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Facts and free resources for preventing the flu in long-term care

Impacts of the flu on seniors ages 65 years and older range from an increased risk for heart attack, stroke, and bacterial lung infection (i.e. bronchitis or pneumonia), as well as a negative impact on ability to function independently. Due to these increased risks, it is unlikely that a senior infected with the flu will regain his or her level of health prior to infection. Effects of the illness may even prove fatal.

Fortunately, there is much that can be done to prevent the flu in long-term care. The Centers for Medicare & Medicaid Services (CMS) require that nursing homes receiving Medicare and Medicaid funding offer all residents influenza and pneumococcal vaccines and document the results. Documentation must be reported as part of the Minimum Data Set (MDS). Exceptions for this requirement are:

  • Vaccination is contraindicated medically
  • The resident or his/her legal representative refuses vaccination
  • The vaccine is not available because of storage

The Centers for Disease Control and Prevention (CDC) advise that anyone aged six months or older receive the influenza vaccination, a recommendation backed by the National Foundation for Infectious Diseases (NFID). The NFID reports that the number of long-term care staff receiving vaccination has increased since last season (2014 – 2015), moving from 64% coverage to 69% coverage — an all-time high for this demographic.

While the NFID recognizes this increase as progress, they warn that the largest vaccination decreases also occurred among long-term care residents.

The flu looks different in older adults

While younger age groups might spike a high fever and experience heightened cold symptoms (such as a runny nose, sore throat, and congestion), seniors ages 65 years and older will experience different symptoms, according to a Call to Action published by the NFID. Instead of a high fever, seniors are more likely to experience malaise and suffer from gastrointestinal symptoms such as pain, diarrhea, nausea, and vomiting. Healthcare professionals should be aware of these symptoms in residents, especially during flu season.

The CDC states that an influenza outbreak could be occurring if there is one confirmed case, along with other cases of respiratory infection in the same unit of the facility. The CDC recommends the following steps be taken if an influenza outbreak is occurring or is suspected:

  • Determine if influenza virus is the causative agent by performing influenza testing on respiratory specimens (i.e. nasal swabs, throat swabs, nasopharyngeal swab, or nasopharyngeal or nasal aspirates) of ill residents with recent onset of signs and symptoms suggestive of influenza.
  • In order of priority, the following influenza tests are recommended:
  1. Reverse transcription polymerase chain reaction (RT-PCR)
  2. Immunofluorescence
  3. Rapid influenza diagnostic tests
  • Due to the possibility of false negative results during influenza season, if influenza is suspected and immunofluorescence or rapid influenza diagnostic test results are negative, perform confirmatory testing using RT-PCR or viral culture. Information on influenza diagnostic testing is available online (https://www.cdc.gov/flu/professionals/diagnosis/index.htm) or by contacting your state public health laboratory.
  • Because of the possibility of false positive results, especially outside of influenza season, perform confirmatory testing using RT-PCR or viral culture if immunofluorescence or rapid influenza diagnostic test results are positive.
  • Viral culture should be performed if additional information on influenza viruses, such as influenza A virus subtype, antigenic characterization to compare with vaccine strains, or antiviral resistance data, are needed. Additionally, viral culture can be used to confirm results from rapid diagnostic testing (as mentioned above)
  • Determining influenza virus type or subtype of influenza A virus can help inform antiviral therapy decisions.
  • Test for other respiratory pathogens as well if it’s not influenza season.
  • Once an outbreak has been identified, outbreak prevention and control measures should be implemented immediately.