| Sıra | DOSYA ADI | Format | Bağlantı |
|---|---|---|---|
| 01. | Facilities Infected Outbreak Hospitalized | pptx | Sunumu İndir |
Transkript
Outbreak of influenza A (H3N2) in a residence for mentally disabled persons in Ljubljana, Slovenia, 2013Epidemiology and Public HealthValencia, Spain4th August 2015
Outbreak of influenza A:Background• Outbreak alert: 27 January 2013 • 3 persons with acute respiratory symptoms in a LTCF for mentally disabled in Ljubljana occurred 25 January 48 residents; 45 employees (1 GP, 2 nurses); majority bed–bound, skilled care/rehabilitation• Outbreak control team: convened on 27 January• Objective: to characterize outbreak, identify factors associated with contracting infection, recommend control measures
Outbreak of influenza A:Case finding and description• Case: resident or employee of the residence for mentally disabled with fever (≥37.5◦C) and cough or any other additional sy between January 25 and 29, 2013 (ILI) + LAB confirmed influenza virus (confirmed) • Microbiology: respiratory pathogens, including influenza viruses
Outbreak of influenza A:Results•Index case: 35 yr old employee8 cases among residents (17% of all residents); 5 cases among staff (11% of all staff)Age: average: 36.8 yrs (range: 13-51); 40-59 yrs: 54%Female:male=1.6:1Bed–ridden: 100% of all residentsVaccinated: 0 staff, 5 residents;24 (50% of all residents), 7 (16% of all staff)
Outbreak of influenza A:Cases of influenza by date of onset
Outbreak of influenza A:Results• Staff: first cases, presentation dispersed • Residents: peak of the outbreak• Hospitalized: 2 residents• Laboratory investigation:– Influenza A (H3N2): 2 cases– Negative for other respiratory pathogens
Outbreak of influenza A:Symptoms and signs reported by casesClinical manifestation No. of individuals (%)Fever 13 (100)Cough 10 (76.9)Sore throat 5 (38.5)Myalgia 5 (38.5)Headache 5 (38.5)Pneumonia 2 (15.4)
Outbreak of influenza A:Control measures• Hand hygiene/disinfection, personal protective equipment, airing of rooms, • Excluding ill staff, no residents group activities until 7 days after cessation of symptoms• Cohort isolation of symptomatic residents• Reducing staff exchange, no new admissions
Outbreak of influenza A:Conclusions• Staff possibly initiated and contributed to the maintenance of transmission• To comply with vaccination recommendations, especially for staff working with persons with risk factors
• Sentinel network of GPs• Weekly No. of consultations for ILI• Samples of nasal swabs• Influenza viruses and type identificationInfluenza outbreaks in facilities:Surveillance
Influenza outbreaks in facilities:Case finding and definition• Case: fever and cough and ≥1 additional symptom (sore throat, arthralgia, myalgia, prostration) (ILI) laboratory confirmed influenza (confirmed) • Outbreak in facility: ≥2 cases within 7 days and with evidence with spread
Influenza outbreaks in facilities:Measures• Notification of PH authorities• Nasopharyngeal swabs for influenza testing• Implementation of infection control measures• Antiviral chemoprophylaxis
Influenza outbreaks in facilities per year: 2011–2015
Month Number of outbreaks (%)Jan 10 (24.4)Feb 20 (48.8)March 10 (24.4)April 1 (2.4)Influenza outbreaks in facilities per month: 2011–2015
Influenza outbreaks in facilities, duration: 2011–2015Year Number of outbreaks (%)Average duration (Min–Max)(days)2011 3 (7.3) 13 (6–17)2012 10 (24.4) 13 (2–24)2013 6 (14.6) 11 (2–31)2014 8 (19.5) 23 (7–49)2015 14 (34.2) 11 (2–22)All outbreaks 41 (100) 14 (2–49)
Influenza outbreaks in facilities, distribution: 2011–2015
Attack rates by facility type: 2011–2015Facility Number of outbreaks (%)AR (Average) AR (Min-Max)Elderly 20 (48.8) 20.3 5.2–42.3Hospital 7 (17.1) 20.5 11.1–40.0Kindergarten 1 (2.4) 34.2Institute 1 (2.4) 16.3Mentally disabled12 (29.3) 20.3 5.2–38.9All outbreaks 41 (100) 20.6 3.1–42.3
Hospitalization rates by facility type: 2011–2015Facility Number of outbreaksHR (Average) HR (Min-Max)Elderly 20 (48.8) 7.5 0–37.0Hospital 7 (17.1) 5.7 0–40.0Institute 1 (2.4) 0Kindergarten 1 (2.4) 7.3Mentally disabled12 (29.3) 11.5 0–40.0All outbreaks 41 (100) 8.0 0–40.0
Attack rates by influenza virus type: 2011–2015Influenza virus Number of outbreaks (%)AR (Median) AR (Q1-Q3)A 34 (82.9) 16.0 13.1–26.1B 5 (12.2) 20.2 11.5–24.0A+B 2 (4.9) 25.2 16.3–34.2All outbreaks 41 (100) 20.0 13.1–26.1
Influenza outbreaks in facilities, MVA: 2011–2015• Delayed notification was associated with increase in the death rate among residents (p < 0.001) and outbreak duration (p=0.027) regardless of facility type/size and viral aetiology• The effects of facility type/size and viral aetiology on the average residents' death and attack rates, duration of outbreaks and time to report to PH authorities was not significant
Influenza outbreaks in facilities, conclusion: 2011–2015• Timely identification and reporting of influenza outbreaks to PH authorities and prompt implementation of competent infection control measures by PH authorities:– Shorter duration of outbreaks – Lower mortality among the infected residents
Thank you for your attention!
Additional slides
Outbreak of influenza A: Recommendations• Outbreaks of influenza should be reported as soon as possible to put control measures in time and prevent future occurrences in LTCFs• Rapid agent identification crucial to control spread of infection• Staff vaccine uptake focus– Optimal vaccine provision models– Public health support
Influenza outbreaks in facilities:Risk factors• Outbreaks of influenza reported every year• Risk factors: age, comorbidities, dementia (institutionalised elderly), shortage of staff, insufficient knowledge of infection control measures• More severe and longer duration
Residents in long–term care facilities (LTCF)• Anatomical and functional changes• Comorbidities/polimedication• Implants, catheters• Malnutrition• Frequent/prolonged ambulatory care and hospitalization• Multiple diagnostic and therapeutic interventions• Closed environment• Limited mobility• Increased susceptibility to infections
Influenza in residents of LTCF• Symptoms atypical or absent• Diagnosis unrecognized and/or undertreated• Prolonged hospital stay• Low influenza vaccination coverage• Higher morbidity and mortality
Facilities Infected Outbreak Hospitalized
Yıl : 2020
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