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

Tina G. Wald, MD; Peter Shult, PhD; Peggy Krause, RN; Barbara A. Miller, BSN; Paul Drinka, MD; and Stefan Gravenstein, MD
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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.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(8):588-593. doi:10.7326/0003-4819-123-8-199510150-00004
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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.


Grahic Jump Location
Figure 1.
Outbreak curve for the entire facility.

The number of illnesses and culture results according to date for all four residential buildings in the facility.

Grahic Jump Location




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