SNF residents are at increased risk for severe disease, hospitalization, and death from infections caused by influenza viruses and the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The ongoing COVID-19 pandemic and the potential for concurrent COVID-19 and influenza outbreaks will complicate the upcoming influenza season. Although the 2020-2021 influenza season was extraordinarily mild, we cannot predict the severity of the 2021-2022 season. Therefore, it is essential for SNFs to optimize all available effective influenza prevention and outbreak control interventions, including influenza vaccination of SNF residents and healthcare personnel (HCP) and prompt initiation of antiviral therapy and chemoprophylaxis when influenza is identified.

On October 5, 2020, the California Department of Public Health (CDPH) issued Recommendations for the Prevention and Control of Influenza in California SNFs during the COVID-19 Pandemic​ (PDF) (This guidance is no longer current. Please refer to the Detecting and Controlling Outbreaks​ webpage for the most current guidance on prevention and control of respiratory infections in SNFs). This document provides recommendations to prevent and manage influenza outbreaks in SNFs in the context of SARS-CoV-2 co-circulation. These recommendations may also apply to other long-term care facilities.

On August 27, 2021 the Centers for Disease Control and Prevention (CDC) posted the Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the ACIP – United States, 2021–2022 Influenza Season report. Since there were no major changes in the report that would influence the influenza prevention and management plan for SNFs, CDPH recommends that facilities review Recommendations for the Prevention and Control of Influenza in California SNFs during the COVID-19 Pandemic (PDF) (This guidance is no longer current. Please refer to the Detecting and Controlling Outbreaks​ webpage for the most current guidance on prevention and control of respiratory infections in SNFs), October 5, 2020, to develop and implement an influenza prevention and control plan. The document provides:

• Similarities and differences between clinically relevant characteristics of influenza viruses and SARS-CoV-2.
• Recommendations for planning for influenza illness and outbreaks relevant to three groups of individuals: residents, healthcare personnel, and family members/visitors.
• Recommendations for identifying the presence of an influenza outbreak and implementing the influenza prevention and control plan.
  

Before influenza begins circulating in the local community, CDPH recommends SNFs be ready with:

• Sufficient influenza vaccines and standing orders for administration, hand hygiene supplies, personal protective equipment, and antiviral medication orders.
• Established lines of communication between the SNF and the local health department.
• Establishing a strong collaborative relationship with the local health department facilitates support in the event of an outbreak, vaccine, or antiviral agent shortage, or if unanticipated events emerge within a given season. 
  

Additionally, for the 2021–2022 season, CDPH continues to emphasize the following:

• Follow the local activity of influenza and other respiratory viruses.
• Weekly surveillance reports of influenza and other respiratory viruses in California will be published beginning on October 15, 2021, on the CDPH Influenza (Flu) and Other Respiratory Diseases webpage.
• Access the CDPH Influenza and other Non-COVID-19 Respiratory Illness Outbreak Quicksheet (PDF).
• Ensure influenza vaccination of residents and staff members:
• Per CDC guidance the influenza vaccine and COVID-19 vaccine may be administered at the same time, but at different anatomical locations.
• Test for other respiratory viruses when there is a cluster of respiratory infections in the facility and influenza and COVID-19 testing is negative.
  

Please report influenza outbreaks immediately to your local health department (PDF) and L&C district office.

If you have any questions about this AFL, please contact the CDPH Healthcare-Associated Infections Program at HAIProgram@cdph.ca.gov.

Sincerely,

Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director

Resources:

• ​​CDPH Recommendations for the Prevention and Control of Influenza in California Skilled Nursing Facilities (SNF) during the COVID-19 Pandemic (PDF) (This guidance is no longer current. Please refer to the Detecting and Controlling Outbreaks​ webpage for the most current guidance on prevention and control of respiratory infections in SNFs)​
  
• CDPH Detecting and Controlling Outbreaks webpage
• CDC Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the ACIP — United States, 2021–22 Influenza Season report
• CDC Overview of Influenza Testing Methods webpage
• CDC Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities webpage
• CDC Antiviral Drugs for Seasonal Influenza: Additional Links and Resources webpage
• CDPH Influenza (Flu) and Other Respiratory Diseases webpage