Surveillance of Respiratory Viruses in Long Term Care Facilities

ObjectiveTo assess the feasibility of conducting respiratory virus surveillance for residents of long term care facilities (LTCF) using simple nasal swab specimens and to describe the virology of acute respiratory infections (ARI) in LCTFs.IntroductionAlthough residents of LTCFs have high morbidity and mortality associated with ARIs, there is very limited information on the virology of ARI in LTCFs.[1,2] Moreover, most virological testing of LCTF residents is reactive and is triggered by a resident meeting selected surveillance criteria. We report on incidental findings from a prospective trial of introducing rapid influenza diagnostic testing (RIDT) in ten Wisconsin LTCFs over a two-year period with an approach of testing any resident with ARI.MethodsAny resident with new onset of respiratory symptoms consistent with ARI had a nasal swab specimen collected for RIDT by nursing staff. Following processing for RIDT (Quidel Sofia Influenza A+B FIA), the residual swab was placed into viral transport medium and forwarded to the Wisconsin State Laboratory of Hygiene and tested for influenza using RT-PCR (IVD CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel), and for 17 viruses (Luminex NxTAG Respiratory Pathogen Panel [RPP]). The numbers of viruses in each of 7 categories [influenza A (FluA ), influenza B (FluB), coronaviruses (COR), human metapneumovirus (hMPV), parainfluenza (PARA), respiratory syncytial virus (RSV) and rhinovirus/enterovirus (R/E)], across the two years were compared using chi-square.ResultsTotals of 164 and 190 specimens were submitted during 2016-2017 and 2017-2018, respectively. RPP identified viruses in 56.2% of specimens, with no difference in capture rate between years (55.5% vs. 56.8%). Influenza A (21.5%), influenza B (16.5%), RSV (19.0%) and hMPV (16.5%) accounted for 73.5% of all detections, while coronaviruses (15.5%), rhino/enteroviruses (8.5%) and parainfluenza (2.5%) were less common. Specific distribution of viruses varied significantly across the two years (Table: X2=48.1, df=6; p<0.001).ConclusionsSurveillance in LTCFs using nasal swabs collected for RIDT is highly feasible and yields virus identification rates similar to those obtained in clinical surveillance of ARI with collection of nasopharyngeal specimens by clinicians and those obtained in a school-based surveillance project of ARI with collection of combined nasal and oropharyngeal specimens collected by trained research assistants. Significant differences in virus composition occurred across the two study years. RSV varied little between years while hMPV demonstrated wide variation. Simple approaches to surveillance may provide a more comprehensive assessment of respiratory viruses in LTCF settings.References(1) Uršič T, Gorišek Miksić N, Lusa L, Strle F, Petrovec M. Viral respiratory infections in a nursing home: a six-month prospective study. BMC Infect Dis. 2016; 16: 637. Published online 2016 Nov 4. doi: 10.1186/s12879-016-1962-8(2) Masse S, Capai L, Falchi A. Epidemiology of Respiratory Pathogens among Elderly Nursing Home Residents with Acute Respiratory Infections in Corsica, France, 2013–2017. Biomed Res Int. 2017; 2017: 1423718. Published online 2017 Dec 17. doi: 10.1155/2017/1423718

Download Full-text

Sensitivity and Specificity of the Quidel Sofia Influenza A+B FIA Rapid Influenza Detection Test in Long-Term Care Facilities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.859 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S355-S355 ◽

Cited By ~ 1

Author(s):

Jonathan Temte ◽

Mary Checovich ◽

Shari Barlow ◽

Peter Shult ◽

Erik Reisdorf ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Symptom Onset ◽

Influenza A ◽

Long Term Care ◽

Respiratory Viruses ◽

Influenza Viruses ◽

Influenza B ◽

Rt Pcr ◽

Term Care

Abstract Background Influenza is a significant pathogen for long-term care facility (LTCF) residents. As part of a randomized controlled trial to assess early detection of influenza in LTCFs, we deployed rapid influenza detection tests (RIDTs) at intervention LTCFs. Our primary objectives for this interim analysis were to evaluate the sensitivity and specificity of the Quidel Sofia® Influenza A+B Fluorescent Immunoassay RIDT in a high-risk, nontraditional population, and to describe the virology of acute respiratory infections (ARI) in LTCF residents. Methods Personnel at LCTFs identified cases of ARI, collected nasal specimens, and ran RIDTs from 10/21/2016 to 4/28/2017. The residual nasal swab and leftover lysis buffer were placed into a viral transport medium tube and sent to the Wisconsin State Laboratory of Hygiene for confirmatory influenza RT-PCR testing. In addition, all specimens were tested for other viruses using the Luminex NxTAG® Respiratory Pathogen Panel. Sensitivity and specificity of the Sofia RIDT were calculated using RT-PCR results as the reference standard. Results Specimens were collected from 228 residents (mean age = 71.3 ± 22.4 years). The mean time from symptom onset to specimen collection was 1.4 ± 1.6 days (range: 0-7 days). Respiratory viruses were identified in 134/228 cases (58.8%); influenza viruses (A: 7.5% and B: 14.5%) were the most commonly detected virus by PCR, followed by rhinovirus/enterovirus (13.2%), RSV (11.0%) and coronaviruses (10.1%). The sensitivities of Sofia RIDT for influenza A and influenza B were 77.8% (95% CI: 52.4–93.6%) and 80.0% (95% CI: 61.4–92.3%), respectively, with specificities of 98.4% (95.3–99.7%) and 97.1% (93.4–99.1%), respectively. Overall performance assessment for influenza A or B yielded a sensitivity of 79.2% (65.0–89.5%) and specificity of 96.1% (91.7–98.6%). The estimated likelihood of discovering one of the first two influenza cases at a LTCF using this RIDT is estimated to be ≥95.7%. Conclusion Although a wide constellation of respiratory viruses cause ARIs within LTCF populations, influenza is very common. Early ARI recognition in residents, with testing shortly after symptom onset, likely contributed to high performance of the Sofia RIDT. Use of RIDTs allows early identification of influenza with high sensitivity and specificity in elderly LTCF residents. Disclosures J. Temte, Quidel: Investigator, Research support

Download Full-text

Use of Antiviral Prophylaxis in Influenza Outbreaks in Long Term Care Facilities

Canadian Journal of Infectious Diseases ◽

10.1155/2000/246037 ◽

2000 ◽

Vol 11 (4) ◽

pp. 187-192 ◽

Cited By ~ 5

Author(s):

Allison McGeer ◽

Daniel S Sitar ◽

Susan E Tamblyn ◽

Faron Kolbe ◽

Pamela Orr ◽

...

Keyword(s):

Influenza A ◽

Long Term Care ◽

The Elderly ◽

Influenza B ◽

Antiviral Prophylaxis ◽

Neuraminidase Inhibitors ◽

Term Care ◽

Care Facilities ◽

Influenza Outbreaks

Influenza is a major cause of illness and death in residents of long term care facilities for the elderly, in part because residents' age and underlying illness increase the risk of serious complications, and in part because institutional living increases the risk of influenza outbreaks. The administration of antiviral medications active against influenza to persons exposed to influenza has been shown to protect them effectively from illness, and mass antiviral prophylaxis of residents is an effective means of terminating influenza A outbreaks in long term care facilities. The only antiviral currently licensed in Canada for influenza prophylaxis is amantadine, a medication active against influenza A but not influenza B. The National Advisory Committee on Immunization recommends that amantadine prophylaxis be offered to residents when influenza A outbreaks occur in long term care facilities. However, there remain a number of unanswered questions about how best to use amantadine for controlling influenza A outbreaks in long term care facilities. In addition, two members of a new class of antivirals called neuraminidase inhibitors have recently been licensed in Canada for the treatment of influenza, and are effective in prophylaxis. Issues in the use of amantadine in the control of outbreaks of influenza A in long term care facilities for the elderly are reviewed, and the potential uses of neuraminidase inhibitors in this setting are discussed.

Download Full-text

Prevention of Influenza in Long-Term–Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/501687 ◽

1999 ◽

Vol 20 (9) ◽

pp. 629-637 ◽

Cited By ~ 77

Author(s):

Suzanne F. Bradley ◽

Keyword(s):

Older Adults ◽

Influenza A ◽

Long Term Care ◽

Influenza B ◽

Case Definitions ◽

Term Care ◽

Standard Case ◽

Care Facilities ◽

Influenza Outbreaks

AbstractInfluenza is a frequent cause of epidemic and endemic respiratory illness in long-term-care facilities (LTCFs), resulting in considerable morbidity and mortality. Detection of influenza outbreaks in this setting can be difficult, because the clinical presentation in older adults is atypical and other pathogens also cause influenza-like illness (ILI) during the influenza season. Use of the standard case definition for influenza has not been effective in detecting episodes in residents of LTCFs. Alternative case-definitions that reflect the atypical presentation of influenza in this population have been recommended but not validated. The use of rapid tests for the detection of influenza in conjunction with more sensitive case definitions of ILI may lead to the earlier detection of influenza outbreaks in LTCFs, earlier initiation of infection control measures, and reduction in transmission.The definition of outbreak, eg, the number of episodes of ILI or episodes of confirmed influenza A that would result in the initiation of antiviral chemoprophylaxis, remains controversial in this setting. The use of newer antivirals could limit the side effects seen in older adults in LTCFs. However, annual vaccination of residents and staff remains the most effective way to prevent the introduction of influenza A or influenza B into LTCFs. In addition, vaccination of LTCF residents reduces rates of illness and pneumonia due to influenza, as well as cardiopulmonary exacerbation, hospitalization, and death.

Download Full-text

Prevention and Control of Influenza A Outbreaks in Long-Term Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/646422 ◽

1992 ◽

Vol 13 (1) ◽

pp. 49-54 ◽

Cited By ~ 4

Author(s):

David W. Bentley ◽

Stefan Gravenstein ◽

Barbara A. Miller ◽

Paul Drinka

Keyword(s):

Influenza A ◽

Long Term Care ◽

Antigenic Variation ◽

Adult Population ◽

Care Facility ◽

Antigenic Drift ◽

Influenza B ◽

Term Care ◽

Care Facilities

No single virus has the health impact of influenza. Influenza has remained epidemiologically important because it escapes host immune pressure through antigenic variation, is highly contagious, and can cause pneumonia and death in the most susceptible hosts. Viral transmission is most efficient where contact between susceptible hosts is greatest. For humans, this includes institutional settings such as daycare centers, schools, hospitals, and long-term care facilities.Of the three types of influenza, influenza C is relatively nonvirulent. Influenza B is most virulent in children; its antigenic stability presumably allows the adult population to benefit from acquired immunity. Influenza A is virulent in people of all ages, especially in those at the extremes of age or with immunocompromising disease; the attack rate in persons over 70 years of age is four times that of adults under 40 years of age. A major factor accounting for recurrent influenza A epidemics is change in the virus (antigenic drift and shift) that renders the vaccine less efficacious. Influenza epidemics cost billions of dollars and result in thousands of deaths annually. This discussion will focus on the prevention and treatment of influenza A in the long-term care facility.

Download Full-text

Evaluation of Viruses Associated With Acute Respiratory Infections in Long-Term Care Facilities Using a Novel Method: Wisconsin, 2016‒2019

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2019.09.003 ◽

2020 ◽

Vol 21 (1) ◽

pp. 29-33 ◽

Cited By ~ 3

Author(s):

Mary M. Checovich ◽

Shari Barlow ◽

Peter Shult ◽

Erik Reisdorf ◽

Jonathan L. Temte

Keyword(s):

Long Term Care ◽

Respiratory Infections ◽

Acute Respiratory Infections ◽

Term Care ◽

Care Facilities ◽

Novel Method

Download Full-text

Vitamin D Supplementation for the Prevention and/or Treatment of Cardiovascular Disease, Cancer, and Other Conditions in Residents of Long-Term Care Facilities

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.104 ◽

2021 ◽

Vol 1 (7) ◽

Author(s):

Keeley Farrell ◽

Jennifer Horton

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Older Adults ◽

Vitamin D ◽

Long Term Care ◽

Respiratory Infections ◽

Vitamin D Supplementation ◽

Term Care ◽

Care Facilities

The results of 1 systematic review suggest that supplementation with vitamin D may provide some benefit for cancer-related mortality in older adults. It is unclear whether there is a benefit of vitamin D supplementation for all-cause mortality; however, no benefit was found for cardiovascular disease mortality, cardiovascular disease events, or cancer incidence. There is limited and mixed evidence on the effectiveness of vitamin D supplementation for dementia and mild cognitive impairment in older adults. The results of 1 systematic review suggest that vitamin D supplementation may provide protection against acute respiratory infections in the overall population; however, this result was not significant in the subgroup of patients older than 65 years. No evidence-based guidelines were identified regarding vitamin D supplementation for the prevention and/or treatment of cardiovascular disease, cancer, and other conditions in elderly patients residing in long-term care facilities.

Download Full-text

Prevention and Control of Influenza a Outbreaks in Long-Term Care Facilities

Infection Control and Hospital Epidemiology ◽

10.2307/30146967 ◽

1992 ◽

Vol 13 (1) ◽

pp. 49-54 ◽

Cited By ~ 14

Author(s):

Stefan Gravenstein ◽

Barbara A. Miller ◽

Paul Drinka

Keyword(s):

Prevention And Control ◽

Influenza A ◽

Long Term Care ◽

Term Care ◽

Care Facilities ◽

And Control

Download Full-text

The effect of timing of oseltamivir chemoprophylaxis in controlling influenza A H3N2 outbreaks in long-term care facilities in Manitoba, Canada, 2014-2015: a retrospective cohort study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.115 ◽

2018 ◽

Vol 39 (8) ◽

pp. 955-960 ◽

Cited By ~ 1

Author(s):

Davinder Singh ◽

Depeng Jiang ◽

Paul Van Caeseele ◽

Carla Loeppky

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Influenza A ◽

Long Term Care ◽

Secondary Infection ◽

Symptomatic Infection ◽

Term Care ◽

Care Facilities

ObjectiveThis study examined the effect of the timing of administration of oseltamivir chemoprophylaxis for the control of influenza A H3N2 outbreaks among residents in long-term care facilities (LTCFs) in Manitoba, Canada, during the 2014–2015 influenza season.MethodsA retrospective cohort study was conducted of all LTCF influenza A H3N2 outbreaks (n=94) using a hierarchical logistic regression analysis. The main independent variable was how many days passed between the start of the outbreak and commencement of oseltamivir chemoprophylaxis. The dependent variable was whether each person in the institution developed influenza-like illness (yes or no).ResultsDelay of oseltamivir chemoprophylaxis was associated with increased odds of infection in both univariate (t=5·41; df=51; P<·0001) and multivariable analyses (t=6·04; df=49; P<·0001) with an adjusted odds ratio of 1.3 (95% confidence interval [CI], 1·2–1·5) per day for influenza A H3N2.ConclusionsThe sooner chemoprophylaxis is initiated, the lower the odds of secondary infection with influenza in LTCFs during outbreaks caused by influenza A H3N2 in Manitoba. For every day that passed from the start of the outbreak to the initiation of oseltamivir, the odds of a resident at risk of infection in the facility developing symptomatic infection increased by 33%.

Download Full-text