Author: Michael Roach, DO – Corporate Medical Director

As a reminder, it is coming up on flu season once again. Soon vaccines will be available for your county.  Jails should vaccinate high-risk patients between November 1, 2018 and February 1, 2019.



Patients will have a cough, sore throat, and fever approximately 48 hours after exposure.  This will be followed by headache, tiredness, runny or stuffy nose, body aches, diarrhea, vomiting.  Symptoms usually last less than a week, but a cough may persist out to two weeks.   Nausea and vomiting for 24-72 hours is commonly gastroenteritis, “stomach flu” and not preventable with the flu vaccine.  New intakes with symptoms should be either tested or isolated from general population.



Flu vaccinations should be administered to those with “high risk” (table 1) at day 14 with their assessment if the detainee will be at the facility past 30 days.  Communication between provider and jail administration should exist at each county for exceptions.

Overall, healthy detainees do NOT need vaccinations or anti-viral treatment, especially if symptoms have been greater than 48 hours.  These patients need symptomatic treatment with Tylenol and increased fluids.  Patients with flu symptoms should be isolated from the “well” population until symptoms have resolved for 48 hours and monitored for worsening symptoms.  Patients, at high risk with severe symptoms or those deemed necessary, may need anti-viral treatment if diagnosed within the first 48 hours of onset of symptoms.

Due to jail staff repeatedly entering and exiting the facility, during this season, it is recommended that all jail staff receive the vaccine.  Jail staff infected should not return to work until asymptomatic for at least 24 hours.  This will reduce the risk for infecting the incarcerated.

Table 1. Persons at High Risk for Complications after contracting Influenza
Age ≥ 65 years
Chronic lung disease (including asthma)
Cardiovascular (except hypertension alone)
Renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes
Neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord,
peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke,
intellectual disability [mental retardation], moderate to severe developmental delay, muscular
dystrophy, or spinal cord injury)
Immunosuppression, including that caused by medications or by HIV infection
Women who are pregnant or postpartum (within 2 weeks after delivery)



  • Vaccinate those at risk
  • Educate staff and detainees on measures to protect themselves:
    1. Frequent hand washing
    2. Cough or sneeze into elbow
    3. Avoid touching the face
      1. Eyes
      2. Nose
      3. Mouth
  • Disinfect touched surfaces:
    1. Doors and door knobs
    2. Hand rails
    3. Telephones
    4. Keys
    5. Tables
    6. Toilets
  • Avoid close contact with those who are symptomatic

For questions or concerns about guidelines or individualization of a program for your jail, please contact your Regional Medical Director or Michael Roach, DO – Corporate Medical Director, at