This page provides guidance for health care professionals, long-term care facilities and other group living settings, schools, child care programs, and shelters on how to recognize, report, and manage influenza-like illness (ILI) or flu and COVID-19 outbreaks.

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For immediate reporting: Submit the Viral Respiratory Illness Outbreak Form or call 802-863-7240 (24/7).

Guidance and information differs based on illness and setting. Click to jump to a section:

Universal Guidance (All settings)

For any respiratory outbreak:

Flu Outbreaks

Flu Outbreak at a Long-Term Care Facility

You can use an online reporting form to report flu or ILI outbreaks. Review the job aid to walk through the online format.

What is an Outbreak?

A single resident with a positive flu test and two or more additional residents with respiratory illness symptoms.

OR

Two or more residents with at least two of the following symptoms:

  • Fever of 100 degrees Fahrenheit or more
  • Nonproductive cough
  • Myalgia (muscle pain)
  • Pharyngitis (sore throat)

If an Outbreak is Suspected

  1. Report influenza-like illness outbreaks to the Health Department 24/7 by calling 802-863-7240 and filling out a viral respiratory illness outbreak report form. It is important to report so that the Health Department can help coordinate testing. Health Department staff will ask about symptoms, onset, case totals, exposure, treatments, outcomes, and actions taken.
  2. Collect specimens from 3-5 residents within 72 hours of symptom onset for surveillance testing at the Vermont Department of Health Laboratory using the testing instructions and forms.
  3. Treat symptomatic residents with antivirals. Do not wait for laboratory confirmation of the flu.
  4. Sick staff should stay home until 24 hours after fever has resolved without the use of fever-reducing medication.
  5. Start a list of sick residents and staff and track symptom onset using the Influenza-like illness line list.
  6. When at least 2 residents/patients are ill within 72 hours of each other and at least one resident has lab-confirmed influenza, promptly initiate antiviral prophylaxis to all non-ill residents. CDC recommends antiviral prophylaxis for a minimum of 2 weeks and continuing for at least 7-10 days after the last known case was identified. 

Actions to Control the Outbreak

  • Stop taking new admissions or transfers when possible.
  • Discourage symptomatic people from visiting.
  • Follow droplet precautions for symptomatic residents.
  • Encourage symptomatic residents to practice respiratory hygiene.
  • Ensure ill employees do not work.
  • Do not float staff between units.
  • Provide training in infection control and hand hygiene for staff.
  • Perform routine and thorough cleaning of commonly touched surfaces.
  • Restrict symptomatic residents to their rooms, or cohort on the infected unit.
  • Limit group activities and serve meals in rooms.
  • If a resident is transferred to another facility during the outbreak, notify the receiving facility of the outbreak whether or not the individual has symptoms.
  • Offer flu vaccine to unvaccinated staff, residents, and new admissions throughout the flu season.

Get a Quick Reference Guide

Get an Outbreak Plan Guide

Vermont Department of Health Resources

CDC Resources for Long-Term Care Facilities

Flu Outbreak at a K-12 School

You can use an online reporting form to report flu or ILI outbreaks. Review the job aid to walk through the online format.

What is an Outbreak?

Increased absenteeism* throughout the school in association with influenza-like illness. This includes:

  • Students who are sent home with fever and cough or sore throat.
  • Absent students with parental reports of flu.
  • Absent students with parental reports of fever and cough or sore throat.

*Increased absenteeism is defined as absentee rates exceeds 10% for entire school; OR absentee rate exceeds 20% of one grade or class. 

If an Outbreak is Suspected

  1. Report influenza-like illness outbreaks to the Health Department 24/7 by filling out a viral respiratory illness outbreak report form.
  2. Sick students and staff should stay home until 24 hours after fever has resolved without the use of fever-reducing medication.
  3. It can be helpful to keep track of students and staff who are part of the outbreak using a line list to fill out the Outbreak Report Form. Here is a template that may be helpful: Influenza-like illness line list. 

Actions to Control the Outbreak

  • Encourage washing hands with soap and water.
  • Provide tissues and no-touch trash cans around the school and classrooms.
  • Routinely clean and disinfect commonly touched surfaces.
  • Send a letter home to parents with flu prevention information.
  • Avoid touching mouth, eyes or nose.
  • Encourage staff to stay home if they are sick.
  • Encourage students not to share food or drinks.
  • Encourage any unvaccinated staff to get vaccinated.
  • Recommend that students and their families get vaccinated.

Get a Quick Reference Guide

Vermont Department of Health Resources

CDC Resources for Schools

Flu Outbreak at a Child Care Facility

What is an Outbreak?

Increased absenteeism throughout the facility in association with influenza-like illness. This includes:

  • Children who go home early with fever and cough or sore throat,
  • Absent children with parental reports of flu,
  • Absent children with parental reports of fever and cough or sore throat.

If an Outbreak is Suspected

  1. Report influenza-like illness outbreaks to the Health Department 24/7 by filling out an viral respiratory illness outbreak report form.
  2. Sick children and staff should stay home until 24 hours after fever has resolved without the use of fever-reducing medication.
  3. It can be helpful to keep track of students and staff who are part of the outbreak using a line list to fill out the Outbreak Report Form. Here is a template that may be helpful: Influenza-like illness line list. 

Actions to Control the Outbreak

  • Encourage washing hands with soap and water.
  • Provide tissues and no-touch trash cans around the facility.
  • Routinely clean and disinfect commonly touched surfaces.
  • Send a letter home to parents with flu prevention information.
  • Avoid touching mouth, eyes, or nose.
  • Discourage sharing of food or drinks between children.
  • Encourage any unvaccinated staff to get vaccinated.
  • Recommend that children and their families get vaccinated.

Get a Quick Reference Guide

Vermont Department of Health Resources

CDC Resources for Child Care Facilities

Flu Outbreak at a Shelter

What is an outbreak?

An outbreak is when you are seeing multiple people at your facility with flu-like symptoms, like:

  • Fever
  • Cough
  • Headache
  • Body aches
  • Fatigue
  • Sore throat
  • Chills

If an outbreak is suspected:

If you are seeing multiple people at your facility with flu-like symptoms, please fill out the viral respiratory illness outbreak report form and call 802-863-7240.

Actions to Control the outbreak

  • Encourage staff to get a flu shot.
  • Be aware when individuals have flu-like symptoms.
  • Staff and volunteers should stay home until their fever has been gone for at least 24 hours.
  • Put up posters around the facility that show hygiene practices, such as covering coughs and sneezes and proper handwashing.
  • Place alcohol-based hand sanitizer in areas where handwashing is not available.
  • Perform routine surface cleaning of commonly-touched surfaces like door knobs.
  • Place tissues and trash cans around the facility.
  • When possible, locate ill individuals away from those that are well.
  • Place cots head-to-toe and keep cots six feet apart.
  • Encourage individuals to report to a staff member if they are feeling ill.

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COVID-19 Long-term Care Facilities and other Group Living Settings

COVID-masked-woman-doctor.jpg

The Health Department works closely with the Department of Disabilities, Aging and Independent Living (DAIL) and long-term care facilities to help them prepare for cases of COVID-19. Other types of group living settings, also called congregate care settings, can follow strategies to detect and prevent the spread of respiratory viruses like COVID-19.

For return-to-work and other guidance for staff with COVID-19 or COVID-19 exposure, please see Interim Guidance for Management of Healthcare Personnel with Suspect or Confirmed Viral Respiratory Illness.

Long-Term Care Facilities are encouraged to report new COVID-19 situations (one or more cases of COVID-19 in your facility) using the Vermont Department of Health Online Outbreak Report Form. 

Do not use this link to update ongoing outbreaks that have already been reported to us. Phone or email can also be used to report cases to the Department. Positive COVID-19 test results should still be reported to the CDC's National Healthcare Safety Network (NHSN). 

A COVID-19 exposure includes when:

  • A staff member or visitor was in the facility while infectious with COVID-19 (two days before symptoms onset or from when they tested positive).
  • A resident tests positive for COVID-19.
  • Clusters of residents or staff have COVID- or flu-like symptoms. 
important

If you identify a COVID-19 exposure at your facility, please test any staff and residents who were in contact with those testing positive. 

Unidentified infection in asymptomatic and low-symptom staff and residents can lead to longer and larger outbreaks in your facility.

Report COVID-19 Cases and Tests

Nursing and health care facilities are required to complete both of the following:

  • Report all COVID-19 cases in your facility to the Health Department. This includes residents and staff who may have been in the facility while infected with COVID-19. This fulfills the statutory requirement to report any COVID-19 outbreaks. For more information, see 5.1 and 5.4 of the Reportable and Communicable Disease Rule.
    • Preferred way to report: All new COVID-19 situations can be reported online using the Vermont Department of Health Outbreak Report Form. A member of our team will follow up with you after submission. Do not use this link to update ongoing situations that have already been reported.
    • Call the Infectious Disease Epidemiology team at 802-863-7240 (option 2) or
    • Email AHS.VDHEpiCOVID19Program@Vermont.gov (monitored during business hours)
  • Report any COVID-19 test results from CMS-certified long-term care facilities to the CDC’s National Healthcare Safety Network (NHSN). If your facility has another electronic lab reporting arrangement with the Health Department, that can also be used to submit results. This fulfills the requirement to report any COVID-19 laboratory results. This reporting does not automatically trigger a response from the Health Department, so it is still necessary to notify the Health Department of outbreaks. For more information, see section 6 of the Reportable and Communicable Disease Rule.

See more on Infectious Disease Reporting and Data

Managing Infections and People with Symptoms 

Isolation

Positive and symptomatic staff who are not moderately or severely immunocompromised should be excluded from work until:

  • At least 3 days have passed from symptom onset or, if asymptomatic, first positive test; AND
  • They are fever-free for at least 24 hours without the use of fever-reducing medication; AND
  • Symptoms are improving and they feel healthy enough to return to work.

Staff who are not moderately or severely immunocompromised should wear source control at work for 7 days since symptom onset or, if asymptomatic, first test.

Staff with respiratory viral infections who are moderately or severely immunocompromised may shed virus for prolonged period. Therefore, consider consulting with an infectious disease specialist, or further antigen testing, to determine how long such staff should be excluded and use source control. 

Read more in the guidance for healthcare personnel with viral respiratory illness.

Positive and symptomatic residents should be separated from people who aren’t known to be infected with COVID-19 to the extent that is safe and feasible. Residents who are infected with COVID-19 can generally be grouped together during their respective isolation periods, barring other health or safety concerns.

Negative and asymptomatic residents can continue group activities and communal dining. However, there may be occasions where the Health Department recommends pausing communal activities on a larger scale when there is uncontrolled transmission.

Facilities are recommended to defer non-urgent visitation when visitors have confirmed or suspected COVID-19, had a known exposure, or are symptomatic. 

Mask Wearing

  • Positive and symptomatic individuals should wear a mask when around individuals who are not known to be infected. Universal masking is recommended in the unit or area of the facility experiencing a COVID-19 or other outbreak until 14 days have passed with no new cases.
  • Staff who are not moderately or severely immunocompromised with a suspected or confirmed respiratory viral infection should wear source control for at least 7 days after the first day of symptoms (or after first testing positive, if no symptoms).
    • Moderately or severely immunocompromised staff may shed virus for longer, so longer duration of source control should be considered.
  • If visitors do come to the facility, they should be encouraged to wear a mask while visiting a resident who has tested positive for COVID or a unit or facility experiencing transmission.
  • Face masks may be worn as a personal preference and should be worn by health care providers or personnel at the request of a patient or resident.

Monitoring and Treatment

  • Plan to monitor the condition of the positive residents at least 3 times per day.
  • Check other staff and residents for symptoms and have a low threshold for work exclusion and symptomatic testing.
  • Consider therapeutic medication for all residents and any staff with health risks, in consultation with their providers.

Testing Recommendations

Admission or Discharge

  • A COVID-19 infection should not prevent admission or discharge, but receiving or discharging facilities should report infections to the sending or receiving facility.
  • Test residents on admission if they have symptoms or are suspected to recently have had high-risk contact with someone with COVID-19.
  • Facilities may choose to test asymptomatic residents at their own discretion or based on Vermont’s Hospitalization Level or other public health guidance.

COVID-19 Exposure 

  • For staff or residents with symptoms, consider administering point-of-care antigen tests immediately. If negative, test again after 48 hours, and again after a subsequent 48 hours.
  • Test staff and residents who had close contact with the person who tested positive for COVID-19. If close contacts cannot be identified, test all staff and residents in the group or unit of the person who tested positive for COVID-19. Close contacts without symptoms should be tested on days 1, 3 and 5 post-exposure. "Day 0” is the most recent exposure date.
  • Continue to notify the Health Department of new cases and suspected outbreaks, and report any COVID-19 test lab results.

Other Considerations to Prevent or Control Outbreaks

  • Implement transmission-based precautions per isolation and masking guidance provided above.
  • Follow licensing requirements about notifying family and potential visitors about infection(s)/suspected outbreaks in facility.
  • Admissions and discharges should continue as planned. If discharging during a period of recent facility infection or outbreaks, please inform all receiving parties (facilities, families, etc.) of the potential exposure to the discharged person.
  • Consider recommending masks for residents when they are:
    • Leaving the facility during periods of heightened respiratory virus activity.
    • At higher risk, or for those who spend time in higher-risk units, during periods of medium Hospitalization Level or when other respiratory viruses are known to be circulating.
  • Do not float staff between units to help prevent and control outbreaks.
  • Provide training in infection control and hand hygiene for staff.
  • Offer the COVID-19 vaccine to unvaccinated or under-vaccinated staff, residents, and new admissions on a regular basis.

Vaccines

The Health Department strongly encourages facilities to ensure that residents and staff are up to date with COVID-19 and other infectious disease vaccines. 

Facilities should have an established relationship with a pharmacy, though not all pharmacies can provide COVID-19 vaccine at this time. Facilities should confirm this capability with their existing partners. If your pharmacy has already been providing the COVID-19 vaccine, discuss their plan for booster doses. If your residents are mobile and can be transported, residents can also make an appointment to be vaccinated at local pharmacies or their primary care clinic. 

Contact Us

Call: 802-863-7240 (option 2)

Email: AHS.VDHEpiCOVID19Program@Vermont.gov (COVID) or ahs.vdhEpiFluSurv@vermont.gov (Flu); monitored during business hours

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