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Lessons from a nursing home outbreak of influenza A
1Department of Tropical Medicine, School of Public Health, University of Hawaii, Honolulu, USA.
Objective:
To characterize risk factors for outbreak-associated influenza illness and death in a nursing home.
Design:
Outbreak investigation with predetermined and concurrently determined risk information.
Setting:
A nursing home service in a multiward chronic care hospital, Honolulu, Oahu, 1989 to 1990.
Patients:
Elderly nursing home patients receiving long-term care.
Interventions:
Influenza vaccination, amantadine administration, and infection control measures.
Results:
Neither routine infection control measures nor vaccination prevented illness, complications, or death in a nursing home outbreak of influenza A. The 55% case-fatality rate resulted from severe pneumonia. Influenza transmission may have been mediated by staff via either contaminated hands or fomites.
Conclusions:
Data from this and other outbreaks suggest that recommendations for preventing nosocomial influenza in the nation's 1.5 million nursing home residents should be reconsidered.