Coles F B, Balzano G J, Morse D L
Bureau of Communicable Disease Control, New York State Department of Health, Albany 12237.
J Am Geriatr Soc. 1992 Jun;40(6):589-92. doi: 10.1111/j.1532-5415.1992.tb02108.x.
To describe the epidemiologic features of an outbreak of influenza A that occurred in a skilled nursing home although over 90 percent of the resident population had previously received influenza vaccine.
Retrospective cohort study.
Skilled nursing home facility in western New York State.
Nursing home residents and patient-care staff.
Incidence of influenza-like illness among vaccinated versus unvaccinated nursing home residents and staff.
Thirty-seven of 124 residents (attack rate = 30%) and 18 of 146 staff (attack rate = 12%) had an influenza-like illness. Staff illness began 16 days prior to onset among residents. Six cases of pneumonia and three influenza-related deaths occurred, all among the vaccinated residents. Ninety percent of the nursing home residents and 10% of the staff received the influenza vaccine prior to the outbreak. The calculated vaccine efficacies were minus 21% and plus 45% for residents and staff, respectively.
While antigenic drift of the circulating influenza virus was the major factor in the apparent vaccine failure, the observed poor staff immunization rate (10%) and absence of surveillance which precluded the use of amantadine chemoprophylaxis suggest that the use of these strategies may be of importance in controlling influenza outbreaks in nursing homes.
描述在一家专业疗养院发生的甲型流感暴发的流行病学特征，尽管超过90%的住院患者此前已接种流感疫苗。
回顾性队列研究。
纽约州西部的专业疗养院设施。
疗养院住院患者和护理人员。
接种疫苗与未接种疫苗的疗养院住院患者和工作人员中流感样疾病的发病率。
124名住院患者中有37人（发病率=30%），146名工作人员中有18人（发病率=12%）出现流感样疾病。工作人员发病比住院患者早16天。发生了6例肺炎和3例与流感相关的死亡，均发生在接种疫苗的住院患者中。90%的疗养院住院患者和10%的工作人员在暴发前接种了流感疫苗。计算得出的住院患者和工作人员的疫苗效力分别为-21%和+45%。
虽然流行的流感病毒的抗原漂移是明显的疫苗接种失败的主要因素，但观察到的工作人员免疫率低（10%）以及缺乏监测从而无法使用金刚烷胺进行化学预防表明，采用这些策略可能对控制疗养院的流感暴发很重要。
