Guidelines for preventing respiratory illness in older adults aged 60 years and above living in long-term care: A rapid review of clinical practice guidelines

Patricia Rios; Amruta Radhakrishnan; Sonia M. Thomas; Nazia Darvesh; Sharon E. Straus; Andrea C. Tricco

In view of vaccine mismatch for H3N2 viruses in 2014-2015 and anticipated reduced VE for that component, it is recommended that antiviral chemoprophylaxis be considered for all staff working at the site of a declared influenza A(H3N2) LTCF outbreak regardless of whether they have received this year's 2014-2015 influenza vaccine. Controlling outbreaks of influenza in LTCF requires a multifaceted approach including: 1. Surveillance for influenza-like illness (ILI) 2. Laboratory testing to identify the cause of ILI 3. Promotion of, and adherence to, infection control guidelines and practices including respiratory etiquette and routine practices, and the use of personal protective equipment 4. Timely communication 5. Influenza immunization for residents and staff 6. Exclusion of ill staff, visitor exclusion and new admission deferral 7. Antiviral drug therapy for ill residents and staff 8. Antiviral drug prophylaxis of non-ill residents and staff 1. Antiviral drug therapy i. Residents: a. Oseltamivir or zanamivir treatment should be administered as soon as the clinical diagnosis of influenza has been made because residents of LTCF are, by definition, at increased risk of complications (6). b. Nasal/nasopharyngeal secretions should be tested to confirm the diagnosis but treatment initiation should not wait for the test result. c. Antiviral therapy works best when initiated within the first 48 h after symptom onset. However, these medications can still help even if begun more than 48 h after illness onset. d. The dosage regimens for adults are oseltamivir 75 mg PO BID or zanamivir two inhalations BID. e. The recommended duration of therapy is five days. f. There is no need to reduce doses in patients with mild to moderate reduced renal function and drug-drug interactions are also not generally a concern (6). ii. Staff: a. Staff with ILI during an outbreak should be offered antiviral treatment and sent home until their symptoms have resolved. b. Dose is per E1id, above.