Influenza outbreak detection and control measures in nursing homes in the United States.
OBJECTIVE
To evaluate the use of influenza vaccine, rapid influenza testing, and influenza antiviral medication in nursing homes in the US to prevent and control outbreaks.


METHODS
Survey questionnaires were sent to 1017 randomly selected nursing homes in nine states. Information was collected on influenza prevention, detection and control practices, and on outbreaks during three influenza seasons (1995-1998).


RESULTS
The survey response rate was 78%. Influenza vaccine was offered to residents and staff by 99% and 86%, respectively, of nursing homes. Among nursing homes offering the influenza vaccine, the average vaccination rate was 83% for residents and 46% for staff. Sixty-seven percent of the nursing homes reported having access to laboratories with rapid antigen testing capabilities, and 19% reported having a written policy for the use of influenza antiviral medications for outbreak control. Nursing homes from New York, where organized education programs on influenza detection and control have been conducted for many years, were more likely to have reported a suspected or laboratory-confirmed influenza outbreak (51% vs 10%, P = .01), to have access to rapid antigen testing for influenza (92% vs 63%, P = .01), and to use antivirals for prophylaxis and treatment of influenza A for their nursing home residents (94% vs 55%, P = .01) compared with nursing homes from the other eight states.


CONCLUSIONS
Influenza outbreaks among nursing home residents can lead to substantial morbidity and mortality when prevention measures are not rapidly instituted. However, many nursing homes in this survey were neither prepared to detect nor to control influenza A outbreaks. Targeted, sustained educational efforts can improve the detection and control of outbreaks in nursing homes.
Zadeh
M M
MM
Influenza Branch, Centers for Disease Control and Prevention, National Centers for Infectious Disease, Division of Viral and Rickettsial Diseases, Atlanta, Georgia 30333, USA.
Buxton Bridges
C
C
Thompson
W W
WW
Arden
N H
NH
Fukuda
K
K
D000998:Antiviral Agents / Q000627:therapeutic use; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000193:education; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D016015:Logistic Models; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data
D000998:Antiviral Agents; D007252:Influenza Vaccines