Objective: To characterize risk factors for outbreak-associated influenza illness and death in a nursing home.
Design: Outbreak investigation with predetermined and concurrently determined risk information.
Setting: A nursing home service in a multiward chronic care hospital, Honolulu, Oahu, 1989 to 1990.
Patients: Elderly nursing home patients receiving long-term care.
Interventions: Influenza vaccination, amantadine administration, and infection control measures.
Results: Neither routine infection control measures nor vaccination prevented illness, complications, or death in a nursing home outbreak of influenza A. The 55% case-fatality rate resulted from severe pneumonia. Influenza transmission 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.