VIRAL RESPIRATORY-INFECTIONS IN THE INSTITUTIONALIZED ELDERLY - CLINICAL AND EPIDEMIOLOGIC FINDINGS

Objective: To prospectively evaluate the incidence and impact of viral respiratory infection in the institutionalized elderly during a winter season. Design: Prospective descriptive study, without intervention. Method: Patients with respiratory illnesses were evaluated by a directed history and physical examination. Nasopharyngeal secretions for viral culture were obtained, and acute and convalescent serum samples were obtained for analysis. Serologic evidence of infection with respiratory syncytial virus (RSV) and parainfluenza were determined by enzyme immunoassay (EIA), and influenza by hemagglutination-inhibition assay and EIA. Setting: A 591-bed nursing home. Participants: Residents with signs or symptoms of acute respiratory illness (nasal congestion, pharyngitis, cough, wheezing, or respiratory difficulty) were eligible for study. Results: A viral etiology was documented in 62 out of 149 illnesses (42%). RSV was the most common virus associated with illness; it was documented in 27% of respiratory illnesses, followed by rhinovirus (9%), parainfluenza (6%), and influenza (1%). RSV was associated with significantly more severe disease when compared with rhinovirus. Clustering of specific viral infections occurred, suggesting nosocomial transmission. Conclusions: Viruses are an important cause of acute respiratory infections in the institutionalized elderly during the winter months.