Respiratory tract outbreak modeling with case definition criteria: A proposal for a standardized clinical approach in nursing homes

Objectives: This study aimed to monitor respiratory tract outbreaks in nursing homes (NH) by applying standardized case definition criteria, pathogen identification and estimated mortality impact. Patients and methods: This longitudinal, observational study described NH outbreaks with temperature (T degrees), upper respiratory sign, lower respiratory sign (LRS), general status deterioration, general signs, and mortality. Viral examinations allowed for analysis of developing outbreaks based on positive, negative, or no tests (Flu+/Flu-/NT-Flu). Results: Forty-six influenza identification episodes (Flu+, 1067 patients), 14 Flu- (409 patients), and 18 NT-Flu (381 patients) were analyzed. Viral examinations were conducted mainly among residents with T degrees (84.8% [302/356]). A specific temperature pattern was observed in Flu+ outbreaks: 35.1% of infected residents with T degrees without LRS, 15.6% in Flu- episodes, and 17.1% vs. 29.1% in LRS without T degrees. A median temperature (MT) of >= 38.3 degrees C was observed in Flu+ outbreaks. MT analysis of the 18 NT-Flu episodes identified five outbreaks with high temperatures (MT >= 38.2 degrees C) and high mortality. Conversely, the 13 NT-Flu outbreaks with lower MT (<38.0 degrees C) were associated with lower total mortality. Similar clinical pictures led to closely comparable all-cause mortality impacts, particularly in Flu+, Flu-, and NT-Flu with MT of >= 38.2 degrees C. Conclusions: Validated sign/symptom monitoring highlighted some specificities of respiratory NH outbreaks and could be a complementary approach, taking into account common and atypical clinical pictures, assessing mortality and initiating virological investigations and infection control measures. (C) 2022 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).