Abstract
BackgroundThe 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.MethodsThe 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.ResultsThe 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).ConclusionsARI 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.Trial registrationThe study was registered on the 1th of December 2011 at ClinicalTrials (NCT01486160).
Highlights
The knowledge on viral respiratory infections in nursing home (NH) residents and their caregivers is limited
The objectives of the study were to assess and compare the incidence of acute respiratory infections (ARI) in NH residents and NH staff, to identify viruses involved in ARI, and to correlate viral etiology with clinical manifestations of ARI in the population observed
A higher incidence rate of lower respiratory tract infection (LRTI) as compared to upper respiratory tract infection (URTI) in NH residents was rather expected, the LRTI vs. URTI ratio found in this study (2.7:1) was substantially higher than the ratio reported for NH residents in Germany (1.4:1) and in Wisconsin (1.7:1) [13, 16]
Summary
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. Picornaviruses (hRV/EV) are predominantly associated with the common cold but are the cause of lower respiratory tract infections, especially in small children and the elderly [7].] HMPV and hCoV are distributed worldwide, and in countries with temperate climates they usually cause winter epidemics, which often follow an RSV outbreak [8, 9]. Scant clinical symptoms combined with a shortage of medical personnel and limited diagnostic facilities can lead to delayed recognition of infections and delayed introduction of preventive measures
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