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Medical care of older persons in residential aged care facilities (Silver Book)

Respiratory infections - influenza

Due to their age, chronic illness and close living conditions, residents of RACFs are at high risk of developing infections and consequently dying due to influenza and pneumonia. Preventive interventions including vaccination and reduction of risk factors can reduce respiratory infections and associated morbidity and mortality. The Australian immunisation handbook recommends influenza and pneumococcus vaccination for residents and influenza vaccination for RACF staff.233

It is important to maintain vaccines between 2°C and 8°C by transporting in cold boxes and storing in refrigerators dedicated to the storage of medications. Regular quality assurance testing of refrigerators is a requirement for both general practice and residential aged care accreditation.

Influenza infections occur seasonally with most cases reported from mid autumn to the end of winter. It is contagious for 3-5 days from onset. Symptoms include fever, headache, myalgia, sore throat and cough for several days, usually with full recovery within 7 days. However, residents of RACFs are at particular risk of complications due to their age and chronic debilitating diseases.

In the aged care home population, influenza vaccination can be 50-60% effective in preventing hospitalisation or pneumonia, and 80% effective in preventing death, even though the effectiveness in preventing influenza illness may be lower. To provide continuing protection, annual vaccination with the most recent strains is necessary before winter. Vaccination is not recommended for residents with anaphylactic hypersensitivity to eggs, a history of Guillian-Barré syndrome (due to risk of developing the syndrome again), or during an acute febrile illness (fever >38.5°C).234

Elderly residents may have an impaired response to vaccination due to age or comorbidities, and outbreaks have occurred in RACFs despite high vaccination rates. Therefore, it is important to prevent individuals introducing the virus into RACFs by vaccinating staff and health care workers (including GPs), and educating visitors to stay away when unwell.235

Infection control programs can reduce the spread of infections through institutions, and limit the impact of outbreaks when they occur. It is advisable that each RACF have a policy on staff influenza immunisation and a surveillance system as infection control measures. An outbreak of influenza is defined as three or more residents with symptoms and fever of at least 37.7°C within a 3 day period. A RACF surveillance system would recognise, notify and diagnose early cases. This enables timely, outbreak control measures to be implemented, in collaboration with attending GPs and departments of health. Additional precautions for droplet transmission should be observed and patients treated symptomatically. Health care workers with influenza should avoid patient contact or take sick leave. Consider vaccination of previously unvaccinated staff and residents, and the use of antiviral treatment according to state health department advice or guidelines.236,237,238

A resource to assist facilities and health care professionals with prevention and management of influenza outbreaks in RACFs has been developed from the National infection control guidelines and the Australian immunisation handbook (8th ed) by the Australian Government Department of Health and Ageing. The Influ-Info Influenza Kit for Aged Care is available at http://www.health.gov.au/internet/wcms/publishing.nsf/ Content/ageing-publicat-influinfo.htm.

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