title: A preventable outbreak of pneumococcal pneumonia among unvaccinated nursing home residents in New Jersey during 2001.
abstract: OBJECTIVE
  To characterize risk factors for invasive pneumococcal infection in a nursing home outbreak.
  
  
  METHODS
  Outbreak investigation, case-control study.
  
  
  METHODS
  A 114-bed nursing home in New Jersey.
  
  
  METHODS
  Case-patients were nursing home residents hospitalized with febrile respiratory illness and radiographic findings consistent with pneumonia, and either sputum specimens positive for diplococci or blood cultures positive for Streptococcus pneumoniae, with illness onset during April 3-24, 2001. Control-patients were selected randomly from remaining residents without respiratory symptoms.
  
  
  METHODS
  Chart reviews were performed for case-patients and control-patients. Serotyping and susceptibility testing were performed on S. pneumoniae isolates. Long-term-care facilities (LTCFs) were surveyed to assess compliance with a state regulation mandating pneumococcal vaccination of residents 65 years and older.
  
  
  RESULTS
  Nine case-patients were identified, with a median age of 86 years (range, 78 to 100 years). The median age of control-patients was 86 years (range, 58 to 95 years). No case-patients versus 9 (50%) control-patients received pneumococcal vaccine before the outbreak (OR, 0; CI95, 0-0.7). Recent antibiotic use, pneumonia history, and physical functioning were not associated with illness. Illness attack rate was 16% among all unvaccinated residents versus 0 among vaccinated residents. S. pneumoniae serotype 14, included in pneumococcal vaccine, was isolated from blood cultures of 7 case-patients. Of 361 LTCFs (42%) that replied to the survey, 28 (8%) were not complying with state immunization regulations.
  
  
  CONCLUSIONS
  This outbreak occurred in an LTCF with low vaccine coverage. Implementing standing order programs, enforcing regulations, documenting vaccinations, and providing education might increase coverage among nursing home residents.
authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, New Jersey 08625, USA.
authors.forename: Christina G
authors.initials: CG
authors.lastname: Tan
authors.forename: Stanley
authors.initials: S
authors.lastname: Ostrawski
authors.forename: Eddy A
authors.initials: EA
authors.lastname: Bresnitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008297:Male; D037141:Mandatory Programs / Q000331:legislation & jurisprudence*; D009515:New Jersey / Q000453:epidemiology; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000592:standards*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity; D014611:Vaccination / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*
chemical_list: D022242:Pneumococcal Vaccines