Aged Care Insite Issue 94 | April-May 2016 | Seite 34

clinical focus

The flu vigil

H
Operators
must be sure
their staff are
well trained
at identifying
and preparing
for influenza
outbreaks.
Leng Boonwaat
interviewed by
Dallas Bastian

alf of the aged-care facilities in South Western
Sydney that should have reported an influenza
outbreak failed to do so.
That’s one of the key findings from a report that
examines the underreporting of influenza outbreaks in
aged-care facilities in the region in 2014.
The report, published in the Western Pacific
Surveillance and Response Journal, states that
the 111 influenza outbreaks reported in aged-care
facilities in NSW that year was the highest number
on record. However, Leng Boonwaat, communicable
diseases co-ordinator for the South Western Sydney
Local Health District Public Health Unit, and his team,
says delays in identification and notification of influenza
outbreaks in aged-care facilities lead to difficulties in
containing the spread of influenza.
“These challenges with influenza outbreak reporting
are not unique to the South Western Sydney Local Health
District,” the authors write. “Other public health units have
reported fear of bad publicity as [a] reason for delays in
notification by aged-care facilities.”
Boonwaat and his team say the Australian
Government’s Department of Health has issued specific
guidelines for prevention and control of influenza
outbreaks in residential-care facilities, and add that
while aged-care facilities have primary responsibility for
managing outbreaks, public health units are required to
promote compliance with the guidelines and facilitate
delivery and administration of antivirals.
They stress, however, that some interventions, such
as effective influenza prophylaxis, can occur only if
public health units are notified in a timely manner.
The authors note that it’s unclear whether
aged-care facilities were cognisant of the influenza
outbreak definition in the guidelines. They say the
study suggests that public health units should ensure
that aged-care facilities understand these guidelines.
“Reminders and education sessions should be
issued to [aged-care facilities] before the beginning
of influenza seasons to ensure facility managers

32 agedcareinsite.com.au

are able to recognise outbreaks and provide timely
notifications to public health units,” they say.
Furthermore, it may be useful for public health units
to conduct influenza preparedness activities, possibly
in the form of desktop exercises.”
Aged Care Insite sat down with Boonwaat to discuss
some of the factors that contribute to underreporting
of influenza outbreaks, what should be done to reduce
the spread of the disease and the relationship between
public health units and residential aged-care facilities in
curbing cases.

Aci: Your paper states there were 111 influenza
outbreaks in aged-care facilities reported in new
south Wales in 2014, the highest number on record.
You wanted to look at the outbreaks that were not
reported. What were the results there?
LB: The results of our investigation were that about
50 per cent didn’t report. That’s in the general article
that was published, but having said that, we did make
a rather conservative estimate about the numbers that
didn’t report. That was based on [instances of] three
or more confirmed cases of influenza that laboratories
notified us about. Seven reported an influenza outbreak
of three or more cases and seven didn’t.

What might have contributed to this level of
reporting?
There are a number of reasons that the level of
reporting might not be as high as we would like,
and that might be partly to do with the fact that
some aged-care facilities might not be that familiar
with the outbreak definition, or there might be an
assumption that the laboratories would need to
confirm influenza before they notified the public
health unit. There might also be some concerns that
the media might be interested or it might reflect
badly on the way an aged-care facility is run if an
influenza outbreak was reported when an outbreak
hadn’t been confirmed yet.