Gastroenteritis and respiratory infection outbreaks in French nursing homes from 2007 to 2018: Morbidity and all-cause lethality according to the individual characteristics of residents

Autoři: Philippe Gaspard aff001;  Anne Mosnier aff003;  Loic Simon aff004;  Olivia Ali-Brandmeyer aff004;  Christian Rabaud aff004;  Sabrina Larocca aff001;  Béatrice Heck aff001;  Serge Aho-Glélé aff005;  Pierre Pothier aff006;  Katia Ambert-Balay aff006
Působiště autorů: Hospital Hygiene Service, Rouffach Hospital Center, Rouffach, France aff001;  UMR 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France aff002;  Open Rome, Paris, France aff003;  Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy University Hospital, Nancy, France aff004;  Department of Epidemiology and Infection Control, Dijon University Hospital, Dijon, France aff005;  University Burgundy Franche-Comté, AgroSup Dijon, PAM UMR A 02.102, Dijon, France aff006;  National Reference Center for Gastroenteritis Viruses, Laboratory of Biology and Pathology, University Hospital, Dijon, France aff007
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222321



Gastroenteritis (GE) and respiratory tract infection (RTI) outbreaks are a significant issue in nursing homes. This study aimed to describe GE and RTI outbreaks with infection and all-cause lethality rates according to the individual characteristics of nursing home residents.


Clinical and virological surveillance were conducted (2007 to 2018). Virus stratifications for the analysis were: outbreaks with positive norovirus or influenza identifications (respectively NoV+ or Flu+), episodes with no NoV or influenza identification or testing (respectively NoV- or Flu-). Associations between individual variables (sex, age, length of stay (LOS), autonomy status) and infection and lethality rates were tested with univariate and Mantel-Haenszel (MH) methods.


61 GE outbreaks and 76 RTI oubreaks (total 137 outbreaks) were recorded involving respectively 4309 and 5862 residents. In univariate analysis, higher infection rates and age were associated in NoV+, NoV-, and Flu+ contexts, and lower infection rates were associated with longer stays (NoV+ and NoV-). In MH stratified analysis (virus, sex (female/male)) adjusted for LOS (<4 or ≥4 years), the odds of being infected remained significant among older residents (≥86 years): NoV+/male (Odds ratio (ORMH): 1.64, 95% confidence interval (CI): 1.16–2.30) and Flu+/female and male (respectively ORMH: 1.50, CI: 1.27–1.79 and 1.73, CI: 1.28–2.33). In univariate analysis, lower autonomy status (NoV+, Flu+ and Flu-) and increased age (Flu+) were associated with higher lethality. In MH adjusted analysis, significant ORage adjusted for autonomy was: Flu+/ ≥86 years compared with <86 years, 1.97 (1.19–3.25) and ORautonomy adjusted for age for the more autonomous group (compared with the less autonomous group) was: Flu+, 0.41 (0.24–0.69); Flu-, 0.42 (0.20, 0.90).


The residents of nursing homes are increasingly elderly and dependent. The specific infection and lethality risks according to these two factors indicate that surveillance and infection control measures are essential and of high priority.

Klíčová slova:

Death rates – Epidemiology – Infectious disease surveillance – Influenza – Influenza viruses – Norovirus – Nursing homes – Respiratory infections


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