H1N1 influenza has paid an unwelcome visit to a number of nursing homes, reports the CDC in MMWR. Three outbreaks occurred in long-term care facilities in Colorado, Maine, and New York during the fall of 2009. Public health officials suspect the number of outbreaks is probably much higher but is difficult to determine because of a lack of national surveillance.
In 2 of the 3 reported outbreaks, ill health-care workers might have served as a source of infection for at least some of the residents. This underscores the need for vaccination of health-care personnel in long-term care facilities.
Although persons aged 65 years and older are generally at lower risk for 2009 H1N1 influenza virus infection, outbreaks can still occur in this age group. Thus, the CDC recommends that all health care personnel in long-term care facilities be vaccinated against both seasonal and 2009 H1N1 influenza. Residents of these facilities should receive seasonal influenza immunization and should also be vaccinated against 2009 H1N1 once demand for vaccine among higher-risk groups has been met.
All 3 outbreaks of 2009 H1N1 influenza in long-term care facilities ended after initiation or reinforcement of recommended infection control practices, including the use of antivirals.
Antivirals are recommended for treatment and chemoprophylaxis of influenza in long-term care facilities. In general, antiviral chemoprophylaxis is recommended for at least 2 weeks, and as long as 1 week after the last resident case of influenza has occurred. In addition, residents who have suspected 2009 H1N1 influenza should receive empiric treatment with either oseltamivir or zanamivir.