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Acute Respiratory Infections in Senior Care Facilities: A Significant Increase in the Number of Cluster Outbreaks at the Start of the Flu Season

Lower respiratory tract infections (LRTI), including influenza, are common in nursing homes for the elderly (EHPAD).

In France, since week 35 of 2011, 372 clusters of ARI cases occurring in long-term care facilities for the elderly have been reported, even though the flu epidemic has not yet peaked. The number of reported episodes has already doubled compared to the 2010–2011 season, but the case fatality rate remains comparable.

Of the 372 reported outbreaks, 72% had no determined etiology, 25% involved influenza, and 3% involved pneumococcal infections.

In the Poitou-Charentes region, 12 clusters of ARI cases in long-term care facilities for the elderly have been reported since week 35 of 2011, including 11 since week 06 of 2012 (February 6–12). This number is three times the number of clusters reported during the 2010–2011 season. For 8 of these outbreaks, the cause was attributed to influenza (4 with an un-subtyped A virus and 4 with no further details). The case fatality rate is 1.7%.

The widespread circulation of the A(H3N2) virus in the community is leading to numerous clusters of ARI cases in long-term care facilities. This is why it is important to identify the first cases in these facilities as quickly as possible and to implement standard control measures without delay to contain the emerging ARI outbreak.

The current situation warrants a reminder of the following measures in long-term care facilities:

• the need to identify the causative agent during episodes of ARI (use of rapid tests),

• the terms of the CSHPF advisory of January 16, 2004, regarding prophylaxis with oseltamivir for at-risk individuals during a flu outbreak in a community,

• when residents of long-term care facilities are hospitalized, samples must be sent to the National Influenza Reference Center for strain typing.