LESSONS FROM A NURSING-HOME OUTBREAK OF INFLUENZA-A

OBJECTIVE: To characterize risk factors for outbreak-associated influe nza illness and death in a nursing home. DESIGN: Outbreak investigatio n with predetermined and concurrently determined risk information. SET TING: A nursing home service in a multiward chronic care hospital, Hon olulu, Oahu, 1989 to 1990. PATIENTS: Elderly nursing home patients rec eiving long-term care. INTERVENTIONS: Influenza vaccination, amantadin e administration, and infection control measures. RESULTS: Neither rou tine infection control measures nor vaccination prevented illness, com plications, or death in a nursing home outbreak of influenza A. The 55 % case-fatality rate resulted from severe pneumonia. influenza transmi ssion 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.