title: Outbreaks of influenza-like illness in long-term care facilities in Winnipeg, Canada.
abstract: BACKGROUND
  Outbreaks of influenza-like illness (ILI) are common in long-term care facilities (LTCFs) and result in significant morbidity and mortality among residents.
  
  
  OBJECTIVE
  We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks.
  
  
  METHODS
  We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents' death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health.
  
  
  RESULTS
  Of a total of 154 reported outbreaks, most (N=80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents.
  
  
  CONCLUSIONS
  Influenza-like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks.
authors.affiliation: Department of Community Health Sciences, University of Manitoba.Winnipeg Regional Health Authority.Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
authors.forename: Salaheddin M
authors.initials: SM
authors.lastname: Mahmud
authors.forename: Laura H
authors.initials: LH
authors.lastname: Thompson
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Nowicki
authors.forename: Pierre J
authors.initials: PJ
authors.lastname: Plourde
mesh_terms: D002170:Canada / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D004196:Disease Outbreaks; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D008134:Long-Term Care; D016019:Survival Analysis
keywords: Epidemiology; influenza-like illness outbreaks; long-term care facilities