title: Public health responses to influenza in care homes: a questionnaire-based study of local Health Protection Units.
abstract: BACKGROUND
  Influenza virus infection poses a major threat to the elderly people in residential care. We sought to describe the extent to which local public health services in England were positioned to detect and respond effectively to influenza-like illness (ILI) in nursing homes.
  
  
  METHODS
  A questionnaire-based survey was conducted in all 34 Health Protection Units (HPUs) regarding the 2004-05 influenza season.
  
  
  RESULTS
  Of the 20 responses, half reported 24 outbreaks of ILI in care homes. The mean resident population attack rate was 41% (range 15-79) with 31 deaths. Staff ILI occurred in 23 of 24 outbreaks. Seven of 20 HPUs stated that a local policy for the management of ILI in nursing homes was in place, with only four specifying the use of neuraminidase inhibitors (NI) for treatment of cases and prophylaxis of residents. In the outbreaks reported, NIs were used for treatment and prophylaxis, respectively, in only 46 and 54% of instances.
  
  
  CONCLUSIONS
  Given the availability of effective interventions for treatment and prophylaxis, there is potential to prevent substantial morbidity and mortality from influenza in at-risk populations. This study suggests that challenges remain in the effective response to influenza outbreaks in care homes and that there are wide variations in practice at local level.
authors.affiliation: Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
authors.forename: R K
authors.initials: RK
authors.lastname: Gupta
authors.forename: H
authors.initials: H
authors.lastname: Zhao
authors.forename: M
authors.initials: M
authors.lastname: Cooke
authors.forename: R
authors.initials: R
authors.lastname: Harling
authors.forename: M
authors.initials: M
authors.lastname: Regan
authors.forename: L
authors.initials: L
authors.lastname: Bailey
authors.forename: J S
authors.initials: JS
authors.lastname: Nguyen-Van-Tam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000600:supply & distribution / Q000627:therapeutic use; D018563:Disease Notification; D004196:Disease Outbreaks / Q000517:prevention & control*; D016330:Frail Elderly; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006291:Health Policy; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D007252:Influenza Vaccines / Q000600:supply & distribution; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D009735:Nursing Homes / Q000592:standards*; D011635:Public Health Administration / Q000592:standards*; D015980:Public Health Practice / Q000592:standards*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D007252:Influenza Vaccines