title: Influenza prevention in nursing homes: Great significance of seasonal variability and spatio-temporal pattern.
abstract: OBJECTIVE
  This work evaluated seasonal variations and spatio-temporal pattern of respiratory tract infections (RTI) in geriatric nursing homes in order to improve effective surveillance, prevention, control and management of RTI.
  
  
  METHODS
  Prospective surveillance of RTI (Low Respiratory Tract infections and Influenza Like Illnesses) was conducted in 11 sites in Alsace over a 10-year period with clinical case definitions and rapid tests (Immunoassay) to identify influenza virus.
  
  
  RESULTS
  Influenza national epidemic was a period at high risk of RTI in nursing homes with variable impacts depending on the seasonal period. 2004-2005, 2008-2009, 2011-2012 and 2012-2013 were the periods with the highest impacts. The higher risk was not well understood during these four influenza epidemics and outbreaks occurred in numerous nursing homes despite the alerts and surveillance.
  
  
  CONCLUSIONS
  Information about seasonal variability and spatio-temporal patterns of the RTI during the national epidemic periods is essential for the nursing homes in order to help the health care workers and the visitors to understand the risk for the residents and then to improve the implementation of the control and prevention measures.
authors.affiliation: Rouffach Hospital Center, Hospital hygiene service, 27, rue du 4(e) RSM, 68250 Rouffach, France; University of Franche-Comté, UMR 6249 Chrono-Environnement, 25000 Besançon, France. Electronic address: ph.gaspard@ch-rouffach.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaspard
authors.affiliation: GROG national network (Regional Group for the Surveillance of Influenza), 75000 Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Mosnier
authors.affiliation: University Hospital of Strasbourg, Institute of virology, 67000 Strasbourg, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Stoll-Keller
authors.affiliation: Rouffach Hospital Center, Hospital hygiene service, 27, rue du 4(e) RSM, 68250 Rouffach, France.
authors.forename: Cathy
authors.initials: C
authors.lastname: Roth
authors.affiliation: Rouffach Hospital Center, Hospital hygiene service, 27, rue du 4(e) RSM, 68250 Rouffach, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Larocca
authors.affiliation: University of Franche-Comté, UMR 6249 Chrono-Environnement, 25000 Besançon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D011159:Population Surveillance; D012621:Seasons