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Health Update: Influenza

Published: January 17, 2017

Influenza activity is rapidly increasing in California and Sonoma County, although other respiratory viruses are also circulating (e.g. RSV). To date, in Sonoma County, 6 severe cases and no deaths in persons aged < 65 have been reported. Clinics, hospital emergency departments and inpatient units are very busy and many local hospitals are near or at capacity. In addition, many long-term care facilities (LTCF) are experiencing influenza outbreaks. During this period of increased influenza activity it is critical to implement appropriate infection control precautions AND for health care facilities to work together to ensure timely hospital discharges and provision of safe care to patients. The California Department of Public Health (CDPH) recently issued an All Facilities Letter addressing this critical need. Early surveillance indicates circulating strains of influenza match vaccine strains. Influenza typically circulates for several months, thus, influenza vaccination should still be encouraged for unvaccinated individuals.

Actions Requested of All Clinicians

  1. Encourage and facilitate flu vaccination for all persons aged 6 months and older, AND pneumococcal vaccination for those at increased risk of pneumococcal disease.
  2. Encourage all with ILI* who are at increased risk for complications to seek medical care promptly.
  3. Treat all hospitalized patients with clinical signs and symptoms consistent with influenza. Use oseltamivir, zanamivir or peramivir.
  4. Send respiratory specimens (from both upper and lower respiratory tract) for confirmatory PCR influenza testing on all hospitalized patients with illness consistent with influenza, especially those in the ICU or fatalities. The Public Health lab can do PCR testing.
  5. Report to Sonoma County Public Health (PH) Disease Control (707) 565-4566
    • outbreaks of undiagnosed ILI* in residents of large group or institutional settings; and
    • individual lab-confirmed cases of seasonal influenza only if they meet the specific reporting criteria described in detail in Oct 2016, Influenza Health Advisory: severe and fatal cases of lab-confirmed influenza in persons 0 - 64 years OR cases of ILI with epidemiological characteristics suggesting variant OR novel influenza infection OR MERS.
  6. Implement infection control precautions described in Oct 2016 Influenza Health Advisory. Note:
    • ALL PERSONS with ILI* should be instructed to stay at home until 24 hours after fever resolves, except patients that require medical evaluation and care.
    • ALL PERSONS with fever & cough should wear a face mask in common areas of health care sites.
    • All hospitalized patients with suspected or confirmed flu should remain in isolation for 7 days after illness onset OR until 24 hours after fever resolution whichever is longer. If clinically ready for discharge, isolation status should not be a barrier.
    • Consult with PH Disease Control (707) 565-4566, if your facility is experiencing an influenza outbreak, OR if your hospital is experiencing difficulty discharging patients.

*ILI (influenza-like illness) is temperature >37.8ºC or 100ºF and cough and/or sore throat, in the absence of a known cause.

Additional Resources:

  • CDC infection control (IC): https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm
  • CDC IC LTCF: https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm
  • CDPH IC LTCFs: http://www.cdph.ca.gov/programs/hai/Documents/RecommendationsForThePreventionAndControlOfInfluenzaOct2016.pdf
  • Sonoma County Public Health: www.sonoma-county.org/flu
  • California Department of Public Health: http://www.cdph.ca.gov/HealthInfo/discond/Pages/Influenza(Flu).aspx