Behaviour and control of influenza in institutions and small societies.

A literature review was undertaken to assess the impact of influenza in enclosed societies. The literature spanned 120 years and included both readily accessible material from online keyword searches, as well as more obscure paper documents found through in-depth library research. Enclosed societies have been predominantly found in some type of institution through this period although noticeable similarities exist in communities isolated by distance and geography. We observe that no matter how isolated a community is, it is not necessarily insulated from infection by influenza and that even where there are no complicating factors, such as the age distribution or the presence of individuals with greater susceptibility in the enclosed population, their organization tends to increase influenza transmission and the risk of secondary infection. The collected accounts demonstrate important features of outbreaks in such societies and the necessity of considering them in pandemic planning: in particular, rapid intervention is essential for the control of influenza spread in such circumstances. Recent experience has shown that administration of modern antiviral drugs, such as neuraminidase inhibitors are effective at moderating outbreaks of influenza, but only in combination with other methods of control. In more remote communities where such drugs are not, or less, readily available, and medical care is limited, such outbreaks can still pose particular difficulties. In all cases delay in correct diagnosis, detection of an outbreak or the implementation of control measures can result in the majority of the enclosed population succumbing to the disease.