The influenza season usually runs between November and April of every year.  During this time, it can be busy for long term care facilities. Flu vaccines are administered to residents. Staff members are encouraged to receive their flu vaccines. All residents are verified to have an active antiviral prescription on file to treat or prevent the influenza infection if needed. Education on proper hand hygiene is provided. These activities are all done in the hope to prevent any influenza outbreak or to be able to manage the outbreak in a somewhat organized manner.

So what happens if front line staff members do not receive their flu vaccines?

If there is a confirmed respiratory outbreak with influenza, the Public Health Unit may order these individuals to stay at home without any compensation.  At that time, they will have the option to receive the flu vaccine. However, the full effect of the vaccine will not take place until two weeks later. So there is still a potential 2 weeks delay to return to work.  If the vaccination rate is low for the facility, this can impact on resources available during the influenza outbreak – that they may not have sufficient staff members to provide care to residents.

Another option is to begin prevention therapy with Tamiflu – an antiviral medication. They may be asked to obtain a prescription from their family doctors or walk-in clinics. Unfortunately, many times they have not fully explained the need for their Tamiflu prescription to their physicians and come back with an incorrect dose of Tamiflu to take.

It can be confusing to determine the dose of Tamiflu to prescribe. It depends on age, the renal function and whether it is needed to treat an influenza infection or to prevent one during an influenza outbreak.

But for an adult with relative normal renal function (CrCL above 60mL/min):

  • The Treatment dose of Tamiflu is 75mg po twice daily for 5 days.
  • The Prevention dose of Tamiflu is 75mg po daily for 10 days or the duration of the outbreak. 

I think there seems to be some communication breakdown here – that we have not properly explained to everyone including staff members, family physicians or prescribers in the community why the Tamiflu prescription is needed for staff members working in a long term care facility or other health care settings. It’s NOT because they are sick or have the influenza infection. It’s because they have to protect themselves and the residents during the influenza outbreak while working at the long term care facility.

Here are some thoughts or suggestions for front line staff members working in the long term care facilities or other health care facilities:

  • If feasible, receive your flu vaccine at the beginning of the flu season. Understand the risks and potential costs of not receiving your flu vaccine.
  • If there is a valid reason that you cannot receive the flu vaccine, then inquire with your manager or supervisor if you should obtain a Tamiflu prescription for the prevention dose at the beginning of the flu season. Do not dispense the prescription unless there is an influenza outbreak at your facility where your manager or supervisor will provide you with additional instruction.
  • If the individual is allergic to Tamiflu, another option is Relenza (Zanamivir) which is given as an inhalation. The prevention dose for institutional outbreak is 2 inhalations (10mg) daily for 28 days or for the duration of the outbreak. Note that Relenza is contraindicated in people with asthma or COPD due to concerns with bronchospasm.
  • If you decide not to receive your flu vaccine, nor to take Tamiflu or Relenza during the influenza outbreak, then be prepared to stay at home without pay for the duration of the outbreak which can range from as short as 10 days to as long as several weeks.

For more information, check out the Flu (Influenza) Awareness Resources page from the Health Canada website here.

In general, many long term care facilities have a well established process to prepare and manage the influenza season. But the awareness around why staff members may require prevention dose of Tamiflu seems to be poorly communicated to relevant stakeholders both internally and externally.

Wishing everyone to stay healthy for the remainder of the flu season!

Advertisements