Influenza and gastro outbreaks in Residential Aged Care Facilities



An influenza-like illness (ILI) is defined as sudden onset of at least one of the following three respiratory symptoms:

  • Cough (new or worsening)
  • Sore throat
  • Shortness of breath

AND at least one of the following four symptoms

  • Fever
  • Malaise (feeling unwell)
  • Headache
  • Myalgia (muscle pain)

A suspected influenza outbreak

  • 3 or more cases of influenza-like illness (ILI) in residents or staff within 3 days (72 hours)

 A confirmed influenza outbreak                                                                            

  • 3 or more cases of influenza-like illness (ILI) in residents or staff within 3 days (72 hours)

AND           at least one of the cases has had a positive laboratory test for influenza
OR             at least two of the cases have tested positive to influenza using a point-of-care tests

It is important to always monitor residents for symptoms that could be related to influenza. When people have these symptoms we call it “influenza-like Illness”. An outbreak is suspected when 3 or more people have these symptoms. The outbreak is confirmed by testing but we recommend infection control measures are implemented immediately and before test results are available.

As soon as you suspect a possible influenza outbreak please phone your local Public Health Unit on 1300 066 055It is important to phone the Public Health Unit as soon as possible so we can support you in managing the outbreak. You should also immediately implement infection control measures, see the NSW Health Poster How to identify respiratory outbreaks and what to do next. 

No, please do not wait for laboratory confirmation. Phone your local Public Health Unit on 1300 066 055 as soon as you identify 3 or more cases of influenza-like illness so that we can support you with outbreak management.

It is valuable in the early stages of a suspected outbreak to swab all residents with ILI using a viral swab. Please phone your local Public Health Unit on 1300 066 055 and discuss testing with a member of the Infectious Diseases Team. If many cases are confirmed or in the later stages of an outbreak swabbing may no longer be necessary.

Restrict new admissions to affected areas of the facility.

  • When transferring residents to hospital during an outbreak advise the ambulance service and hospital admitting officer of the nature of the outbreak. 
  • A transfer form can be provided with the patient notes. This is available in section on page 34 of the NSW Flu Info Kit.
  • Residents who have been transferred to hospital with influenza may return to the facility providing there is appropriate accommodation and infection control measures in place.
  • Re-admission of residents who have been transferred to hospital without influenza (for another medical reason) is not generally recommended during an outbreak; however, in practice this may not be feasible. Therefore if there is no alternative, the resident may be re-admitted providing infection control measures are in place.

If you have any concerns please phone your local Public Health Unit on 1300 066 055.

For more information see the Guidelines for the Prevention, Control and Public Health Management of Influenza Outbreaks in Residential Care Facilities in Australia

No, you should not stop a resident’s family member from visiting. However, you must inform families and visitors about the influenza outbreak and the risk of serious illness. We advise against the use of terms like “lockdown” which can be unhelpful when managing the situation and distressing to family members. The aim is to carefully manage visits rather than prevent them from occurring.    

Ensure signs are clearly visible throughout the centre. Ask visitors to only visit the resident they have come to see and wash their hands with soap and water (or use an alcohol hand sanitiser) before and after the visit.

Ask family members and visitors to keep visits to a minimum and to not visit if they have a cough or other flu-like symptoms until they are well.

For more information see the NSW Health poster Help Protect our Residents and the Flu Info-Kit

Antiviral medication can be used for treatment or prophylaxis. 

As treatment

Treatment with influenza antiviral medication (Tamiflu) should be considered for any resident thought to have influenza, especially if at increased risk of complications, and should be started within 48 hours of onset of symptoms for maximum benefit.

As Prophylaxis

In some situations prophylaxis with influenza antivirals may be recommended in addition to other outbreak control measures.

  • This decision must be made in consultation with the Public Health Unit, the facility’s Outbreak Manager and residents’ GPs.
  • Consideration must be given to medication safety issues, compliance, timing and availability of obtaining and administering medication.
  • If prophylaxis with influenza antivirals is recommended, then it should be given to ALL asymptomatic residents (regardless of vaccination status) and ALL unvaccinated staff, AND it must be started within a 24 hour period.

  • Prior to the start of influenza season ensure that you have contacted your pharmacy to check how quickly they can obtain large stocks should antiviral influenza prophylaxis be recommended. 
  • The pharmacy will need to be able to supply smaller amounts for treatment of individual cases.
  • It is the responsibility of the facility to report and manage influenza outbreaks with the assistance of the local Public Health Unit. 
  • In some outbreaks management involves using anti-viral medication (Tamiflu) as prophylaxis for residents and staff.  Therefore it is the responsibility of the aged care facility to purchase stocks.
  • Phone your local Public Health Unit on 1300 066 055 if you have any difficulties or questions.

The Guidelines for the Prevention, Control and Public Health Management of Influenza Outbreaks in Residential Aged Care Facilities in Australia recommend that all residents and staff of aged care facilities have an annual influenza vaccination.

Influenza vaccination for staff both protects them and provides an additional layer of protection for high risk residents. Best practice targets are 95% vaccination coverage, in both staff and residents, prior to the beginning of the flu season.

Since May 2018, Australian Government-subsidised providers of residential aged care are required to

  • Provide staff and volunteers with access to free flu vaccination each year. Providers are required to cover the cost of the program.
  • Actively promote the benefits of an annual vaccination for their staff and volunteers, and for the health outcomes of care recipients.
  • Keep records of the number of staff that receive a flu vaccination each year (whether or not under the approved provider’s flu vaccination scheme).

Unvaccinated staff are at higher risk of acquiring and transmitting influenza. During a confirmed influenza outbreak, it is recommended that unvaccinated staff only be allowed to work if asymptomatic and wearing a mask, or if asymptomatic and taking appropriate antiviral prophylaxis.

Staff members with an ILI should be excluded from work while they are infectious, that is, at least 5 days after onset of acute illness, or until they are symptom free, whichever is longer.

For more information, see the NSW Health Vaccine Storage and Cold Chain Management website and the National Vaccine Storage Guidelines - Strive for 5.

A gastroenteritis outbreak in a residential care facility is defined as two or more people with diarrhoea and/or vomiting in a facility at one time.

Under the NSW Public Health Act 2010, residential aged care facilities are legally required to notify suspected outbreaks of gastroenteritis to their local Public Health Unit.

  • Commence infection control measures and cleaning
  • Inform the facility Infection Control Practitioner & facility management
  • Inform medical team, collect faecal specimens for laboratory testing
  • Post signs and alcohol-based hand rubs at entrance to affected areas
  • Notify your local Public Health Unit on 1300 066 055
  • Distribute information to staff, residents and visitors

For more information see the NSW Gastro Pack for Hospitals and Aged Care Facilities