A Rhinovirus Outbreak among Residents of a Long-Term Care Facility

doi:10.1059/0003-4819-123-8-199510150-00004

A Rhinovirus Outbreak among Residents of a Long-Term Care Facility

From the University of Wisconsin Medical School, the University of Wisconsin, the William S. Middleton Veterans Administration Hospital, and the Wisconsin State Laboratory of Hygiene, Madison, Wisconsin; and the Wisconsin Veterans Home, King, Wisconsin. Acknowledgments: The authors thank Susan Voeks and Shiela Schultz for assistance in collecting data and obtaining cultures and Carol Kirk for culture processing and supervision. Grant Support: In part by National Institutes of Health grants AG00213 (Dr. Wald) and AG09632 and AG00548 (Dr. Gravenstein). Requests for Reprints: Stefan Gravenstein, MD, University of Wisconsin, Institute on Aging, 1300 University Avenue, Room 2245 MSC, Madison, WI 53706. Current Author Addresses: Dr. Wald: University of Medicine & Dentistry of New Jersey, Robert Wood Johnson Medical School, Department of Medicine, Division of General Internal Medicine and Geriatrics, One Robert Wood Johnson Place, New Brunswick, NJ 08903.

Abstract

Objective: To describe the epidemiology of and clinical findings associated with a rhinovirus outbreak that occurred among institutionalized elderly persons.

Design: Retrospective review of medical records and nursing surveillance reports.

Setting: A 685-bed, long-term care facility for veterans and their spouses.

Patients: 33 persons from whom rhinovirus was cultured.

Measurements: Throat and nasopharyngeal virus culture; review of medical records to determine underlying diseases, signs and symptoms of respiratory illness, illness duration, and interventions during illness; and review of nursing surveillance reports to determine room locations of ill persons.

Results: Between 14 August and 2 September 1993, the number of respiratory illnesses increased. Throat and nasopharyngeal virus cultures were taken from 67 ill residents; 33 cultures yielded rhinovirus, and no other respiratory virus was isolated. Geographic clustering of persons infected with rhinovirus was observed. Of those persons with rhinovirus infections, 100% had upper respiratory symptoms, 34% had gastrointestinal symptoms, 71% had systemic symptoms, 66% had lower respiratory symptoms (including productive cough), and 52% had new abnormalities on lung auscultation. The 17 persons with rhinovirus infection who had chronic obstructive pulmonary disease had more severe illnesses: Five (29%) required glucocorticoid or bronchodilator therapy for illness-associated bronchospasm; 2 required transfer out of the facility; 1 developed a radiographically documented infiltrate; and 1 died of respiratory failure.

Conclusions: Rhinovirus may cause epidemic, clinically important respiratory illness in nursing home residents. A large proportion of residents may become ill, and infection may be severe in persons with underlying lung disease.