Managing acute respiratory infection outbreaks in care homes: A cross-sectional study of public health response across South East England.

Abstract

Background: Acute respiratory infection (ARI) outbreaks in care homes remain a significant burden, especially during influenza season. Prompt public health responses and timely antiviral administration are crucial for mitigating transmission and minimising the impacts of outbreaks. This study aimed to assess the timeliness and appropriateness of the public health response to notifications of ARI in care homes during flu season, across the South East England region.

Methods: This was a cross-sectional study analysing ARI in care home notifications during 2024/25 Chief Medical Officer (CMO)-declared flu season. A combination of quota and random sampling was used for detailed analysis. Descriptive and inferential statistical analyses were used to evaluate timeliness of public health response and antiviral prescribing patterns.

Results: During the study period, 340 ARI incidents were notified among 2737 care homes, and 103 care homes were included in the detailed analysis. The median time from first symptom onset to public health notification was 4 days (IQR 3-7 days), whereas the median time from most recent reported symptom onset to public health assessment was 1 day (IQR 0-1 day), indicating a prompt public health response following outbreak notification. The median time interval from risk assessment to antiviral recommendation was the same day. Prior to public health assessment, 66/82 (80.5%) care homes reviewed by a GP had residents commenced on antibiotics, 4/82 (4.9%) on antivirals, and 7/82 (8.5%) on both antibiotics and antivirals.

Conclusion: Our findings suggest that public health response following notification of ARI outbreaks in care homes was generally prompt. However, delays in outbreak recognition and notification, barriers to timely antiviral prescribing, and frequent antibiotic prescribing despite influenza-like illness criteria being met highlight the need to streamline antiviral prescribing pathways and strengthen antimicrobial stewardship in this setting.