Lessons from a nursing home outbreak of influenza A.
OBJECTIVE
To characterize risk factors for outbreak-associated influenza illness and death in a nursing home.


METHODS
Outbreak investigation with predetermined and concurrently determined risk information.


METHODS
A nursing home service in a multiward chronic care hospital, Honolulu, Oahu, 1989 to 1990.


METHODS
Elderly nursing home patients receiving long-term care.


METHODS
Influenza vaccination, amantadine administration, and infection control measures.


RESULTS
Neither routine infection control measures nor vaccination prevented illness, complications, or death in a nursing home outbreak of influenza A. The 55% case-fatality rate resulted from severe pneumonia. Influenza transmission may have been mediated by staff via either contaminated hands or fomites.


CONCLUSIONS
Data from this and other outbreaks suggest that recommendations for preventing nosocomial influenza in the nation's 1.5 million nursing home residents should be reconsidered.
Morens
D M
DM
Department of Tropical Medicine, School of Public Health, University of Hawaii, Honolulu, USA.
Rash
V M
VM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004196:Disease Outbreaks; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D008134:Long-Term Care; D008875:Middle Aged; D009735:Nursing Homes; D009976:Orthomyxoviridae Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D012307:Risk Factors; D014611:Vaccination
D007252:Influenza Vaccines