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. 2000 Apr 18;162(8):1133–1137.

Surveillance for outbreaks of respiratory tract infections in nursing homes

M Loeb 1, A McGeer 1, M McArthur 1, R W Peeling 1, M Petric 1, A E Simor 1
PMCID: PMC1232363  PMID: 10789627

Abstract

BACKGROUND: Outbreaks of respiratory tract infections are common in long-term care facilities for older people. The objective of our study was to determine both the frequency of such outbreaks and their clinical and epidemiological features. METHODS: Prospective surveillance for outbreaks of respiratory tract infections and a retrospective audit of surveillance records were conducted in 5 nursing homes in metropolitan Toronto over 3 years. The clinical manifestations of infected residents were identified and microbiological investigations for causal agents were conducted. RESULTS: Sixteen outbreaks, involving 480 of 1313 residents, were identified prospectively during 1 144 208 resident-days of surveillance, for an overall rate of 0.42 infections per 1000 resident-days. Another 30 outbreaks, involving 388 residents, were identified retrospectively. Outbreaks occurred year-round, with no seasonal pattern. Pathogens included influenza virus, parainfluenza virus, respiratory syncytial virus, Legionella sainthelensi and Chlamydia pneumoniae. Multiple pathogens were detected in 38% (6/16) of the prospectively identified outbreaks. Of the 480 residents in the prospectively identified outbreaks 398 (83%) had a cough, 194 (40%) had fever and 215 (45%) had coryza. Clinical findings were nonspecific and could not be used to distinguish between causal agents. Pneumonia developed in 72 (15%) of the 480 residents, and 58 (12%) required transfer to hospital. The case-fatality rate was 8% (37/480). INTERPRETATION: Our findings emphasize the importance of adequate surveillance for outbreaks of respiratory tract infections in nursing homes and of early diagnosis so that appropriate interventions can be promptly instituted.

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Selected References

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  1. Alvarez S., Shell C. G., Woolley T. W., Berk S. L., Smith J. K. Nosocomial infections in long-term facilities. J Gerontol. 1988 Jan;43(1):M9–17. doi: 10.1093/geronj/43.1.m9. [DOI] [PubMed] [Google Scholar]
  2. Arden N. H., Patriarca P. A., Fasano M. B., Lui K. J., Harmon M. W., Kendal A. P., Rimland D. The roles of vaccination and amantadine prophylaxis in controlling an outbreak of influenza A (H3N2) in a nursing home. Arch Intern Med. 1988 Apr;148(4):865–868. [PubMed] [Google Scholar]
  3. Davies H. D., Matlow A., Petric M., Glazier R., Wang E. E. Prospective comparative study of viral, bacterial and atypical organisms identified in pneumonia and bronchiolitis in hospitalized Canadian infants. Pediatr Infect Dis J. 1996 Apr;15(4):371–375. doi: 10.1097/00006454-199604000-00017. [DOI] [PubMed] [Google Scholar]
  4. Falsey A. R., McCann R. M., Hall W. J., Tanner M. A., Criddle M. M., Formica M. A., Irvine C. S., Kolassa J. E., Barker W. H., Treanor J. J. Acute respiratory tract infection in daycare centers for older persons. J Am Geriatr Soc. 1995 Jan;43(1):30–36. doi: 10.1111/j.1532-5415.1995.tb06238.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Falsey A. R., Treanor J. J., Betts R. F., Walsh E. E. Viral respiratory infections in the institutionalized elderly: clinical and epidemiologic findings. J Am Geriatr Soc. 1992 Feb;40(2):115–119. doi: 10.1111/j.1532-5415.1992.tb01929.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Farber B. F., Brennen C., Puntereri A. J., Brody J. P. A prospective study of nosocomial infections in a chronic care facility. J Am Geriatr Soc. 1984 Jul;32(7):499–502. doi: 10.1111/j.1532-5415.1984.tb02234.x. [DOI] [PubMed] [Google Scholar]
  7. Finnegan T. P., Austin T. W., Cape R. D. A 12-month fever surveillance study in a veterans' long-stay institution. J Am Geriatr Soc. 1985 Sep;33(9):590–594. doi: 10.1111/j.1532-5415.1985.tb06314.x. [DOI] [PubMed] [Google Scholar]
  8. Gomolin I. H., Leib H. B., Arden N. H., Sherman F. T. Control of influenza outbreaks in the nursing home: guidelines for diagnosis and management. J Am Geriatr Soc. 1995 Jan;43(1):71–74. doi: 10.1111/j.1532-5415.1995.tb06246.x. [DOI] [PubMed] [Google Scholar]
  9. Jacobson C., Strausbaugh L. J. Incidence and impact of infection in a nursing home care unit. Am J Infect Control. 1990 Jun;18(3):151–159. doi: 10.1016/0196-6553(90)90180-z. [DOI] [PubMed] [Google Scholar]
  10. Kohn M. A., Farley T. A., Sundin D., Tapia R., McFarland L. M., Arden N. H. Three summertime outbreaks of influenza type A. J Infect Dis. 1995 Jul;172(1):246–249. doi: 10.1093/infdis/172.1.246. [DOI] [PubMed] [Google Scholar]
  11. Lee Y. L., Thrupp L. D., Lee R., Nothvogel S., Farsad N., Cesario T. Infection surveillance and antibiotic utilization in a community-based skilled nursing facility. Aging (Milano) 1996 Apr;8(2):113–122. doi: 10.1007/BF03339565. [DOI] [PubMed] [Google Scholar]
  12. Leonardi G. P., Leib H., Birkhead G. S., Smith C., Costello P., Conron W. Comparison of rapid detection methods for influenza A virus and their value in health-care management of institutionalized geriatric patients. J Clin Microbiol. 1994 Jan;32(1):70–74. doi: 10.1128/jcm.32.1.70-74.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Loeb M., McGeer A., McArthur M., Walter S., Simor A. E. Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Arch Intern Med. 1999 Sep 27;159(17):2058–2064. doi: 10.1001/archinte.159.17.2058. [DOI] [PubMed] [Google Scholar]
  14. Maesaki S., Kohno S., Koga H., Kaku M., Yoshitomi Y., Yamada H., Matsuda H., Higashiyama Y., Hara K., Seto M. An outbreak of Legionnaires' pneumonia in a nursing home. Intern Med. 1992 Apr;31(4):508–512. doi: 10.2169/internalmedicine.31.508. [DOI] [PubMed] [Google Scholar]
  15. Mathur U., Bentley D. W., Hall C. B. Concurrent respiratory syncytial virus and influenza A infections in the institutionalized elderly and chronically ill. Ann Intern Med. 1980 Jul;93(1):49–52. doi: 10.7326/0003-4819-93-1-49. [DOI] [PubMed] [Google Scholar]
  16. McGeer A., Campbell B., Emori T. G., Hierholzer W. J., Jackson M. M., Nicolle L. E., Peppler C., Rivera A., Schollenberger D. G., Simor A. E. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control. 1991 Feb;19(1):1–7. doi: 10.1016/0196-6553(91)90154-5. [DOI] [PubMed] [Google Scholar]
  17. Meiklejohn G., Hall H. Unusual outbreak of influenza A in a Wyoming nursing home. J Am Geriatr Soc. 1987 Aug;35(8):742–746. doi: 10.1111/j.1532-5415.1987.tb06352.x. [DOI] [PubMed] [Google Scholar]
  18. Nicholson K. G., Baker D. J., Farquhar A., Hurd D., Kent J., Smith S. H. Acute upper respiratory tract viral illness and influenza immunization in homes for the elderly. Epidemiol Infect. 1990 Dec;105(3):609–618. doi: 10.1017/s0950268800048251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Nicolle L. E., McIntyre M., Zacharias H., MacDonell J. A. Twelve-month surveillance of infections in institutionalized elderly men. J Am Geriatr Soc. 1984 Jul;32(7):513–519. doi: 10.1111/j.1532-5415.1984.tb02236.x. [DOI] [PubMed] [Google Scholar]
  20. Nuorti J. P., Butler J. C., Crutcher J. M., Guevara R., Welch D., Holder P., Elliott J. A. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N Engl J Med. 1998 Jun 25;338(26):1861–1868. doi: 10.1056/NEJM199806253382601. [DOI] [PubMed] [Google Scholar]
  21. Saah A. J., Neufeld R., Rodstein M., La Montagne J. R., Blackwelder W. C., Gross P., Quinnan G., Kaslow R. A. Influenza vaccine and pneumonia mortality in a nursing home population. Arch Intern Med. 1986 Dec;146(12):2353–2357. [PubMed] [Google Scholar]
  22. Scheckler W. E., Peterson P. J. Infections and infection control among residents of eight rural Wisconsin nursing homes. Arch Intern Med. 1986 Oct;146(10):1981–1984. [PubMed] [Google Scholar]
  23. Staynor K., Foster G., McArthur M., McGeer A., Petric M., Simor A. E. Influenza A outbreak in a nursing home: the value of early diagnosis and the use of amantadine hydrochloride. Can J Infect Control. 1994 Winter;9(4):109–111. [PubMed] [Google Scholar]
  24. Sérié C., Barme M., Hannoun C., Thibon M., Beck H., Aquino J. P. Effects of vaccination on an influenza epidemic in a geriatric hospital. Dev Biol Stand. 1977 Jun 1;39:317–321. [PubMed] [Google Scholar]
  25. Tamblyn S. E. Recognizing and controlling respiratory disease outbreaks in long-term care facilities. CMAJ. 1997 Nov 1;157(9):1257–1260. [PMC free article] [PubMed] [Google Scholar]
  26. Tang P. W., Toma S., Rajkumar W. D. Detection of urinary antigens of Legionella pneumophila serogroup 12 by broad-spectrum enzyme-linked immunosorbent assay. J Clin Microbiol. 1989 Apr;27(4):783–784. doi: 10.1128/jcm.27.4.783-784.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Troy C. J., Peeling R. W., Ellis A. G., Hockin J. C., Bennett D. A., Murphy M. R., Spika J. S. Chlamydia pneumoniae as a new source of infectious outbreaks in nursing homes. JAMA. 1997 Apr 16;277(15):1214–1218. [PubMed] [Google Scholar]
  28. Wald T. G., Miller B. A., Shult P., Drinka P., Langer L., Gravenstein S. Can respiratory syncytial virus and influenza A be distinguished clinically in institutionalized older persons? J Am Geriatr Soc. 1995 Feb;43(2):170–174. doi: 10.1111/j.1532-5415.1995.tb06384.x. [DOI] [PubMed] [Google Scholar]
  29. Wald T. G., Shult P., Krause P., Miller B. A., Drinka P., Gravenstein S. A rhinovirus outbreak among residents of a long-term care facility. Ann Intern Med. 1995 Oct 15;123(8):588–593. doi: 10.7326/0003-4819-123-8-199510150-00004. [DOI] [PubMed] [Google Scholar]

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