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State of California—Health and Human Services Agency
California Department of Public Health

AFL 20-80
October 12, 2020

Skilled Nursing Facilities

Recommendations for the Prevention and Control of Influenza during the Coronavirus Disease 2019 (COVID-19) Pandemic

All Facilities Letter (AFL) Summary

This AFL provides recommendations to prevent and manage influenza outbreaks in skilled nursing facilities (SNFs) during the COVID-19 pandemic.

SNF residents are at increased risk for severe disease, hospitalization, and death from infections caused by influenza viruses and the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The ongoing COVID-19 pandemic and the potential for concurrent COVID-19 and influenza outbreaks will complicate the upcoming influenza season; therefore, it is essential for SNFs to optimize all available effective influenza prevention and outbreak control interventions, including influenza vaccination of SNF residents and healthcare personnel (HCP) and prompt initiation of antiviral therapy and chemoprophylaxis when influenza is identified.

On October 5, 2020, the California Department of Public Health (CDPH) issued "Recommendations for the Prevention and Control of Influenza in California SNFs during the COVID-19 Pandemic" (PDF). This document provides recommendations to prevent and manage influenza outbreaks in SNFs in the context of SARS-CoV-2 co-circulation. These recommendations may also apply to other long-term care facilities.

CDPH recommends facilities review "Recommendations for the Prevention and Control of Influenza in California SNFs during the COVID-19 Pandemic" (PDF) to develop and implement an influenza prevention and control plan. The document provides:

  • Similarities and differences between clinically relevant characteristics of influenza viruses and SARS-CoV-2
  • Recommendations for planning for influenza illness and outbreaks relevant to three groups of individuals: residents, healthcare personnel, and family members/visitors.
  • Recommendations for identifying the presence of an influenza outbreak and implementing the influenza prevention and control plan

Before influenza begins circulating in the local community, CDPH recommends SNFs be ready with sufficient influenza vaccine and standing orders for administration, hand hygiene supplies, personal protective equipment, antiviral medication orders, and established lines of communication between the SNF and the local health department. Establishing a strong collaborative relationship with the local health department facilitates needed support in the event of an outbreak, vaccine or antiviral agent shortage, or if unanticipated events emerge within a given season. 

Please report influenza outbreaks immediately to your local health department (PDF) and L&C district office.

If you have any questions about this AFL, please contact the CDPH Healthcare-Associated Infections Program at



Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director



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