Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-04T21:22:26.242Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Chlamydia pneumoniae Infection in a Japanese Nursing Home, 1999-2000

Published online by Cambridge University Press:  21 June 2016

Kazutoshi Nakashima ,
Takeshi Tanaka ,
Michael H. Kramer ,
Hiroshi Takahashi ,
Takaaki Ohyama ,
Toshio Kishimoto ,
Hironori Toshima ,
Shigeyuki Miwa ,
Atsushi Nomura  and
Naoki Tsumura
...Show all authors
Kazutoshi Nakashima*
Affiliation:
Infectious Disease Surveillance Center, Yamaguchi, Japan
Takeshi Tanaka
Affiliation:
Infectious Disease Surveillance Center, Yamaguchi, Japan National Institute of Infectious Diseases, Tokyo, the Fukuoka Quarantine Station, Yamaguchi, Japan
Michael H. Kramer
Affiliation:
Infectious Disease Surveillance Center, Yamaguchi, Japan Bundesministerium für Gesundheit und Soziale Sicherung, Bonn, Germany
Hiroshi Takahashi
Affiliation:
Infectious Disease Surveillance Center, Yamaguchi, Japan
Takaaki Ohyama
Affiliation:
Infectious Disease Surveillance Center, Yamaguchi, Japan
Toshio Kishimoto
Affiliation:
Department of Virology I, Yamaguchi, Japan
Hironori Toshima
Affiliation:
Fukuoka, theToshima Clinic, Yamaguchi, Japan
Shigeyuki Miwa
Affiliation:
Nagato Environment and Health Center, Yamaguchi, Japan
Atsushi Nomura
Affiliation:
Nagato Environment and Health Center, Yamaguchi, Japan
Naoki Tsumura
Affiliation:
Department of Pediatrics, Kurume University School of Medicine, Yamaguchi, Japan
Kazunobu Ouchi
Affiliation:
Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
Nobuhiko Okabe
Affiliation:
Infectious Disease Surveillance Center, Yamaguchi, Japan
*
Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjyuku, Tokyo 162-8640, Japan ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To identify risk factors for infection and severe illness due to Chlamydia pneumoniae.

Methods.

To identify risk factors for infection, we conducted a case-control study among nursing home residents who had onset of symptoms during December 1, 1999, to February 20, 2000. To identify risk factors for severe illness among nursing home residents, we conducted a retrospective cohort study.

Setting.

A nursing home providing long-term and day care services for elderly patients in Japan.

Participants.

Fifty-nine residents and 41 staff members of a nursing home.

Results.

The attack rates for respiratory illness were 53% (31 of 59) among residents and 22% (9 of 41) among staff. Infection was confirmed in 15 resident and 2 staff case patients by isolation of C. pneumoniae from nasal swab specimens. Fifteen resident case patients developed severe illness (ie, bronchitis, pneumonia, and hypoxia); one case patient died. The median age of resident case patients was 87 years. We could identify neither the source of the outbreak nor significant risk factors for infection and severe illness in residents. However, residents with a higher level of physical activity were more likely to become infected, whereas older residents (aged more than 85 years) and those with a lower level of physical activity were more likely to develop severe illness (P>.05). Contact with residents was a risk factor for infection in staff (relative risk, undefined; P = .04).

Conclusions.

C. pneumoniae can cause large outbreaks of infection and severe illness among elderly persons, and its transmission is likely to be enhanced by close contacts among people in nursing homes. Therefore, early detection of an outbreak by means of better surveillance, and subsequent isolation of patients, may be effective control measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1171 - 1177
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Falck, G, Heyman, L, Gnarpe, J, Gnarpe, H. Chlamydia pneumoniae (TWAR): a common agent in acute bronchitis. Scand J Infect Dis 1994; 26:179–287.CrossRefGoogle ScholarPubMed
2. Ouchi, K, Nakazawa, T, Karita, M, Kanehara, Y. Prevalence of Chlamydia pneumoniae in acute lower respiratory infection in the pediatric population in Japan. Acta Paediatr Jpn 1994; 36:256–260.CrossRefGoogle ScholarPubMed
3. Miyashita, N, Niki, Y, Matsushima, T, Okimoto, N. Community-acquired Chlamydia pneumoniae pneumonia. Chest 2000; 117:615–616.CrossRefGoogle ScholarPubMed
4. Thom, DH, Grayston, JT, Campbell, LA, Kuo, CC, Diwan, VK, Wang, SP. Respiratory infection with Chlamydia pneumoniae in middle-aged and older adult outpatients. Eur J Clin Microbiol Infect Dis 1994; 13:785–792.CrossRefGoogle ScholarPubMed
5. Gaillat, J. Clinical manifestations of Chlamydia pneumoniae infections [in French]. Rev Med Interne 1996; 17:987–991.CrossRefGoogle ScholarPubMed
6. Lim, WS, Macfarlane, JT, Boswell, TC, et al. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax 2001; 56:296–301.CrossRefGoogle ScholarPubMed
7. Kuo, CC, Jackson, LA, Campbell, LA, Grayston, JT. Chlamydia pneumoniae (TWAR). Clin Microbiol Rev 1995; 8:451–461.CrossRefGoogle ScholarPubMed
8. Kishimoto, T. Studies on Chlamydia pneumoniae, strain TWAR infection, 2: seroepidemiology of TWAR on healthy controls and patients with acute respiratory infections [English abstract; in Japanese]. Kansenshogaku Zasshi 1990; 64:986–993.CrossRefGoogle ScholarPubMed
9. Persson, K. Epidemiological and clinical aspects on infections due to Chlamydia pneumoniae (strain TWAR). Scand J Infect Dis Suppl 1990; 69:63–67.Google ScholarPubMed
10. Grayston, JT, Campbell, LA, Kuo, CC, et al. A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis 1990; 161:618–625.CrossRefGoogle ScholarPubMed
11. Ekman, MR, Grayston, JT, Visakorpi, R, Kleemola, M, Kuo, CC, Saikku, P. An epidemic of infections due to Chlamydia pneumoniae in military conscripts. Clin Infect Dis 1993; 17:420–425.CrossRefGoogle ScholarPubMed
12. Kleemola, M, Saikku, P, Visakorpi, R, Wang, SP, Grayston, JT. Epidemics of pneumonia caused by TWAR, a new Chlamydia organism, in military trainees in Finland. J Infect Dis 1988; 157:230–236.CrossRefGoogle ScholarPubMed
13. Mordhorst, CH, Wang, SP, Grayston, JT. Outbreak of Chlamydia pneumoniae infection in four farm families. Eur J Clin Microbiol Infect Dis 1992; 11:617–620.CrossRefGoogle ScholarPubMed
14. Blasi, F, Cosentini, R, Denti, F, Allegra, L. Two family outbreaks of Chlamydia pneumoniae infection. Eur Respir J 1994; 7:102–104.CrossRefGoogle ScholarPubMed
15. Kishimoto, T, Kimura, M, Kubota, Y, Miyashita, N, Niki, Y, Soejima, R. An outbreak of Chlamydia pneumoniae infection in households and schools. In: Proceedings of the Eighth International Symposium on Human Chlamydial Infections, June 19-24, 1994. Gouvieux-Chantilly, France: Societa Editrice Esculapio; 1994.Google Scholar
16. Kishimoto, T, Soejima, R. Current topics of chlamydial respiratory tract infections: special reference to the epidemiology and clinical findings of Chlamydia pneumoniae infections in Japan. Intern Med 1993; 32:934–937.CrossRefGoogle Scholar
17. Troy, CJ, Peeling, RW, Ellis, AG, et al. Chlamydia pneumoniae as a new source of infectious outbreaks in nursing homes. JAMA 1997; 277:1214–1218.CrossRefGoogle ScholarPubMed
18. Gnarpe, J, Gnarpe, H, Gause-Nilsson, I, Lundorg, P, Steen, B. Seropreva-lence of antibodies to Chlamydia pneumoniae in elderly people: a two-decade longitudinal and cohort difference study. Scand J Infect Dis 2000; 32:177–179.Google Scholar
19. Toshima, Y, Tsumura, N, Ikezawa, S, Suda, H. Is Chlamydia pneumoniae prevalent in the elderly? Nihon Iji Shinpo 2000; 3987:37–42.Google Scholar
20. Roblin, PM, Dumornay, W, Hammerschlag, MR. Use of HEp-2 cells for improved isolation and passage of Chlamydia pneumoniae . J Clin Microbiol 1992; 30:1968–1971.CrossRefGoogle ScholarPubMed
21. Kishimoto, T. Diagnosis of infections with difficulty in isolation and identification of causative organisms, 2: Chlamydia pneumoniae infection [in Japanese]. Nippon Naika Gakkai Zasshi 1998; 87:2197–2202.Google ScholarPubMed
22. Kishimoto, T, Matsushima, T, Morikawa, T, Kawagoe, K. Assay of specific anti-Chlamydia pneumoniae antibodies by ELISA method, 3: setting of serological criteria [in Japanese]. Kansenshogaku Zasshi 1999; 73:457–466.CrossRefGoogle ScholarPubMed
23. Schafer, H, Ewig, S. Acute exacerbations in chronic obstructive pulmonary disease (COPD)—microbial patterns and risk factors. Monaldi Arch Chest Dis 2000; 55:415–419.Google ScholarPubMed
24. Hahn, DL. Chlamydia pneumoniae, asthma, and COPD: what is the evidence? Ann Allergy Asthma Immunol 1999; 83:271-288, 291; quiz 91-92.CrossRefGoogle ScholarPubMed
25. Kanamoto, Y, Ouchi, K, Mizui, M, Ushio, M, Usui, T. Prevalence of antibody to Chlamydia pneumoniae TWAR in Japan. J Clin Microbiol 1991; 29:816–818.CrossRefGoogle ScholarPubMed
26. Ouchi, K, Kanamoto, Y, Ushio, M. Prevalence of antibodies to Chlamydia pneumoniae (strain TWAR) and other Chlamydia in Japan [English abstract; in Japanese]. Kansenshogaku Zasshi 1991;65:19–25.CrossRefGoogle ScholarPubMed