Over the past week, Tacoma-Pierce County Health Department has received reports of several outbreaks of influenza in
congregate living facilities, including nursing homes and assisted living homes. We received the first report this season of
an influenza-related death last week.
Antiviral treatment given early after the onset of influenza symptoms may decrease complications of influenza and
shorten the duration of illness. Those for whom antiviral treatment is recommended include people over age 65,
children under age two, pregnant and early postpartum women; people with asthma and other chronic lung conditions;
and people with chronic conditions including diabetes, renal, hepatic, cardiac, hematologic and neurologic conditions.
Those with morbid obesity (BMI>40) and American Indian/Alaska Native people are also at increased risk for
complications and are recommended for antiviral treatment.
During outbreaks of influenza at group living facilities, the Centers for Disease Control and Prevention (CDC)
recommends that all residents take preventive antiviral medication, even if they have had a seasonal flu vaccination.
Household members of an influenza case can also receive chemoprophylaxis.
Oseltamivir (Tamiflu) is the most frequently used medication, and is prescribed as follows:
- Treatment of Influenza- Oseltamivir 75 mg twice daily for five days. Recommended duration for antiviral
treatment is five days. Treatment is most effective if started within 48 hours of onset of symptoms. For those
who are hospitalized and with severe illness, treatment is recommended even if not started within 48 hours.
- Chemoprophylaxis of Influenza- Oseltamivir 75mg once daily for 10 days. For control of outbreaks in long-term
care facilities and other health care facilities, CDC recommends antiviral chemoprophylaxis for a minimum of
two weeks and up to one week after the most recent known case was identified.
- A reduction in the dose of oseltamivir is recommended for persons with impaired renal clearance. See
prescribing details www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
In outbreak situations, it is also recommended that unvaccinated staff take chemoprophylaxis. Vaccinated staff may also
be considered for chemoprophylaxis. Find full guidelines for outbreak control in long term care facilities at
www.tpchd.org/files/library/17a3b37e96aac5b6.pdf. Institutional outbreaks of influenza are reportable to the Health
Department at (253) 798-6410.
Please continue to offer influenza vaccine throughout the season as flu is expected to circulate until spring. Health care
workers and the general public should practice good hand washing, respiratory etiquette and stay home from work or
school if they are sick.