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Carla J. Troy, MHSc; Rosanna W. Peeling, PhD; Andrea G. Ellis, DVM; James C. Hockin, MD; Deborah A. Bennett, BScN; Monica R. Murphy; John S. Spika, MD

JAMA. 1997;277(15):1214-1218.

Abstract
Objective.
—To determine the extent and severity of illness and mode of transmission of Chlamydia pneumoniae infection in 3 nursing home outbreaks.

Design and Setting.
—Retrospective cohort study in 3 nursing homes in Ontario from September to November 1994.

Subjects.
—A total of 549 residents and 65 staff members.

Main Outcome Measures.
—Morbidity and mortality were determined by a review of disease surveillance forms, residents' charts, and a self-administered questionnaire to staff. Single and paired serum samples for C pneumoniae serological testing and nasopharyngeal swabs for Cpneumoniae culture were collected, and direct fluorescent antibody assays were performed to confirm C pneumoniae infection.

Results.
—The attack rates for confirmed and suspected cases combined were 68%, 46%, and 44% among residents in nursing homes A, B, and C, respectively, and 34% among nursing home C staff. A total of 16 cases of pneumonia confirmed by chest x-ray and 6 deaths were identified. The spectrum of illness among nursing home C residents included a new cough in 58 (100%), fever in 37 (64%), sore throat in 14 (24%), and hoarseness in 8 (14%). Staff members at nursing home C were more likely to report hoarseness (P<.001) and sore throat (P<.001). Residents who smoked had onset of illness earlier than nonsmokers (P=.007), which perhaps is related to airborne transmission in a designated smoking room.

Conclusions.
—Chlamydia pneumoniae caused serious morbidity and mortality among residents and morbidity among staff; Cpneumoniae is an important cause of respiratory disease outbreaks in nursing homes, and diagnostic tests must be readily available for early recognition of C pneumoniae infections.

Author Affiliations
From the Ontario Ministry of Health, Toronto (Ms Troy); Field Epidemiology Training Program (Drs Ellis and Hockin and Ms Troy), Bureaus of Microbiology (Dr Peeling), and Infectious Diseases (Dr Spika), Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario; the Windsor-Essex County Health Unit, Windsor, Ontario (Ms Bennett); and the Windsor Regional Public Health Laboratory (Ms Murphy).

Footnotes
Reprints: James C. Hockin, MD, Field Epidemiology Training Program, Laboratory Centre for Disease Control, 0602B Tunney's Pasture, Ottawa, Ontario, Canada K1A 0L2 (e-mail: fetp@hpe.hwc.ca).

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