Two Outbreaks of Severe Respiratory Disease in Nursing Homes Associated with Rhinovirus

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Abstract
Objectives: To characterize illness and identify the etiology for two nursing home outbreaks of respiratory illness. Design: Multisite outbreak investigations; cohort. Setting: Two nursing homes in Pennsylvania. Participants: Facility A residents (n=170), Facility B residents (n=124), and employees (n=91). Measurements: Medical records for Facility A and B residents were reviewed, and employees from Facility B self‐administered a questionnaire to identify risk factors for illness. Serological, oropharyngeal, and nasopharyngeal specimens were collected for both outbreaks, and testing for respiratory pathogens was performed. Results: In Facility A, 40 (24%) of 170 residents were identified with respiratory illness; 13 (33%) case‐patients had radiographically confirmed pneumonia, 15 (38%) were taken to a hospital, and two (5%) died. Of 10 specimens collected from symptomatic Facility A case‐patients, four (40%) tested positive using reverse transcription polymerase chain reaction for rhinovirus. In Facility B, 77 (62%) of 124 residents had respiratory illness, and 40 (52%) had radiographically confirmed pneumonia; 12 (16%) case‐patients were hospitalized, and five (6%) died. Of 19 respiratory specimens collected from symptomatic Facility B case‐patients, six (32%) were positive for rhinovirus; one was from an employee. Five (50%) of 10 rhinovirus‐positive cases in both outbreaks had clinical and radiographic evidence of pneumonia. Conclusion: These investigations suggest that rhinoviruses may be an underrecognized cause of respiratory outbreaks in nursing homes, capable of causing pneumonia and perhaps death.