Multipronged Approach Advocated to Prevent Influenza, Pneumonia in Nursing Homes

As the peak season for respiratory illnesses approaches, health officials are warning that preventing transmission within long-term care facilities requires a multipronged approach, including vaccination, testing, and, when needed, antiviral chemoprophylaxis.

John G. Jordan, MD, who is with the CDC’s Epidemic Intelligence Service, and officials with the Florida Department of Health recently reported on an influenza A H3 outbreak and an associated cluster of patients with pneumonia that “resulted in a 46% attack rate and four deaths,” in a Florida nursing facility. 

Between Nov. 29 and Dec. 29, 2014, 44 of 95 residents and 6 of 75 staff members in this particular nursing facility had fever and respiratory illnesses associated with influenza. The report’s authors noted that of the 44 ill residents, 19 had documentation of receiving influenza vaccination. Of the 51 asymptomatic residents, 65% had vaccination documentation. Last year’s primary strains of influenza were a lower match than those of vaccine strains when compared with previous years, health officials have said. 

“Neither influenza testing nor prescription of antiviral medications occurred during the initial cluster, which was followed by extensive secondary transmission,” according to the researchers, who emphasized that this outbreak demonstrated the need for response protocols in the event of an influenza outbreak in a nursing home setting. 

Ian Branam, Health Communications Specialist at the CDC’s National Center for Immunization and Respiratory Diseases commented on the study’s findings, noting that, “vaccines are very good at preventing severe disease, needing treatment in the hospital, and death.”

William Schaffner, MD, who was not affiliated with the study but serves as medical director for the National Foundation for Infectious Diseases, noted that there are more than 200,000 hospitalizations per year due to influenza, and approximately 30,000 deaths. He said that viral or secondary pneumonias are commonly seen following influenza outbreaks in nursing home settings, making vaccination very important to preventing disease spread. If older adults are vaccinated against influenza, it boosts the chances for herd immunity in congregate facilities, Dr Schaffner explained. 

To reduce the chance of influenza in older adult healthcare settings, Dr Schaffner noted that all healthcare workers in the facility must be vaccinated to protect themselves and patients. He stated that nursing homes should require their workers to get vaccinated.

The 2015-2016 vaccines have different influenza A (H3N2) and influenza B (Yamagata lineage) components compared with last season’s vaccines. These changes were made based on expert predictions of which strains will circulate this season. 

There are two types of pneumococcal vaccines: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). The two are complementary and mutually supported, and adults older than age 65 should receive both types by getting PCV13 first, followed by the PPSV23 11 months later. If the polysaccharide 23 has already been given, patients can wait 1 year and then receive the conjugate 13, according to Dr Schaffner.

Other ways to prevent the spread of respiratory illnesses like influenza in nursing facilities include employing good infection control techniques such as: isolating sick patients, washing hands, wearing masks, and administering antivirals in the early stages of an outbreak, according to the CDC report.

References

1. Jordan JG, Pritchard S, Nicholson G, et al. Notes from the field: pneumonia associated with an influenza A H3 outbreak at a skilled nursing facility — Florida, 2014. MMWR. 2015;64(35):985-986.