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Influenza Risk in Nursing Homes

September 7th, 2011

Every year the Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months old and older get a yearly influenza vaccine. And this is especially true for people over age 65, who are at greater risk of serious complications from the flu compared with young, healthy adults. In the United States, it’s estimated that 90 percent of seasonal flu-related deaths and more than 60 percent of flu-related hospitalizations occur in people 65 years and older. This is because our immune defenses become weaker with age.

The most vulnerable are elderly people who live in nursing homes. They fall within the vulnerable age category…plus they often have other, quite serious illnesses. In addition, institutions in general are hotbeds of person-to-person transmission of contagious viruses. According to an article by Dr. Robert Booy, Professor and Head of Clinical Research at the National Centre for Immunisation Research and Surveillance at the University of Sydney, Australia:

Flu outbreaks in nursing homes can lead to pneumonia, stroke and heart attacks among elderly residents. Staff are a major potential source of infection, but only around one in five get an annual flu shot. Ensuring more get vaccines, and that doctors intervene early when an outbreak occurs, may be the key to saving lives.

PREVENTING INFLUENZA

According to American Family Physician, the primary method of preventing flu is the influenza vaccine:

A number of studies have also shown that nursing homes with high rates of vaccinated residents have fewer outbreaks of influenza than nursing homes with lower vaccination rates. A similar correlation exists among the staff members of nursing homes. The higher the proportion of staff receiving the influenza vaccine, the lower the incidence of influenza among staff and residents during an outbreak. In addition, vaccination of both residents and staff can lead to herd immunity. To achieve this goal, the vaccination rate among residents and staff should exceed 80 percent.

If you choose to get vaccinated, here are some facts you need to know:

  • Influenza season runs from October through May.
  • It takes about two weeks for vaccines to take effect, so to be protected for the whole season, vaccines should be given before October.
  • Even though it is ideal to be vaccinated before October, flu season’s peak is between the end of December and March. You can still have protection even if you’re not vaccinated until February.

DO NOT get vaccinated if:

  • You have previously had a severe reaction after a flu shot. Talk to your doctor about options.
  • You have ever had Guillain-Barre. Talk with your doctor about options.
  • If you have any severe, life-threatening allergies, especially allergies to eggs. Talk with your doctor about options.
  • If you currently have a moderate or severe illness. Your immune system is already dealing with healing an illness, and you won’t want to challenge it additionally with a vaccine. Talk with your doctor about options.

TREATMENT

There are two main types of antiviral medications that can minimize the symptoms of flu:

  1. ion channel activity blockers, which include Symmetrel (amantadine) and Flumadine (rimantadine), are effective only in treating Type A influenza;
  2. neuraminidase inhibitors, which include Relenza (zanamivir) and Tamiflu (oseltamivir), are effective and treating both Type A and Type B influenza viruses.

All these medications are only available by prescription. No matter which flu-fighting medication your doctor chooses, it must be taken within two days of the start of the illness—later than that, and they will have no effect. That’s why it is important to recognize and report flu symptoms immediately. This is no time to try to “tough it out”—see a doctor as soon as you feel “flu-ish.”

SYMPTOMS:  INFLUENZA VS THE COMMON COLD

The difference between the symptoms of flu and the common cold isn’t a matter of degree. The medical journal American Family Physician provides detailed information so you don’t have to be confused anymore:

  • SYMPTOM ONSET
    • Flu:  abrupt. Some people can tell you the exact hour they fell ill with flu.
    • Cold: gradual.
  • FEVER
    • Flu: common, 100 to 104 degrees F
    • Cold: uncommon
  • MUSCLE PAIN
    • Flu: severe and common
    • Cold: uncommon
  • JOINT PAIN
    • Flu: severe and common
    • Cold: uncommon
  • LOSS OF APPETITE
    • Flu: common
    • Cold: uncommon
  • HEADACHE
    • Flu: severe and common
    • Cold: uncommon, or mild
  • COUGH (DRY)
    • Flu: severe and common
    • Cold: mild to moderate
  • FATIGUE
    • Flu: common, lasting 2 to 3 weeks
    • Cold: mild, short-lasting
  • STUFFY NOSE
    • Flu: occasional
    • Cold: common
  • SNEEZING
    • Flu: occasional
    • Cold: common
  • SORE THROAT
    • Flu: occasional
    • Cold: common

CONTAINING OUTBREAKS

Recognizing an influenza outbreak in a nursing home can be difficult because the clinical presentation of flu can vary in this population of patients. Symptoms in a nursing home resident may range from the classic influenza symptoms mentioned above to a simple functional decline.

Anytime a nursing home resident presents with influenza-like symptoms or another respiratory illness, the possibility of an influenza outbreak should be considered, and then confirmed by laboratory testing. The general process is to:

  • Isolate residents with flu or suspected flu;
  • Isolate residents taking one of the ion channel activity blockers, because they may shed medication-resistant virus;
  • Offer to vaccinate unvaccinated residents and staff;
  • Encourage sick staff to take time off work to avoid infecting residents;
  • All staff and physicians should wear masks and wash hands frequently.

If your loved one is in a nursing home during a flu outbreak, you can do your part, too. Talk with your doctor about whether receiving a vaccine is a good idea for you. If you feel sick, don’t visit the nursing home to avoid infecting this fragile population. Wear a face mask if you do visit, even if you are healthy. Question the staff about how the outbreak is being handled, and what specifically is being done to keep your loved one safe.

Flu season is stressful for everyone, but nursing home residents most of all. The best news is that by June, it will all be over.

RESOURCES

To read the CDC’s information sheet, click here:  What you need to know about the 2011-2012 influenza vaccine

To read the article in American Family Physician, click here:  Influenza in the Nursing Home

To read Dr. Robert Booy’s article, click here:  Protecting our elderly