Early suspicions centred on influenza as cause of deaths

A DOCTOR WRITES:Six deaths in one place over a 10-day period will always ring alarm bells

THE DEATH of six older residents of a Donegal nursing home in a short period of time has come as a shock to local people. Apart from the grief of families and friends, there is the understandable fear of an unexplained, deadly illness in the community.

From early on it was clear the illness was due to an infectious agent. It has affected many of the residents and some staff. It is a respiratory illness from which five staff members have recovered but that continues to cause serious illness in some residents.

The nursing home can cater for some 48 people aged over 65. They are a frail group, many with dementia, and with co-morbid diseases such as chronic obstructive airways disease, heart failure and chronic kidney disease. These illnesses make them especially vulnerable to infectious diseases such as influenza, which often tips the chronic illness into an acute and life-threatening condition.

Early suspicions centred on influenza as the cause, although other respiratory viruses and even bacteria were in the frame. We now know that samples from patients tested positive for Influenza A (H3). It has been a comparatively late influenza season this year and, although past its peak, the virus is still in active circulation. According to the latest figures from the national Health Protection Surveillance Centre (HPSC), Influenza A (H3) has been the dominant virus detected during this flu season. It is a different strain from the avian flu and is mainly a threat to older people.

To date this season, three influenza associated deaths have been reported to the HPSC, all in patients aged 65 years or older. One patient was infected with influenza B and two were infected with influenza A (H3). Some eight influenza outbreaks have been reported, including three in community hospitals/long-stay units and two in residential units. However, it recently emerged that the make-up of the H3 virus has altered slightly over the winter; this means the seasonal influenza vaccine may not be as effective as had been hoped when it was made last autumn.

Another possible culprit could have been a virus called the respiratory syncytial virus (RSV). As its name suggests, it attacks the upper and lower respiratory tracts and it particularly targets babies and young children. But it does infect all age groups and the number of samples testing positive for RSV is higher than normal for this time of year. RSV causes pneumonia, which remains one of the commonest causes of death in older people.

In the meantime, all residents with symptoms are being treated with a broad-spectrum antibiotic, while preventive anti-viral medication has been administered to the remainder.

Some of the issues the ongoing investigation must address are: was there an adequate take-up of this year’s seasonal flu vaccine among residents of Nazareth House in Buncrana?

When the illness was first identified, were appropriate isolation measures taken? Were measures to prevent cross-infection fully updated and operational?

In this regard, the nursing home regulator Hiqa has carried out two recent inspections on the Buncrana unit.

A cluster of deaths in one place over a 10-day period will always trigger alarm bells.

But whatever the outcome of the investigation, it may in the end be due to a statistical blip among a group of frail older people for whom infectious disease continues to be a leading cause of death.