VCH Influenza Prevention and Control Program For Residential Care Facilities 2019/2020 - VCH Communicable Disease Control

VCH Influenza Prevention and Control
Program For Residential Care Facilities
             2019/2020

     VCH Communicable Disease Control

Quick Reminders

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Learning Objectives
      Identify the VCH       • Immunization
    influenza prevention     • Infection control practices
        program goals        • Use of antivirals

     List the steps to get
    ready for the start of   • Pre-season Planning and Prevention
       influenza season

    Describe the Outbreak    • Case definitions of ILI
       Prevention and        • Detection/Surveillance
      Control Protocols      • Outbreak Management for ILI

                             • VCH
    Forms and Resources      • BCCDC
                             • Other

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Quick
         Program    RemindersGoals
                  Overview:

1. To reduce illness and death associated with
   influenza
2. To reduce predictable and preventable pressures on
   the health care system incurred by influenza

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Impact of Influenza in Canada
       One of the top 10 leading causes of death
    #1 cause of mortality from a vaccine preventable
                         disease
    Related to an average of 12,200 hospitalizations
                ~ 3,500 deaths per year

                         Summary of the NACI Seasonal Influenza Vaccine Statement for 2019-2020.
                         CCDR. June 6, 2019. Volume 45-6. Page 150.

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Quick
        Program     Reminders
                Overview: Strategies
1. Immunization Campaign
    • Vaccination is the single most effective way to protect
      residents and staff from influenza

    Immunize as soon as you have vaccine

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Quick
      Program     Reminders
              Overview: Strategies
2. Infection Control Measures
      • Hand Hygiene
      • Contact precautions
      • Droplet/Respiratory precautions
      • Routine practices

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Quick
      Program     Reminders
              Overview: Strategies
3. Antivirals
   • Have recent creatinine clearance levels and
     standing orders for all residents.
   • Have a plan in place with your pharmacist to have
     timely access to antivirals when needed.

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Quick Reminders
    2018/19 Influenza Season Highlights
•   Nearly all influenza viruses typed since the beginning of
    the season have been Influenza A¹

•   58% of A(H3N2) and 22% A(H1N1)pdm09 laboratory
    detections have been among elderly adults ≥ 65 years of
    age despite comprising about 18% of the population in
    BC¹

•   For VCH: a total of 46 long-term care facility outbreaks
    were reported²
                     ¹BC Influenza Surveillance Bulletin. Influenza Season 2018-2019, Number 22, Week 17. April 21-27, 2019
                     ²VCH Public Health Surveillance Unit, Flu season 2018-2019

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2018/19 Influenza Season Highlights

                  BC Influenza Surveillance Bulletin. Influenza Season 2018-2019, Number 22, Week 17. April 21-27, 2019.

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2018/19 Influenza Season Highlights

                 BC Influenza Surveillance Bulletin. Influenza Season 2018-2019, Number 22, Week 17. April 21-27, 2019.

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Quick Reminders
     2018/2019 Influenza Program Highlights
     2018/2019 Facility ILI Outbreaks by Organism Type and Historical Comparison (n=46)

                                                                                  Data Source: VCH
                                                                                  Facility Outbreak
                                                                                   Database, as of
                                                                                  September 2019.

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Quick Reminders

           Canadian Sentinel Practioner Surveillance Network. BCCDC Statistics and Research.

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Getting Ready

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First Steps
Update your policies and resources
Obtain serum creatinine clearance levels
Get pre-printed/signed orders
Pre-arrange antivirals with Pharmacy
Replenish supplies (masks, swab kits)
Review resources
Monitor for ILI

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Pre-season Planning and Prevention
Identify an influenza lead responsible for:
     •   Prompt identification of suspect outbreak
     •   Implementation of control measures
     •   Monitoring of cases
     •   Reporting to MHO or designate
     •   Organizing and disseminating outbreak
         communication tools

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Vaccine Components: What’s new in 2019-2020

     New:
     • A/Brisbane/02/2018 (H1N1)pdm09-like virus
     • A/Kansas/14/2017 (H3N2)-like virus
     Remain the same:
     • B/Colorado/06/2017-like virus
     • B/Phuket/3073/2013-like virus (in quadrivalent
       vaccines only)

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Product Choice: Age 65+

            Fluviral®
            Agriflu®

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Product Choice: Age 65+

                  Fluzone HD®
• Trivalent Inactivated Influenza vaccine with fourfold
  dose of antigen compared to standard dose
  influenza vaccines
• Provides better protection for this age group
• Not publicly funded, availability and cost may vary

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Pneumococcal Vaccine - PNEUMOVAX®23

 • Persons age 65+
 • Residents of LTCF
 • Certain medical or living conditions

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Influenza Prevention Policy
• All staff must:
     – Report their immunization status
     – If unimmunized, wear a mask for the season
     – Use PPE and follow infection control practices
     – Follow usual protocol to report illness

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Pre-season Planning and Prevention
Antivirals
        Do not delay the PREPARATION

     The sooner antivirals are given, the
     more effective they are in controlling
     the outbreak

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Case Definitions - ILI
• Acute onset of respiratory illness with fever
  and cough and one or more of the following:
     – Headache
     – Sore throat
     – Arthralgia
     – Myalgia
     – Prostration

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Case Definition: ILI Outbreak

Two or more cases of ILI in residents and/or staff
within a 7-day period with at least one case
identified as a resident

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Outbreak Detection: Reporting
Immediately report a suspect ILI outbreak to the
MHO or designate

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Outbreak detection: Swabs
Obtain Viral Specimens ASAP
     – up to 6 residents with symptom onset within the
       past 72 hours
     – Forward specimens to BCCDC Laboratory for
       testing ASAP (same day results if received by
       BCCDC before 1200)
     – ILI Outbreak Specimen Collection Instructions

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Outbreak Detection: Outbreak Control

• Implement outbreak control measures
     –   Facility
     –   Residents
     –   Staff
     –   Visitors

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Outbreak Declared

All outbreak control measures take priority over
routine operations until the outbreak is declared
               over by the MHO

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Outbreak control measures
• LTCF Checklist for the Management of
  Influenza-like-Illness

• VCH Influenza Prevention and Control
  Program for Residential Care Facilities

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Outbreak Declared Over

• When is an outbreak declared over?
     •   Control measures will be continued until the outbreak
         is declared over by the MHO
     •   Generally, 6 days after the onset of symptoms in the
         last case

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Outbreak Declared Over by MHO
• Lift control measures, including the use of antivirals
• Complete the VCH Influenza-Like-Illness Outbreak
  Report form
• Order replacement viral specimen kits outbreak
  specimen collection and shipping form
• Consider a debrief with your facility
• Remain alert for possible new cases/suspect
  outbreaks
     – Report to MHO immediately

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Reporting
1. VCH Influenza-like-illness (ILI) Outbreak
   report

     – Located at: www.vch.ca/eflubinder

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Reporting
2. Influenza Immunization Report

     – Located at: www.vch.ca/eflubinder

       •   Due 31 January 2020

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Forms and Resources: eflubinder
     – www.vch.ca/eflubinder
     – LTCF Check list for the Management of ILI

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Additional Information
• BCCDC Foundations of Influenza-Disease and Vaccines:
  www.bccdclearning.ca
• VCH PH Influenza Immunization Program update
• BCCDC Immunization Manual
     – Chapter 4 - Administration of Biological Products
     – Chapter 5 - Management of Anaphylaxis in a Non-Hospital
       Setting
     – Chapter 6 - Management of Biologicals
     – Chapter 7 - Biological products
     – Chapter 9 - Adverse Events Following Immunizations
       (AEFI’s)

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Summary
• Influenza is the leading cause of death from a
  vaccine preventable disease in Canada
• Vaccinate as soon as you have vaccine
• Complete the steps for preparedness
• Report any suspect cases of ILI to the MHO or
  designate
• Resources: www.vch.ca/eflubinder

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