Chlamydia pneumoniae as a New Source of Infectious Outbreaks in Nursing Homes

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Abstract
Objective. —To determine the extent and severity of illness and mode of transmission of Chlamydia pneumoniae infection in 3 nursing home outbreaks. Design and Setting. —Retrospective cohort study in 3 nursing homes in Ontario from September to November 1994. Subjects. —A total of 549 residents and 65 staff members. Main Outcome Measures. —Morbidity and mortality were determined by a review of disease surveillance forms, residents' charts, and a self-administered questionnaire to staff. Single and paired serum samples forC pneumoniaeserological testing and nasopharyngeal swabs forCpneumoniaeculture were collected, and direct fluorescent antibody assays were performed to confirmC pneumoniaeinfection. Results. —The attack rates for confirmed and suspected cases combined were 68%, 46%, and 44% among residents in nursing homes A, B, and C, respectively, and 34% among nursing home C staff. A total of 16 cases of pneumonia confirmed by chest x-ray and 6 deaths were identified. The spectrum of illness among nursing home C residents included a new cough in 58 (100%), fever in 37 (64%), sore throat in 14 (24%), and hoarseness in 8 (14%). Staff members at nursing home C were more likely to report hoarseness (P<.001) and sore throat (P<.001). Residents who smoked had onset of illness earlier than nonsmokers (P=.007), which perhaps is related to airborne transmission in a designated smoking room. Conclusions. —Chlamydia pneumoniaecaused serious morbidity and mortality among residents and morbidity among staff;Cpneumoniaeis an important cause of respiratory disease outbreaks in nursing homes, and diagnostic tests must be readily available for early recognition ofC pneumoniaeinfections.

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