Viral respiratory infections in a nursing home: a six-month prospective study.
The knowledge on viral respiratory infections in nursing home (NH) residents and their caregivers is limited. The purpose of the present study was to assess and compare the incidence of acute respiratory infections (ARI) in nursing home (NH) residents and staff, to identify viruses involved in ARI and to correlate viral etiology with clinical manifestations of ARI.



The prospective surveillance study was accomplished in a medium-sized NH in Slovenia (central Europe). Ninety NH residents and 42 NH staff were included. Nasopharyngeal swabs were collected from all participants at enrollment (December 5th, 2011) and at the end of the study (May 31st, 2012), and from each participant that developed ARI within this timeframe. Molecular detection of 15 respiratory viruses in nasopharyngeal swab samples was performed.



The weekly incidence rate of ARI in NH residents and NH staff correlated; however, it was higher in staff members than in residents (5.9 versus 3.8/1,000 person-days, P = 0.03), and was 2.5 (95 % CI: 1.36-4.72) times greater in residents without dementia than in residents with dementia. Staff members typically presented with upper respiratory tract involvement, whereas in residents lower respiratory tract infections predominated. Respiratory viruses were detected in 55/100 ARI episodes. In residents, influenza A virus, respiratory syncytial virus, and human metapneumovirus were detected most commonly, whereas in NH staff rhinovirus and influenza A virus prevailed. 38/100 ARI episodes (30/56 in residents, 8/44 in staff) belonged to one of three outbreaks (caused by human metapneumovirus, influenza A virus and respiratory syncytial virus, respectively). NH residents had higher chances for virus positivity within outbreak than HN staff (OR = 7.4, 95 % CI: 1.73-31.48, P < 0.01).



ARI are common among NH residents and staff, and viruses were detected in a majority of the episodes of ARI. Many ARI episodes among NH residents were outbreak cases and could be considered preventable.



The study was registered on the 1thof December 2011 at ClinicalTrials ( NCT01486160 ).
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia. tina.ursic@mf.uni-lj.si.
Tina
0000-0002-5621-7167
T
Uršič
Department of Infectious Diseases, Maribor University Medical Center, Ljubljanska 5, 2000, Maribor, Slovenia.
Nina Gorišek
NG
Miksić
Faculty of Medicine, Institute for Biostatistics and Medical Informatics, Vrazov trg 2, 1104, Ljubljana, Slovenia.
Lara
L
Lusa
Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia.
Franc
F
Strle
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia.
Miroslav
M
Petrovec
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009297:Nasal Mucosa / Q000821:virology; D009735:Nursing Homes; D011159:Population Surveillance; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D017524:Slovenia / Q000453:epidemiology
Human metapneumovirus; Human rhinovirus/enterovirus; Influenza A virus; Nursing home; Nursing home caregivers; Nursing home residents; Respiratory infections; Respiratory syncytial virus; Viral etiology; Visitors