European Journal of Epidemiology

, Volume 24, Issue 3, pp 149–155 | Cite as

Surveillance of lower respiratory tract infections outbreaks in nursing homes in France

  • Sophie Vaux
  • Isabelle Poujol
  • Isabelle Bonmarin
  • Daniel Lévy-Bruhl
  • Jean-Claude Desenclos


Lower respiratory tract infections (LRTI) are the leading cause of infectious deaths in nursing homes. An early reporting procedure of LRTI outbreaks to local public health authorities was set up in France in 2006 in order to reduce the morbidity and the mortality related to these events. Local public health authorities reported these outbreaks to the French institute for Public Health Surveillance through a web application allowing a real-time exchange of information. Between August 2006 and July 2007, 64 outbreaks were reported. In more than 30% of the episodes, influenza virus was detected. On average, attacks rates were 22% for the residents and 7% for the staff. Staff members were affected in at least 56% of outbreaks. Average influenza vaccine uptake was 91% for the residents and 38% for the staff. The time for control measures implementation was 6.7 days on average and control measures were implemented after reporting in 36% of outbreaks. When control measures were implemented more than 2 days after the onset of the first case, the duration of outbreaks was longer (16.4 days vs. 8.3 days, < 0.005) and residents had an increased rate of LRTI (P < 0.001) than when these measures were implemented earlier. These data show that the influenza immunization coverage for staff working in nursing homes is limited. The implementation of control measures is often delayed, although recommendations stress that they should start upon diagnosis of the first case. Reporting creates a dialog between nursing homes and public health professionals which facilitates outbreak management.


Disease outbreaks Frail elderly Nursing homes Respiratory tract infections 



Representatives of InVS at regional level


Local public health authorities


95% Confidence interval


Institut de veille sanitaire


Lower respiratory tract infection


Relative risk



We acknowledge nursing homes staff, local public health authorities and CIREs for management of outbreaks and for providing data and the Réseau Sentinelles (Inserm) for providing data.


  1. 1.
    Carrat F, Valleron AJ. Influenza mortality among the elderly in France, 1980–90: how many deaths may have been avoided through vaccination? J Epidemiol Community Health. 1995;49(4):419–25. doi: 10.1136/jech.49.4.419.PubMedCrossRefGoogle Scholar
  2. 2.
    Reichert TA, Simonsen L, Sharma A, Pardo SA, Fedson DS, Miller MA. Influenza and the winter increase in mortality in the United States, 1959–1999. Am J Epidemiol. 2004;160(5):492–502. doi: 10.1093/aje/kwh227.PubMedCrossRefGoogle Scholar
  3. 3.
    Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289(2):179–86. doi: 10.1001/jama.289.2.179.PubMedCrossRefGoogle Scholar
  4. 4.
    Menec VH, MacWilliam L, Aoki FY. Hospitalizations and deaths due to respiratory illnesses during influenza seasons: a comparison of community residents, senior housing residents, and nursing home residents. J Gerontol A Biol Sci Med Sci. 2002;57(10):M629–35.PubMedGoogle Scholar
  5. 5.
    Arden NH. Control of influenza in the long-term-care facility: a review of established approaches and newer options. Infect Control Hosp Epidemiol. 2000;21(1):59–64. doi: 10.1086/501702.PubMedCrossRefGoogle Scholar
  6. 6.
    Iorio AM, Neri M, Lepri E, Camilloni B, Basileo M, Sigismondi N, et al. An influenza A/H3 outbreak during the 2004/2005 winter in elderly vaccinated people living in a nursing home. Vaccine. 2006;24(44–46):6615–9. doi: 10.1016/j.vaccine.2006.05.037.PubMedCrossRefGoogle Scholar
  7. 7.
    Monto AS, Rotthoff J, Teich E, Herlocher ML, Truscon R, Yen HL, et al. Detection and control of influenza outbreaks in well-vaccinated nursing home populations. Clin Infect Dis. 2004;39(4):459–64. doi: 10.1086/422646.PubMedCrossRefGoogle Scholar
  8. 8.
    Hansmann Y, Doyle A, Remy V, Jaulhac B, Christmann D, Lesens O, et al. An outbreak of Pneumococcal pneumonia among residents of a retirement home in France during October 2003. Infect Control Hosp Epidemiol. 2006;27(11):1252–4. doi: 10.1086/508842.PubMedCrossRefGoogle Scholar
  9. 9.
    Louie JK, Yagi S, Nelson FA, Kiang D, Glaser CA, Rosenberg J, et al. Rhinovirus outbreak in a long term care facility for elderly persons associated with unusually high mortality. Clin Infect Dis. 2005;41(2):262–5. doi: 10.1086/430915.PubMedCrossRefGoogle Scholar
  10. 10.
    Louie JK, Schnurr DP, Pan CY, Kiang D, Carter C, Tougaw S, et al. A summer outbreak of human metapneumovirus infection in a long-term-care facility. J Infect Dis. 2007;196(5):705–8. doi: 10.1086/519846.PubMedCrossRefGoogle Scholar
  11. 11.
    Nakashima K, Tanaka T, Kramer MH, Takahashi H, Ohyama T, Kishimoto T, et al. Outbreak of Chlamydia pneumoniae infection in a Japanese nursing home, 1999–2000. Infect Control Hosp Epidemiol. 2006;27(11):1171–7. doi: 10.1086/508825.PubMedCrossRefGoogle Scholar
  12. 12.
    Thigpen MC, Thomas DM, Gloss D, Park SY, Khan AJ, Fogelman VL, et al. Nursing home outbreak of invasive group a streptococcal infections caused by 2 distinct strains. Infect Control Hosp Epidemiol. 2007;28(1):68–74. doi: 10.1086/508821.PubMedCrossRefGoogle Scholar
  13. 13.
    Ministère de la Santé et des solidarités.Direction générale de la Santé. Recommandations relatives aux conduites à tenir devant des infections respiratoires aiguës en collectivités de personnes âgées. Rapport du coneil supérieur d’hygiène publique de France. Section des maladies transmissibles (Novembre 2005). [cited 2008 July 3]; .
  14. 14.
    Carrat F, Flahault A, Boussard E, Farran N, Dangoumau L, Valleron AJ. Surveillance of influenza-like illness in France. The example of the 1995/1996 epidemic. J Epidemiol Community Health. 1998;52(1):32S–8S.PubMedGoogle Scholar
  15. 15.
    Gomolin IH, Kathpalia RK. Influenza. How to prevent and control nursing home outbreaks. Geriatrics. 2002;57(1):28–34.PubMedGoogle Scholar
  16. 16.
    Jefferson T, Foxlee R, Del MC, Dooley L, Ferroni E, Hewak B, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ. 2008;336(7635):77–80. doi: 10.1136/bmj.39393.510347.BE.PubMedCrossRefGoogle Scholar
  17. 17.
    Jefferson T, Rivetti D, Rivetti A, Rudin M, Di PC, Demicheli V. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet. 2005;366(9492):1165–74. doi: 10.1016/S0140-6736(05)67339-4.PubMedCrossRefGoogle Scholar
  18. 18.
    Monto AS, Hornbuckle K, Ohmit SE. Influenza vaccine effectiveness among elderly nursing home residents: a cohort study. Am J Epidemiol. 2001;154(2):155–60. doi: 10.1093/aje/154.2.155.PubMedCrossRefGoogle Scholar
  19. 19.
    Remarque EJ, Cools HJ, Boere TJ, van der Klis RJ, Masurel N, Ligthart GJ. Functional disability and antibody response to influenza vaccine in elderly patients in a Dutch nursing home. BMJ. 1996;312(7037):1015.PubMedGoogle Scholar
  20. 20.
    Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333(7581):1241. doi: 10.1136/bmj.39010.581354.55.PubMedCrossRefGoogle Scholar
  21. 21.
    Thomas RE, Jefferson TO, Demicheli V, Rivetti D. Influenza vaccination for health-care workers who work with elderly people in institutions: a systematic review. Lancet Infect Dis. 2006;6(5):273–9. doi: 10.1016/S1473-3099(06)70462-5.PubMedCrossRefGoogle Scholar
  22. 22.
    Shugarman LR, Hales C, Setodji CM, Bardenheier B, Lynn J. The influence of staff and resident immunization rates on influenza-like illness outbreaks in nursing homes. J Am Med Dir Assoc. 2006;7(9):562–7. doi: 10.1016/j.jamda.2006.06.002.PubMedCrossRefGoogle Scholar
  23. 23.
    Hofmann F, Ferracin C, Marsh G, Dumas R. Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs. Infection. 2006;34(3):142–7. doi: 10.1007/s15010-006-5109-5.PubMedCrossRefGoogle Scholar
  24. 24.
    Kimura AC, Nguyen CN, Higa JI, Hurwitz EL, Vugia DJ. The effectiveness of vaccine day and educational interventions on influenza vaccine coverage among health care workers at long-term care facilities. Am J Public Health. 2007;97(4):684–90. doi: 10.2105/AJPH.2005.082073.PubMedCrossRefGoogle Scholar
  25. 25.
    Dutheil N. Les établissements d’hébergement pour personnes âgées en 2003: locaux et équipements. Etudes et résultats. Direction de la recherche des études de l’évaluation et des statistiques 2005 March [cited 2008 Apr 14]; .
  26. 26.
    Gupta RK, Zhao H, Cooke M, Harling R, Regan M, Bailey L, et al. Public health responses to influenza in care homes: a questionnaire-based study of local Health Protection Units. J Public Health (Oxf). 2007;29(1):88–90. doi: 10.1093/pubmed/fdl082.CrossRefGoogle Scholar
  27. 27.
    Noël D, Vaux S, Fonteneau L, Guthmann JP, Lévy-Bruhl D. Survey of influenza vaccination coverage and its determinants in nursing homes in France, season 2007–2008. In: The 2nd European Scientific Conference on Applied Infectious Disease Epidemiology, 19–21 November 2008. Berlin, Germany: European Centre for Disease Prevention and control, 74.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Sophie Vaux
    • 1
  • Isabelle Poujol
    • 1
  • Isabelle Bonmarin
    • 1
  • Daniel Lévy-Bruhl
    • 1
  • Jean-Claude Desenclos
    • 1
  1. 1.Département des maladies infectieusesInstitut de Veille Sanitaire (InVS) (French Institute for Public Health Surveillance)Saint-Maurice CedexFrance

Personalised recommendations