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Epidemiologic Notes and Reports Impact of Influenza on a Nursing Home Population -- New York

During December 1982, 49 (60.5%) of 81 residents at a skilled-nursing facility in upstate New York experienced influenza-like illness (1) with elevated temperature ( greater than or equal to 37.8 C (100.0 F) oral or greater than or equal to 38 C (100.4 F) rectal) and at least one of the following symptoms: cough, congestion, or sore throat. Six of the clinically diagnosed cases occurred sporadically before December 18, when the main cluster began, and the outbreak peaked on December 21 (Figure 1). Influenza type A(H3N2) virus was grown from three of six respiratory specimens cultured from ill residents on December 24. Six residents were hospitalized following influenza-like illnesses. Three of those, as well as one non-hospitalized resident with influenza-like illness, died, for a case-fatality ratio of 8.2%. Sixty-five (80.2%) of the 81 residents were female, and 38 (58.5%) of those were ill. The mean age for all patients was 86.4 years.

All residents except one were more than 65 years old, and 78 (96.3%) had at least one pre-existing medical condition for which influenza vaccine is strongly recommended (2). Influenza vaccine had been offered to all residents in October 1982, and permission to give it was received for 54 (66.7%), all of whom were vaccinated. Using the case definition above, the clinical attack rate for the vaccinated residents was 48.1%, and for the 27 unvaccinated residents, 85.2%, resulting in a calculated rate of vaccine efficacy in preventing clinical influenza illness of 43.5%.

During December, the number of visits for acute respiratory disease (ARD) at the emergency room (ER) of an adjacent hospital increased to 171 (31% of total visits) from 64 (14.5% of total visits) in November; during the week ending December 12, 33% of ER visits were for ARD, compared with 20% or less during each of the preceding 2 weeks, and 10%-15% in early and mid-November. Reported by R Stricof, MPH, D Morse, MD, R Rothenberg, MD, State Epidemiologist, New York State Dept of Health; M Johnson, D Weaver, MD, W Luft, MD, Robert Packer Hospital, Sayre, V Pidcoe, DVM, Pennsylvania Dept of Health; WHO Collaborating Center for Influenza, Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: This outbreak is unusual for its high attack rate of influenza-like illness, which ranged from 48% in vaccinated residents to 85% in non-vaccinated residents. Although the overall estimated attack rates are based only on clinical illness, without supportive diagnostic results for most patients, the probability that the outbreak was largely associated with influenza viruses is supported by the finding that the impact of the outbreak was apparently lessened by vaccine use in more than half the residents. To reduce the impact of influenza on nursing home residents, it appears desirable that, except where specifically contraindicated (e.g., persons with egg allergy), consent for vaccination be given by all residents or relatives responsible for them, and that communications from hospitals or physicians about increased influenza activity be rapidly made available to those in the locality responsible for infection control measures in nursing homes.

References

  1. CDC. Influenza update--United States. MMWR 1983;32:17.

  2. ACIP. Influenza vaccines 1982-1983. MMWR 1982;31:349-53.



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