Two outbreaks of severe respiratory disease in nursing homes associated with rhinovirus.
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.
Hicks
Lauri A
LA
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
Shepard
Colin W
CW
Britz
Phyllis H
PH
Erdman
Dean D
DD
Fischer
Marc
M
Flannery
Brendan L
BL
Peck
Angela J
AJ
Lu
Xiaoyan
X
Thacker
W Lanier
WL
Benson
Robert F
RF
Tondella
Maria L
ML
Moll
Mària E
ME
Whitney
Cynthia G
CG
Anderson
Larry J
LJ
Feikin
Daniel R
DR
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
D000914:Antibodies, Viral; D004279:DNA, Viral