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We describe seasonal influenza-like illness (ILI) outbreaks in long-term care facilities in the Health Service Executive (HSE) East area of Ireland in the 2013/2014 influenza season, risk factors associated with outbreak duration and attack rates, and management challenges. Separate questionnaires were distributed to 28 facilities who reported an outbreak and to public health specialists leading outbreak management, with a 79% response rate. Mean outbreak duration (21 vs 17 days; p=0.046) was longer in facilities with staff vaccination rates of <40%. Facilities with a high attack rate (≥50%) were less likely to have an outbreak plan (p=0.03). Smaller facilities (under 50 residents) had a higher attack rate (50% vs 23%, p=0.003) even when controlled for staff vaccination rate (p=0.01). Prior to the outbreak, resident vaccination rates were high (82%, above the World Health Organization target of 75%) but staff vaccination rates were low (39%). Reported challenges to ILI outbreak management in long term care facilities included visitor restrictions, staff education issues, outbreak notification delays and lack of outbreak lead in facilities. Targeted public health-assisted planning, training and response, comprising of staff vaccination, education, written policies, with early notification and prompt response would facilitate a more co-ordinated approach to the management of outbreaks, and reduction in infection rates and consequent morbidity. DOI : 10.14302/issn.2577-137X.ji-16-1139 Corresponding author: Dr Lois O’Connor, Lismacfinnan, Killorglin, Co. Kerry, Ireland. lois_oconnor@hotmail.com Running title: Characteristics of institutional influenza outbreaks 2013/14 Received: May 30, 2016; Accepted: Dec 05, 2016; Published: Jan 06, 2017 Freely Available Online www.openaccesspub.org | JI CC-license DOI :10.14302/issn.2577-137X.ji-16-1139 Vol-1 Issue 1 Pg. no.23 Introduction Influenza-like illness (ILI) outbreaks are a major cause of morbidity and mortality among residents of long-term care facilities (LTCFs) globally. Residents are at high risk of influenza due to the closed environment of LTCFs and the limited mobility of residents, both of which facilitate transmission of infection [1]. A previous review of influenza outbreaks in LTCFs highlighted attack rates of up to 60% (2).In addition, residents of LTCFs are at higher risk of complications of influenza and can be poorly protected by influenza vaccination [3]. Influenza can persist unrecognised in LTCFs for several months, due to atypical presentation in residents, and outbreaks may not be reported [4]. It is therefore essential that LTCFs maintain a high index of suspicion during the influenza season and have an appropriate surveillance system in place to monitor for symptoms of ILI in residents and staff. Evidence suggests that early detection, high resident and staff vaccination rates and prompt initiation of antiviral medication results in better outbreak control, reduced hospitalisation, morbidity and mortality [5, 6, 7]. In Ireland, under infectious diseases legislation, the local Medical Officer of Health, located in regional Departments of Public Health must be informed by the attending clinician of any suspected outbreak of ILI (S1 707: 2003). Departments of Public Health provide guidance, expertise and support on the management and control of outbreaks [8]. National and international guidelines are also available for the management of influenza outbreaks [8-10]. Information on what makes a LTCF vulnerable to an ILI outbreak is lacking. The reasons are likely to be complex and multi-factorial. We undertook an indepth survey of a series of notified ILI outbreaks in LTCFs. The aim was to identify risk factors and management challenges for facilities and public health authorities in order to target recommendations for improvement. We describe the epidemiological features of outbreaks including numbers affected, attack rate, hospitalisation rate and deaths for outbreaks of ILI notified by 22 of 108 LTCFs in the HSE East region (population 1.6 million) of Ireland, to the Department of Public Health during the 2013/2014 season.

journal of immunization

Epidemiology and Management of Seasonal Influenza Outbreaks in Long-Term Care Facilities in the Health Service Executive East Area of Ireland During the 2013-2014 Influenza Season