Deadly flu outbreak troubles health officials

Influenza or norovirus outbreaks occurred in five long-term care or assisted-living facilities in Flathead County in January, according to health officials. During that time, 104 people were infected and three people died of a flu-related illness.

Some Flathead City-County Board of Health members expressed frustration during a regular meeting Thursday that four of the five facilities don’t require employees to get flu vaccinations.

Health officials at the meeting said many facilities allow vaccination exemptions for staff with personal or religious reasons to avoid the shots. Board Chair David Myerowitz said those exemptions put residents at risk.

“I find it inexcusable, it’s a political answer that ‘it’s corporate’ or ‘we can’t force our people to get vaccinated,’” he said. “Actually, they can … All you have to say is it’s a condition of employment.”

Three facilities experienced influenza outbreaks that impacted 47 people according to a report by the health department. Two facilities experienced norovirus outbreaks that spread to 57 people.

Norovirus can’t be prevented by a vaccination. Health officials said hand washing and clean facilities are important to stop the spread of the virus.

The department’s report left the involved facilities anonymous. Vice Chairperson Wayne Miller said that “secrecy contributes to the problem.”

“Can we identify which of these facilities had patients who were subsequently hospitalized and died?” he asked county health officials.

Deputy Health Officer Hillary Hanson said not without providing information that could possibly identify patients.

“At that point, we’re talking about confidential health information,” Hanson said.

She said state-registered facilities have to follow infection control policies. However, she said those regulations don’t currently include influenza.

“That being said, the public has a right to ask what a facility’s influenza policies are. It’s a question I would ask,” she said.

THERE are six long-term care and 13 assisted-living facilities in Flathead County.

Flathead County Health Officer Joe Russell said flu cases among these at-risk populations are going to happen since vaccinations aren’t 100 percent successful.

“But we know people in assisted living are safer when there’s a higher vaccination rate among the facility’s employees,” Russell said. “I think we’re going to continue to crusade to try and change [facility] policies to include that influenza vaccination.”

In January’s outbreaks, the three flu-related deaths occurred in one long-term care facility. Each person who died had overlapping illnesses paired with the flu.

Of the organization’s 77 residents, 15 caught the flu. One employee also tested positive.

While control measures were implemented by the organization, the flu spread to a nearby facility.

According to the department’s report, the company doesn’t require staff vaccinations. The facility’s policy mandates employees who aren’t vaccinated to wear face masks “in certain areas of the facility at all times.”

“We have absolutely no way of knowing whether the mask rule is enforced,” Myerowitz said.

Vice Chairperson Miller said he was concerned when health officials visit facilities, “you don’t know who is vaccinated and who isn’t.”

“That’s not something we can change,” Hanson replied.

Hanson said facilities are required to report a cluster or outbreak. She said, ideally, facilities will report their second or third influenza or norovirus case.

A 35-resident facility waited to call the department to report a strand of norovirus cases until three residents were sick. Eventually, eight residents and seven employees tested positive for the virus.

According to the report, the organization didn’t have an influenza policy or implement control measures “quick enough.” Instead of dedicating specific staff to only care for ill residents, the facility allowed workers to jump between healthy and infected patients.

A norovirus outbreak in another Flathead Valley long-term care facility infected 42 people — 23 residents and 19 staff. The report stated health officials discovered the outbreak while performing surveillance calls.

The facility was not cleaning with bleach, “restricting visitors or isolating ill residents in a timely manner,” according to the report.

Hanson said once health officials told the facility about the outbreak, department staff visited the site to provide education and ensure interventions were implemented.

“We have a good relationship with most places — which of course want to take care of their residents. They’re often looking to us on what to do,” she said.

Hanson said if a facility decides not to follow the department’s instructions, it’s possible for the advice to turn into a requirement.

IN FEBRUARY, the number of flu cases began to dip across the state.

Since the flu season began Oct. 2, 2016, the state health department has reported 5,459 flu cases, 575 hospitalizations and 13 influenza-related deaths in Montana.

Hanson said as of Feb. 25, Flathead County has recorded 805 confirmed influenza illnesses. So far, there have been four flu-related deaths and 55 influenza-related hospitalizations in the county.

Of the hospitalizations, 22 occurred in January and over half of those patients had an influenza vaccination. The majority of those hospitalizations involved older adults.

Russell said seniors are typically at higher risk for the flu.

“That’s why it’s important for assisted-living facilities to have policies in place to protect their residents,” he said. “It’s also important for family members not to visit grandma or grandpa when they’re sick and employees to stay home when they’re sick. It’s a change in mindset.”

The Centers for Disease Control and Prevention recommends influenza vaccination for everyone 6 months and older to help prevent influenza illness.

For more information, visit http://dphhs.mt.gov/publichealth/cdepi/diseases/influenza.