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State of California—Health and Human Services Agency
California Department of Public Health

AFL 06-31
October 31, 2006

Skilled Nursing Facilities
Intermediate Care Facilities
General Acute Care Hospitals
Acute Psychiatric Hospitals
Intermediate Care Facilities-Developmentally Disabled
Intermediate Care Facilities-Developmentally Disabled-Nursing
Intermediate Care Facilities-Developmentally Disabled-Habilitative
Correctional Treatment Centers
Congregate Living Health Facilities
Department of Social Services

Recommendations for the Prevention, Detection, and Control of Influenza in California Long-Term Care Facilities

Enclosed are the Recommendations for the Prevention, Detection, and Control of Influenza in California Long-Term Care Facilities, revised for the 2006-2007 influenza season. The most significant changes from the 2005-2006 recommendations are:

  • Some of the sections, particularly infection control, were re-written, with the hope of being clearer and easier to understand. We would appreciate any feedback, particularly when the guide is used to manage an outbreak.
  • A sample declination form for employees who decline an offer of influenza vaccination is provided and recommended for use.
  • Amantadine and rimantadine (adamantanes) are not recommended for use due to resistance in influenza viruses in California and in the United States.
  • The vaccine supply this year is anticipated to be sufficient.

All health-care workers should be vaccinated against influenza annually. Facilities are strongly encouraged to provide vaccine to healthcare workers by using approaches that maximize immunization rates. Please encourage your staff to get vaccinated against the flu and do all that you can to ensure that they do. Many major organizations recommend that annual health-care workers influenza vaccination be required to be offered by employers, and that employees be required to sign a declination form if they do not wish to be vaccinated. California Senate Bill 739 will make this mandatory in acute care hospitals beginning July 2007, and a draft California Division of Occupational Safety and Health (Cal/OSHA) regulation would make this mandatory in all health-care facilities.

The California Adult Immunization Coalition consists of over 20 organizations committed to developing a long-term, strategic, and integrated effort to improve adult immunization rates for adults. One component of this effort is an initiative to immunize health care workers against influenza. Information and toolkits to assist acute care and long-term care healthcare facilities immunize health care workers are available at the California Adult Immunization Coalition website.

Influenza outbreaks occur during the winter months, and as a result, about 2,000 Californians die each year. Influenza is a particularly serious problem in nursing homes where residents are at high risk of developing serious complications or dying due to their age and health problems. Once the influenza virus enters a nursing home, it can spread rapidly. During nursing home outbreaks more than half of the residents can become infected, and some require hospitalization or die. The Department of Health Services and local health departments should be immediately notified of outbreaks of respiratory illness in healthcare facilities. We can provide assistance in: (1) laboratory testing to determine the cause (outbreaks of respiratory illness may be caused by other pathogens); (2) taking measures to control the outbreak, and (3) determining the need for influenza antiviral medications or additional vaccine. California regulations require that any outbreak of illness in a healthcare facility be reported to both the local health department and the Department of Health Services Licensing and Certification district office.

The Department of Health Services encourages facility staff to review these advisory recommendations. Influenza vaccine is available for purchase from a number of providers; if you need help identifying a provider contact your local health department. Questions regarding outbreak control should be referred to your local health department and to Jon Rosenberg M.D. or Sue Chen, Division of Communicable Disease Control at (510) 620-3434. Written comments about the information contained in these recommendations should be addressed to Dr. Rosenberg, California Department of Health Services, Division of Communicable Disease Control, 850 Marina Bay Parkway, Richmond, CA 94804.


Original signed by Jon Rosenberg

Jon Rosenberg, M.D.
Division of Communicable Disease Control

Attachment: Recommendations for the Prevention, Detection, and Control of Influenza in California Long-Term Care Facilities (PDF)

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