HSE guidelines warned flu jab may not stop outbreak

HSE guidelines warn that the type of virus which caused a lethal nursing home outbreak could spread rapidly in enclosed settings and, among older people, may not be stopped by the flu jab.

The comments are made in the health service’s latest guidelines on the dangers of flu-like illnesses, published just months before six people died and at least 27 were infected at Nazareth House.

The influenza type A (H3) outbreak, the seasonal strain of which was only confirmed after tests at the National Viral Reference Laboratory at UCD, is particularly dangerous for an older population.

According to the detailed in HSE guidelines sent to all managers overseeing residential healthcare facilities such as nursing homes last year, nursing homes and other residential facilities are considered a particular risk area.

This is because the facilities are home to a large number of elderly people, many of whom have chronic medical conditions, who are living in close proximity to each other in communal living arrangements.

Those suffering from the illness should also be masked during transportation to ensure it does not spread further.

During an outbreak, a flu-like illness can jump from one person to others in a short space of time, with a significantly increased chance of severe health problems due to the older population involved.

The guidelines state that seasonal flu should be expected to infect between 2% and 16% of a nursing home population, and up to 40% during an outbreak.

As 33 of the 45 residents at Nazareth House were infected, the facility’s infection rate stands at almost 70%.

Best practice during such an outbreak, according to the HSE, is to immediately implement infection control and quarantine measures — alongside the use of anti-viral drugs — so that unaffected residents and staff are not put at further risk.

In addition, while the guidelines recommend that nursing home residents should receive the flu vaccine at the start of winter, it by no means guarantees the person will not still become infected.

Flu vaccines have a 70% to 90% protection rate among people under the age of 65, falling to 50% to 60% in the older age group.

Preventative measures

The HSE’s role is confined to public health matters and ensuring the flu virus — which has already led to the deaths of six people over the age of 80 — is prevented from spreading further.

As part of this process, Health Protection Surveillance Centre director Dr Darina O’Flanagan, sent samples from the deceased and 27 more infected residents and staff at Nazareth’s House, for urgent tests at the National Viral Reference Laboratory at UCD.

These tests took place yesterday to identify the exact strain to be the seasonal influenza type A (H3) — information which will play a key role in preventing further deaths.

The HSE North-West’s director of public health, Dr Peter Wright, is currently overseeing a quarantine of the facility, with visitors barred from entering until the cause of the outbreak is known.

* Health Information and Quality Authority (HIQA)’s role:

HIQA’s role is confined to ensuring national elderly care standards are being met by management at Nazareth House.

After being alerted to the cluster of deaths at the facility in a “direct” conversation with Health Minister Dr James Reilly on Monday, the body immediately sent officials to the private nursing home.

More members of its inspection team arrived in Buncrana, Co Donegal, yesterday to ensure service and infection control standards are being met.

While Nazareth House has a strong local reputation as a high-quality private nursing home, HIQA is entitled to close the facility or seek the transfer of residents to another location if it feels their health and safety is at risk due to a failure on management’s behalf.

— Fiachra Ó Cionnaith