ABSTRACT
Viral respiratory infections, although extremely common during childhood, decrease in frequency with increasing age. In general, older adults experience approximately one upper respiratory infection (URI) per year (1). Although the incidence of infection is lower, the morbidity of these respiratory viruses is significantly greater in the elderly compared to the young. The reasons for more severe disease are multifactorial and include an aging lung, the presence of comorbid conditions, and age-related immune dysfunction. In long-term care facilities, the rates of acute respiratory tract infection vary depending on the season studied and the methods used for diagnosis. Several studies estimate the rate of URI to be 1-3 per resident per year. Acute respiratory tract infection was reported at a rate of 6.3/100 person-months in a study conducted during the winter at a 590-bed long-term care facility in Rochester, New York (2). Forty-two percent of these infections were proven to be caused by viruses. The devastating effect of influenza outbreaks is well defined in the nursing home population, but the impact of other viruses is less well known. Respiratory syncytial virus (RSV) infection has emerged as an important pathogen causing significant morbidity and mortality approaching that of influenza infection. Although less data are available, other viruses, such as parainfluenza, coronavirus, human metapneumovirus, and rhinoviruses, have also been described as pathogens in elderly adults and may also contribute to increased mortality. Control of viral respiratory infections in chronic care facilities can be challenging because specific diagnosis is often difficult. Congregate settings, hands-on attention required by staff and residents, and cognitive deficits that hamper disease recognition all contribute to the spread of viruses and the development of outbreaks. In this chapter, the clinical presentation and impact of influenza, RSV, coronavirus, parainfluenza, human metapneumovirus, and rhinovirus infections in residents of long-term care facilities will be reviewed. The mode of transmission and methods for prevention of these viruses will also be discussed.
