[Investigation of an outbreak of norovirus gastroenteritis in a geriatric hospital]. / Investigation d'une épidémie de gastro-entérite à norovirus dans un hôpital gériatrique.

In aged-care facilities, gastroenteritis outbreaks are responsible for big trouble in the management of cares to the elderly. In November 2002, a gastroenteritis outbreak was observed in 5 of the 6 wards of the geriatric hospital La Charité, University Hospital of Saint-Etienne, France, with an attack rate of 38.5% in the elderly (70 infected from 182 patients) and of 26.0% in the nursing staff (40 infected from 154 agents). The outbreak lasted 30 days with a peak corresponding to 79.8% of the cases between the 11(th) and the 20(th) of November. The first cases were observed in the two short-term-care wards; then, the outbreak spread rapidly to 3 of the 4 long-term care units. Health care workers were contaminated later than the elderly (P < 0.001 by Kruskal-Wallis test). A self-administered questionnaire was documented by most of the nursing staff; the most frequently observed clinical symptoms in this population were nausea (82.5%), abdominal pain (80.0%), diarrhoea (70.5%), asthenia (67.5%) and vomiting (62.5%). Thirty-five percent of the health care workers ceased their work. The causative agent of the gastroenteritis was identified by RT-PCR in the stools of 5 aged persons as a norovirus close to the Lordsdale strain (genogroup II). These findings illustrate the respective role of elderly and health care workers in the spread of the gastroenteritis outbreak inside the geriatric hospital.

[Outbreaks due to respiratory syncytial virus and influenzavirus A/H3N in institutionalized aged. Role of immunological status to influenza vaccine and possible implication of caregivers in the transmission]. / Infections groupées à virus respiratoire syncytial et à influenzavirus A/H3N2 chez des sujets âgés en institution. Influence du statut vaccinal anti-grippal et implication possible des soignants dans la transmission.

OBJECTIVES: Report of epidemiological, clinical and virological data collected from the prospective surveillance of febrile episodes observed in aged residents of a long-stay care unit of 33 beds, at the University Hospital of Saint-Etienne, during the 1997-1998 winter season. METHODS: Systematic collection of clinical and biological data from febrile patients (> or = 38 degrees C) on a form, including virological findings obtained from a nasal swab and paired serum specimens. RESULTS: From 38 patients (37 of them having been vaccinated against influenza in October 1997), 18 febrile episodes were recorded in 16 subjects, including 3 respiratory syncytial virus infections and a late-occurring outbreak (March 1998) of influenza due to a A/H3N2 strain (15 cases, 14 of them virologically confirmed). No death was noted after the influenza outbreak. In 8 of the 9 tested patients with influenza, "protective" titres of antibodies directed towards the hemagglutinin of the vaccinal strain were present by radial hemolysis test three months before the beginning of the outbreak. During the influenza outbreak, the attack rate of symptomatic infection was 45.5% in elderly and 47.5% in healthcare workers (mainly unvaccinated). The occurrence of the first cases in the latter suggests their possible role in the transmission of the virus to the aged. CONCLUSION: This study underlines the epidemic circulation of multiple respiratory viruses during the same winter season in long-stay care facilities, the occurrence of clinical influenza infections in vaccinated patients exhibiting protective antibody titres and the role of unvaccinated healthcare workers in the propagation of influenza in institutionalised aged.

[Viral respiratory infections as cause of fever in hospitalized aged patients during a winter season]. / Place des viroses respiratoires dans les hyperthermies de sujets âgés hospitalisés au cours d'une saison hivernale.

PURPOSE: In the geriatric units of the University Hospital of Saint-Etienne, 129 cases of fever (38 degrees C or more) were recorded prospectively during the 1995-1996 winter period in a population of 503 hospitalised patients (25.6%), and were investigated for the detection of a viral aetiology. METHODS: In febrile patients, a standard form was used to record clinical and biological parameters, including the results of investigations for respiratory viruses from a nasal swab and dual serum specimens. RESULTS: A clinical or radiological respiratory infection was found in 69 cases (53.5% of all cases of fever), including 14 respiratory syncytial virus (RSV) infections. In comparison to nonviral respiratory infections, the RSV infections were characterised by the prevalence of anorexia (57% vs 20%, P < 0.05) and rhinorrhea (64% vs 5%, P < 0.01). No influenza infection was recorded despite the concomitant circulation of influenza virus in the community. A nosocomial outbreak of RSV infection (nine cases, attack rate of 18.7%) was identified in a long-stay care unit. CONCLUSION: This study illustrates the high prevalence (10.9%) of RSV infections in elderly patients with fever during this season and the importance of hygienic measures to control the spread of nosocomial outbreaks.

[Tolerance of influenza vaccination in the aged and the nursing staff in a geriatric hospital]. / Tolérance de la vaccination grippale chez les sujets âgés et le personnel soignant d'un hôpital gériatrique.

The tolerance of influenza vaccination (Vaxigrip, Pasteur-Mérieux) was evaluated during four consecutive years (1989-1992) in the geriatric hospital of Saint-Etienne from questionnaires concerning 327 vaccinations in the aged (group 1) and 88 vaccinations in members of the nursing staff (group 2). Minor local symptoms were the more common incidents, respectively for each group: blotch (9.8 and 21.6%), pain (9.2 and 47.7%), nodule (2.4 and 13.6%). Fatigue (4.0 vs 12.5%) and fever (6.1 vs 4.5%) were the more frequent among general symptoms, respectively in each group. No major vaccinal accident was recorded. These results underline that influenza vaccination is well tolerated, much more in aged people than in members of the nursing staff.

Is there a relationship between malnutrition, inflammation, and post-vaccinal antibody response to influenza viruses in the elderly?

This study was designed to explore the relationship between malnutrition, inflammation, and the specific antibody response after influenza vaccination in the elderly. Eighty-two aged subjects, immunized annually against influenza with a trivalent inactivated vaccine, were evaluated for 9 protein markers (albumin, thyroxin-binding prealbumin, transferrin, immunoglobulins (Ig) G, M, and A, orosomucoid, haptoglobin, and C reactive protein) and for their antibody response to influenza viruses in comparison to 29 younger adults who received the same vaccine and 21 unvaccinated adults. IgM and nutritional markers were significantly reduced in the aged as compared to controls, while the opposite pattern was seen for IgA and inflammatory markers. No difference was observed between the elderly and the controls with regard to the antibody response to influenza virus after vaccination. Reciprocally, influenza immunization had no influence on the levels of the protein variables. These results suggest that the protein status does not play an important role in the antibody response to influenza vaccination in the elderly, a fact which could be related to the slight involvement of cellular immunity in the defense against influenza reinfection.

[Survey with three epidemiological markers after 22 cases of diarrhea caused by Clostridium difficile in a geriatric hospital]. / Enquête a l'aide de trois marqueurs épidémiologiques après 22 diarrhées a Clostridium difficle dans un hôpital gériatrique.

In a geriatric hospital of Saint-Etienne (Charité), among 153 patients having presented a nosocomial diarrhea from September 1990 to August 1991 Clostridium difficile (C.d.) has been isolated in 22 cases. Two of the nine units of the hospital had the highest incidence rates: 4.6 and 3.7%. In the faeces of 16 patients, C.d. was toxinogenic. In all cases, except one, antibiotic preceded diarrhea. Amoxicillin + clavulanic acid treatment was the most frequently responsible (65%). For detecting an eventual outbreak, several epidemiologic markers were evaluated: Clindamycin MIC, protein profiles, serotyping. Clindamycin susceptibility differentiated two Cd. types, but has no epidemiologic value. Protein profiles, performed by SDS-Page, individualized 6 different profiles, but 10 strains gave no classifiable profiles. Serotyping, applied by M. Delmée, appeared as the most interesting marker. Inquiry allowed to eliminate an outbreak but revealed two episodes of cross contaminations in the 3 units, 2 of them having the highest incidence rates. Markers proved persistence of the same C.d. strain in some patients who were correctly treated by metronidazole.

Role of influenza vaccination in the elderly during an epidemic of A/H1N1 virus in 1988-1989: clinical and serological data.

During a winter epidemic of A/H1N1 influenza virus, we evaluated the protection conferred by vaccination of 285 residents of a nursing home. Fifteen of 204 members of the nursing staff were also vaccinated. Serological determinations were performed before and after vaccination using radial hemolysis (RH) and neuraminidase inhibition (NI) tests. In the outbreak period, only one influenza case was noted in the vaccinated elderly and none among the vaccinated nursing staff. On the other hand, 38 cases (20%) occurred in the unvaccinated hospital personnel. Twenty-one percent of the elderly people exhibited seroconversion to the vaccinal strain by RH and NI while 27 and 20% of the vaccinated nursing staff seroconverted by the same tests, respectively. Thus, the clinical protection conferred by influenza vaccination was excellent and much greater than expected from serological results.

[Mean osteoplastic surface in zones of plexiform neo-osteogenesis compared with mean osteoplastic surface measured on the fetal bone]. / Surface ostéoplastique moyenne au niveau des zones de néo-ostéogenèse plexiforme, comparaison avec la surface ostéoplastique moyenne mesurée dans l'os foetal.

In some pathologic cases, areas of woven bone can be observed in and around human adult bones. This plexiform neo-osteogenesis looks like fetal bone. The mean osteoplastic surface was quantified in these different kinds of bony tissues. The formation of this plexiform neo-osteogenesis is discussed.