title: Two outbreaks of severe respiratory disease in nursing homes associated with rhinovirus.
abstract: OBJECTIVE
  To characterize illness and identify the etiology for two nursing home outbreaks of respiratory illness.
  
  
  METHODS
  Multisite outbreak investigations; cohort.
  
  
  METHODS
  Two nursing homes in Pennsylvania.
  
  
  METHODS
  Facility A residents (n = 170), Facility B residents (n = 124), and employees (n = 91).
  
  
  METHODS
  Medical records for Facility A and B residents were reviewed, and employees from Facility B self-administered a questionnaire to identify risk factors for illness. Serological, oropharyngeal, and nasopharyngeal specimens were collected for both outbreaks, and testing for respiratory pathogens was performed.
  
  
  RESULTS
  In Facility A, 40 (24%) of 170 residents were identified with respiratory illness; 13 (33%) case-patients had radiographically confirmed pneumonia, 15 (38%) were taken to a hospital, and two (5%) died. Of 10 specimens collected from symptomatic Facility A case-patients, four (40%) tested positive using reverse transcription polymerase chain reaction for rhinovirus. In Facility B, 77 (62%) of 124 residents had respiratory illness, and 40 (52%) had radiographically confirmed pneumonia; 12 (16%) case-patients were hospitalized, and five (6%) died. Of 19 respiratory specimens collected from symptomatic Facility B case-patients, six (32%) were positive for rhinovirus; one was from an employee. Five (50%) of 10 rhinovirus-positive cases in both outbreaks had clinical and radiographic evidence of pneumonia.
  
  
  CONCLUSIONS
  These investigations suggest that rhinoviruses may be an underrecognized cause of respiratory outbreaks in nursing homes, capable of causing pneumonia and perhaps death.
authors.affiliation: Respiratory Diseases Branch, National Center for Infectious Diseases, Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. lauriahicks@yahoo.com
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.forename: Colin W
authors.initials: CW
authors.lastname: Shepard
authors.forename: Phyllis H
authors.initials: PH
authors.lastname: Britz
authors.forename: Dean D
authors.initials: DD
authors.lastname: Erdman
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: Brendan L
authors.initials: BL
authors.lastname: Flannery
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Peck
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Lu
authors.forename: W Lanier
authors.initials: WL
authors.lastname: Thacker
authors.forename: Robert F
authors.initials: RF
authors.lastname: Benson
authors.forename: Maria L
authors.initials: ML
authors.lastname: Tondella
authors.forename: Mària E
authors.initials: ME
authors.lastname: Moll
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Anderson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000276:immunology; D004279:DNA, Viral / Q000235:genetics; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010414:Pennsylvania / Q000453:epidemiology; D010850:Picornaviridae Infections / Q000453:epidemiology* / Q000821:virology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012229:Rhinovirus / Q000235:genetics / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral