Healthcare Infection Prevention
Lack of vaccination prime risk factor
Seven infected lived in same ward
In underscoring the need for pneumococcal immunization in long-term care facilities, the Centers for Disease Control released an investigation report of an outbreak earlier this year in New Jersey. The key facts reported include:1
• On April 24, 2001, seven cases of pneumococcal pneumonia with bacteremia among residents of a nursing home were reported to the Hamilton Township (NJ) Department of Health.
• All seven diagnoses were confirmed with blood cultures positive for Streptococcus pneumoniae. Illness onset among the residents occurred during April 3-24; four residents died.
• The nursing home is a 114-bed facility that employs approximately 200 staff, including nurses, restorative aides, and other administrative and support personnel. None of the employees was known to have pneumonia or laboratory-confirmed pneumococcal disease during this period.
• On further investigation, two additional residents were identified to have been hospitalized during April 3-24 with pneumonia. Seven of the nine patients had blood cultures positive for S. pneumoniae. All isolates were serotype 14, belonged to the same clonal group and penicillin-sensitive but resistant to erythromycin. Sputum specimens from the two remaining residents were Gram stain positive for diplococci and findings from chest radiographs were consistent with pneumonia. Seven of the residents lived in the same wing of the nursing home.
• A case-control study was conducted to determine risk factors for pneumococcal pneumonia among residents of the nursing home. Cases included the nine residents hospitalized with pneumonia. Two controls per case-patient were selected randomly from among nursing home residents without pneumonia symptoms who resided in the wing where most of the case-patients resided during March 1- April 26. Nursing home medical records of case-patients and controls were reviewed, and a standardized form was used to abstract data.
• Case patients had a median age of 86 (78-100); seven (78%) were women. Controls had a median age of 85 (58-95), and 17 (94%) were women. (None of nine case patients vs. nine of 18 controls; odds ratio = 0; 95% confidence interval = 0 — 0.7). A case control study revealed that illness was strongly associated with lack of documentation of receipt of pneumococcal polysaccharide vaccine (PPV).
• At the time of the initial case of pneumococcal illness on April 3, 2001, 53 (49%) of the 108 residents had received PPV. When the outbreak was recognized, PPV was offered to all 55 nonvaccinated residents; 37 (67%) received vaccine. The remaining 18 were either ineligible for PPV or refused it.
• The nursing home restricted transfers or admissions of patients with no history of having received PPV.
Reference
1. Centers for Disease Control and Prevention. Outbreak of pneumococcal pneumonia among unvaccinated residents of a nursing home — New Jersey, April 2001. MMWR 2001; 50:707-710.
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