Guidance

[Withdrawn] Management of acute respiratory illness in prisons and places of detention

Updated 6 April 2022

This guidance was withdrawn on

The information of this guidance has been superseded by information in Acute respiratory illness, including flu and COVID-19 in prisons.

Applies to England

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This publication is available at https://www.gov.uk/government/publications/seasonal-flu-in-prisons-and-detention-centres-in-england-guidance-for-prison-staff-and-healthcare-professionals/management-of-acute-respiratory-illness-in-prisons-and-places-of-detention

Co-circulation of both coronavirus (COVID-19) and influenza in the community and in prisons and places of detention (PPD) remains likely.

Early detection and rapid response

When someone in a PPD develops an acute respiratory illness (ARI), COVID-19 isolation and control measures should be put in place while awaiting confirmation of the causative organism, and cellmates should be isolated irrespective of vaccination status.

Risk assessment

Viral respiratory pathogens can spread very rapidly in PPD, so when 2 or more cases of ARI are detected in a PPD setting it is important to act rapidly to undertake a risk assessment, initiate testing and put in place appropriate control measures. The initial risk assessment should consider the likelihood of influenza given the local epidemiological situation, at risk individuals and the influenza and COVID-19 (including booster) vaccination status of the population.

Consideration should be given to early case ascertainment across the setting, including identifying those with symptoms elsewhere in the establishment.

Testing

Healthcare staff should swab symptomatic cases with a polymerase chain reaction (PCR) test as soon as possible. Rapid PCR testing – to include both COVID-19 and influenza – is critical to identifying the causative organism and guiding pathogen-specific control measures.

Ideally, samples should be sent to a UKHSA regional public health laboratory (or an NHS laboratory if local arrangements exist) for respiratory virus multiplex PCR testing. If samples are sent to a laboratory that is not undertaking multiplex testing, 2 swabs will be required, one for COVID-19 and a second for influenza and other ARIs.

Vaccination

Ensure eligible individuals are actively offered vaccination for influenza and COVID-19, including booster vaccinations where applicable. Target high-risk individuals and settings as early as possible – for example contacts and secure setting locations where individuals are at particular risk, such as older aged population or those with underlying health conditions that may mean they are at higher risk of severe disease from COVID-19 or influenza.

Pathogen-specific treatments and prophylaxis

Pathogen-specific treatments are available for certain high-risk individuals with either COVID-19 or influenza. In addition, influenza antivirals can be given as prophylaxis. Influenza antivirals should ideally be given within 36 to 48 hours of symptom onset or exposure, so if influenza is likely, consider organising antiviral treatment and prophylaxis prior to receiving test results. COVID-19 antivirals or nMAB can only be given following a positive COVID-19 PCR result.

Outbreak management

The flowchart published alongside this guidance summarises the main actions to be taken based on the results of PCR testing.

More information can be found on:

Flowchart: accessible text version

Prison resident is symptomatic: recommend clinical review to ascertain whether case meets definition for COVID-19 or influenza. (Older residents may not present with classic symptoms; consider diagnoses if there is a sudden deterioration in physical or mental health).

1a)
Isolate symptomatic cases and follow preventing and controlling outbreaks of preventing and controlling outbreaks of COVID-19 in prisons and places of detention. Arrange PCR testing as soon as possible. If 2 or more cases inform health protection team (HPT) and test symptomatic cases for both COVID-19 and influenza – ideally using multiplex testing to include other respiratory viruses.

1b)
If epidemiological situation suggests influenza, HPT to consider influenza antiviral treatment and prophylaxis prior to availability of test results.

2)
Test results

2a)
If COVID-19 positive and influenza negative:

  • arrange contact tracing, isolate cases and contacts (unless exempt) for 10 days, and follow guidance on preventing and controlling outbreaks of COVID-19 in prisons and places of detention
  • outbreak control team (OCT) to consider mass testing for COVID-19 at days 0, 7 and 10 based on a dynamic risk assessment
  • consider stopping influenza antivirals if started
  • the OCT can consider standing the outbreak down 10 days after the most recent cases providing there is confidence that transmission chains have been identified and controlled through mass testing

2b)
If influenza positive and COVID-19 negative:

  • isolate cases until symptoms resolve (usually 5 days), isolate cellmates for 48 hours, and follow guidance on flu in prisons and secure settings
  • assess need for influenza antiviral treatment and prophylaxis (if not already started)
  • outbreak can be declared over 5 days after most recent case

2c)
If COVID-19 positive and Influenza positive:

2d)
If COVID-19 negative and Influenza negative:

  • manage as clinically indicated
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