaths from all causes in care homes fell by around a third, from 6409 the previous week to 4248.12 Deaths involving covid-19 as a proportion of all deaths in care homes continued to rise, however, to 39.2%, from 37.8% in the previous week. Speaking at a press briefing hosted by the Science Media Centre, David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, said that the …

What proportion of care home outbreaks are caused by norovirus? An analysis of viral causes of gastroenteritis outbreaks in care homes, North East England, 2016\u20132018

BackgroundOutbreaks of infectious gastroenteritis are common in care homes for the elderly. Norovirus can cause these outbreaks, but diagnosis is frequently based solely on clinical characteristics. Our objective in this study was to describe the epidemiology of norovirus and other gastrointestinal pathogens in these settings.MethodsWe analysed surveillance data from gastroenteritis outbreaks reported in North East England between 04 July 2016 to 01 July 2018. Stool samples taken during these outbreaks were tested for a range of viral and bacterial pathogens. We described the epidemiology of these outbreaks and explored the characteristics of norovirus outbreaks versus from other viral causes using multivariable logistic regression.ResultsFrom the 566 care home gastroenteritis outbreaks in this study, we found that norovirus was the pathogen most frequently isolated. Norovirus was detected in 64% of outbreaks with a pathogen identified. Sapovirus was found in 13%; rotavirus in 11%. We found that norovirus outbreaks were associated with higher attack rates (aOR 1.03, 95% CI 1.01–1.05) and fewer cases sampled (aOR 0.74, 95% CI 0.60–0.91), compared to outbreaks caused by other viral pathogens.ConclusionsThese results are important as they quantify the contribution of norovirus to gastroenteritis outbreaks in care homes. Given this evidence, we emphasize the importance of non-specific outbreak interventions that can affect the impact of all such outbreaks. We further recommend that these findings are used to inform the implementation strategies of any norovirus-specific interventions such as a norovirus vaccine.

Estimating the burden of care home gastroenteritis outbreaks in England, 2014\u20132016

BackgroundOutbreaks of infectious gastroenteritis in care homes are common, with norovirus a frequent cause. In England there is no co-ordinated national surveillance system. We aimed to estimate the burden of these outbreaks.MethodsUsing a generalised linear mixed effects regression model we described the relationship between the observed number of care home outbreaks and covariates. Estimated model parameters were used to infer uplift in the number of outbreaks expected if all areas were subjected to enhanced surveillance. From this we then estimated the total burden of care home gastroenteritis outbreaks in this period.ResultsWe estimated a total of 14,146 care home gastroenteritis outbreaks in England during 2014–2016; this is 47% higher than the reported total and a rate of 32.4 outbreaks per 100 care homes per year. The median number of outbreaks from the model estimates was 31 (IQR 20–46) compared to 19 (IQR 12–34) reported from routine surveillance.ConclusionsThis estimated care home gastroenteritis burden in England indicates that current surveillance substantially underestimates the number of outbreaks, by almost half. Improving this surveillance could provide better epidemiological knowledge of the burden of norovirus to inform public health policy, particularly with the advent of norovirus vaccines.

Outbreaks of influenza-like illness in care homes inthe East of England: impact of variations in neuraminidase inhibitor provision.

To examine the differences in outcomes related to variable provision of antivirals in care home respiratory outbreaks. This is a retrospective observational study. Routinely collected outbreak surveillance data reported from care home staff was recorded using a standard template and extracted from the Public Health England health protection electronic records. Data included numbers of people affected, provision of oseltamivir, hospitalization, and deaths during the outbreak in the care home. Oseltamivir provision was categorized by proportion of eligible residents prescribed it on advice. Additional data on microbiological diagnoses were obtained directly from the hospital laboratories. Logistic regression was used to examine associations between oseltamivir provision and hospitalizations and deaths in care homes. One hundred and sixty-eight outbreaks were reported from 28th July 2016 until 27th March 2017, affecting 1459 residents and 347 staff. There were 76 hospital admissions and 37 deaths overall. Although deaths and hospital admissions also occurred in outbreaks caused by other respiratory viruses, outbreaks caused by influenza had the highest median number of people affected and a greater proportion of hospital admissions and deaths. Of the 56 outbreaks caused by influenza, there was a significant increase in the odds of the care home reporting deaths when oseltamivir was not used (odds ratio=8.15, 95% confidence interval=1.38-48.20, P=0.02). There were also non-significant reductions in duration of outbreak and hospital admissions in care home outbreaks with oseltamivir treatment. Partial or no provision of oseltamivir was associated with poorer outcomes in laboratory-confirmed influenza outbreaks.