Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-25T07:19:18.878Z Has data issue: false hasContentIssue false

Prevention and Control of Influenza A Outbreaks in Long-Term Care Facilities

Published online by Cambridge University Press:  21 June 2016

David W. Bentley
Affiliation:
William S. Middleton Memorial Veterans' Hospital, Madison, King, Wisconsin
Stefan Gravenstein*
Affiliation:
Section of Geriatrics, Department of Medicine, University of Wisconsin-Madison, King, Wisconsin William S. Middleton Memorial Veterans' Hospital, Madison, King, Wisconsin
Barbara A. Miller
Affiliation:
Section of Geriatrics, Department of Medicine, University of Wisconsin-Madison, King, Wisconsin
Paul Drinka
Affiliation:
Section of Geriatrics, Department of Medicine, University of Wisconsin-Madison, King, Wisconsin William S. Middleton Memorial Veterans' Hospital, Madison, King, Wisconsin Wisconsin Veterans' Home, King, Wisconsin
*
University of Wisconsin, Institute on Aging and Adult Life, 425 Henry Mall, Room 330, Madison, WI 53706

Extract

No single virus has the health impact of influenza. Influenza has remained epidemiologically important because it escapes host immune pressure through antigenic variation, is highly contagious, and can cause pneumonia and death in the most susceptible hosts. Viral transmission is most efficient where contact between susceptible hosts is greatest. For humans, this includes institutional settings such as daycare centers, schools, hospitals, and long-term care facilities.

Of the three types of influenza, influenza C is relatively nonvirulent. Influenza B is most virulent in children; its antigenic stability presumably allows the adult population to benefit from acquired immunity. Influenza A is virulent in people of all ages, especially in those at the extremes of age or with immunocompromising disease; the attack rate in persons over 70 years of age is four times that of adults under 40 years of age. A major factor accounting for recurrent influenza A epidemics is change in the virus (antigenic drift and shift) that renders the vaccine less efficacious. Influenza epidemics cost billions of dollars and result in thousands of deaths annually. This discussion will focus on the prevention and treatment of influenza A in the long-term care facility.

Type
Topics in Long-Term Care
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bartlett, JG. Pneumonia. In: Hazzard, WR, Andres, R, Bierman, EL, Blass, JP, eds. Principles of Geriatric Medicine and Gerontology. New York. NY: McGraw-Hill: 1990:509517.Google Scholar
2. Prevention and control of influenza. Recommendations of the Immunization Practices Advisory Committee. MMWR. 1991;40:115.Google Scholar
3. Silverberg, E, Lubera, JA Cancer statistics 1989. Cancel: 1989;39:9.Google ScholarPubMed
4. Alling, DW, Blackwelder, WC, Stuart-Harris, CH. A study in excess mortality during influenza epidemics in the United States, 1968–1976 . Am J Epidemiol. 1981;113:3043.CrossRefGoogle ScholarPubMed
5. Arden, NH, Patriarca, PA, Kendal, AI? Experiences in the use and efficacy of inactivated influenza vaccine in nursing homes. In: Kendal, AP, Patriarca, PA, eds. Options for the Control of Influenza. New York, NY: Alan R Liss, Inc; 1986: 155168.Google Scholar
6. Centers for Disease Control. Influenza vaccine efficacy in nursing home outbreaks reported during 1981–1982. MMWR. 1982;31:190195.Google Scholar
7. Mast, EE, Harmon, MW, Gravenstein, S, et al. Emergence and possible transmission of amantadine-resistant viruses during nursing home outbreaks of influenza A (H3N2). Am J Epidemiol. In press.Google Scholar
8. Patriarca, PA, Arden, NH, Koplan, JP, Goodman, RA. Prevention and control of type A influenza infections in nursing homes. Benefits and costs of four approaches using vaccination and amantadine . Ann Intern Med. 1987; 107:732740.CrossRefGoogle ScholarPubMed
9. Ganguly, R, Russell, DW, Yangco, BV, Chmel, H, Cameron, DJ, Sinnott, J. Influenza vaccination status among healthcare professionals for prevention of nosocomial infection to hospitalized elderly patients. Serodiagnosis and Immunotherapy in Infectious Disease. 1990;4:309315.CrossRefGoogle Scholar
10. Arden, NH, Patriarca, PA, Fasano, MB, et al. The roles of vaccination and amantadine prophylaxis in controlling an outbreak of influenza A (H3N2) in a nursing home. Arch Intern Med. 1988;148:865868.CrossRefGoogle Scholar
11. Barker, WH, Mullooly, JP. Influenza vaccination of elderly persons: reduction in pneumonia and influenza hospitalizations and deaths. JAMA. 1980;244:25472549.CrossRefGoogle ScholarPubMed
12. Gross, PA, Quinnan, GV, Rodstein, M, et al. Association of influenza immunization with reduction in mortality in an elderly population: a prospective study. Arch Intern Med. 1988; 148:562565.CrossRefGoogle Scholar
13. Patriarca, PA, Weber, JA, Parker, RA, et al. Efficacy of influenza vaccine in nursing homes. Reduction in illness and complications during an influenza A (H3N2) epidemic, JAMA. 1985;253:11361139.CrossRefGoogle ScholarPubMed
14. Fox, JP, Elveback, L, Scott, W, et al. Herd immunity. Basic concept and relevance to public health immunization practices. Am J Epidemiol. 1971;94:179189.CrossRefGoogle ScholarPubMed
15. Levine, M, Beattie, BL, McLean, DM, Corman, D. Characterization of the immune response to trivalent influenza vaccine in elderly men. J Am Geriatr Soc. 1987;609615.CrossRefGoogle ScholarPubMed
16. Peterson, LR, Fedson, DS. Prevention, management and control of influenza in the institutional setting. Am J Med. 1987;82 (suppl 6A):5860.CrossRefGoogle Scholar
17. Gross, PA, Rodstein, M, LaMontagne, JR, et al. Epidemiology of acute respiratory illness during an influenza outbreak in a nursing home. Arch Intern Med. 1988;148:559561.CrossRefGoogle ScholarPubMed
18. Kendal, AP. Epidemiologic implications of changes in the influenza virus genome. Am J Med. 1987;82:414.CrossRefGoogle ScholarPubMed
19. Gross, PA, Ennis, FA, Gaerlan, PF, et al. A controlled double-blind comparison of reactogenicity and protective efficacy of whole virus and split product influenza vaccines in children. J Infect Dis. 1977;136:623632.CrossRefGoogle ScholarPubMed
20. Gravenstein, S, Drinka, P Duthie, EH, et al. Risks for influenza and respiratory illness in vaccinated elderly. Aging: Immunology and Infectious Disease. 1990;2:185193.Google Scholar
21. Gross, PA, Quinnan, GV, Weksler, ME, et al. Immunization of elderly people with high doses of influenza vaccine. J Am Geriatr Soc. 1988;36:209212.CrossRefGoogle ScholarPubMed
22. Gross, PA, Weksler, ME, Quinnan, GV, et al. Immunization of elderly people with two doses of influenza vaccine. J Clin Microbiol. 1987;25:17631765.CrossRefGoogle ScholarPubMed
23. Gravenstein, S, Duthie, EH, Miller, BA, et al. Augmentation of influenza antibody response in elderly men by thymosin alpha one. J Am Geriutr Soc. 1989;37:18.CrossRefGoogle Scholar
24. Gravenstein, S, Miller, BA, Ershler, WB, et al. Low sensitivity of CDC case definition for H3N2 influenza in elderly nursing home subjects. Clinical Research. 1990;38:547A.Google Scholar
25. Bean, B, Moore, BM, Sterner, B, et al. Survival of influenza viruses on environmental surfaces. J Infect Dis. 1982;146:4751.CrossRefGoogle ScholarPubMed
26. Bryson, YJ, Monahan, C, Pollack, M, Shields, WD. A prospective double-blind study of side effects associated with the administration of amantadine for influenza A virus prophylaxis. J Infect Dis. 1980;141:543547.CrossRefGoogle ScholarPubMed
27. Dolin, R, Bentley, DW. Amantadine and rimantadine: prophylaxis and therapy of influenza A in adults. In: Kendal, AP, Patriarca, PA, eds. Options for the Control of Influenza. New York, NY: Alan R Liss, Inc; 1986:317326.Google Scholar
28. Monto, AS, Gunn, RA, Bandyk, MG, King, CL. Prevention of Russian influenza by amantadine. JAMA. 1979:241:10031007.CrossRefGoogle ScholarPubMed
29. NIH. Amantadine: does it have a role in prevention and treatment of influenza? A NIH Consensus Develoument Conference. Ann Intern Med. 1980:92:256258.CrossRefGoogle Scholar
30. Wolfson, L, Whipple, R, Amerman, P, Tobin, JN. Gait assessment in the elderly: a gait abnormality rating scale and its relations to falls. J Geront. 1990:45:M12M19.CrossRefGoogle Scholar
31. Peters, NL, Oboler, S, Hair, C, et al. Treatment of an influenza A outbreak in a teaching nursing home. Effectiveness of a protocol for prevention and control. J Am Geriutr Soc. 1989;37:210218.CrossRefGoogle Scholar
32. Gravenstein, S, Mast, E, Drinka, P Langer, E, Miller, BA, Davis, JP. Amantadine prophylaxis in 880 nursing home subjects: strategies in toxicity reduction. The Gerontologist. 1989;29:252A.Google Scholar
33. Rowe, JW. The effect of age on creatinine clearance in man: a cross-sectional and longitudinal study. J Gerontol. 1976:31:155.CrossRefGoogle ScholarPubMed
34. Jackson, GG. The development and clinical evaluation of amantadine for prophylaxis and treatment of influenza A. In: Kendal, AP, Patriarca, PA, eds. Options for the Control of Influenza. New York, NY: Alan R Liss, Inc; 1986:293317.Google Scholar