title: Non-influenza respiratory viruses may overlap and obscure influenza activity.
abstract: OBJECTIVE
  To report the number and timing of influenza A isolates, as well as overlapping respiratory viruses. Co-circulating respiratory viruses may obscure the determination of influenza activity.
  
  
  METHODS
  Prospective clinical surveillance for the new onset of respiratory illness followed by viral cultures during seven separate influenza seasons.
  
  
  METHODS
  The Wisconsin Veterans Home, a skilled nursing facility for veterans and their spouses.
  
  
  RESULTS
  Influenza A isolates were encountered in greater numbers than non-influenza A isolates during three seasons. Seasonal variability is striking. In December 1992, we identified a large outbreak of respiratory illness. Influenza type B was cultured from 102 residents. In December 1995, influenza A was cultured from 285 people in Wisconsin. At that time, we identified outbreaks of respiratory illness in two of our four buildings. Based on statewide data, we suspected an influenza outbreak; however, 26 isolates of parainfluenza virus type 1 were cultured with no influenza. The potential importance of culturing at the end of the season was demonstrated in 1991-1992 when an outbreak of respiratory syncytial virus (RSV) overlapped and extended beyond influenza A activity.
  
  
  CONCLUSIONS
  When interpreting new clinical respiratory illnesses as a basis for declaring an outbreak of influenza A, clinicians should realize that co-circulating respiratory viruses can account for clinical illnesses. Clinicians might utilize healthcare dollars efficiently by performing cultures to focus the timing of influenza A chemoprophylaxis. Cultures could be performed when clinical outbreak criteria are approached to confirm an outbreak. Culturing of new respiratory illness could begin again before the anticipated discontinuation of prophylaxis (approximately 2 weeks).
authors.affiliation: Wisconsin Veterans Home, King, Wisconsin 64946-0620, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Drinka
authors.forename: S
authors.initials: S
authors.lastname: Gravenstein
authors.forename: P
authors.initials: P
authors.lastname: Krause
authors.forename: E H
authors.initials: EH
authors.lastname: Langer
authors.forename: L
authors.initials: L
authors.lastname: Barthels
authors.forename: M
authors.initials: M
authors.lastname: Dissing
authors.forename: P
authors.initials: P
authors.lastname: Shult
authors.forename: M
authors.initials: M
authors.lastname: Schilling
mesh_terms: D000368:Aged; D003139:Common Cold / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D009980:Influenza A virus / Q000302:isolation & purification*; D009981:Influenza B virus / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D008297:Male; D009735:Nursing Homes; D010222:Parainfluenza Virus 1, Human / Q000302:isolation & purification; D011159:Population Surveillance / Q000379:methods*; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification; D010253:Respirovirus Infections / Q000453:epidemiology / Q000821:virology; D012229:Rhinovirus / Q000302:isolation & purification; D012621:Seasons; D014728:Veterans; D014922:Wisconsin / Q000453:epidemiology