Skip to main content
ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #219967
Title: LONG TERM CARE FACILITIES: A CORNUCOPIA OF VIRAL PATHOGENS

Author
item FALSEY, ANN - UNI OF ROCHESTER, NY
item Dallal, Gerald
item FORMICA, MARIA - UNI OF ROCHESTER, NY
item ANDOLINA, GLORIA - UNI OF ROCHESTER, NY
item HAMER, DAVIDSON - BOSTON UNIVERSTIY, MA
item LEKA, LYNETTTE - JM USDA HNRCA @ TUFTS
item Meydani, Simin

Submitted to: Journal of the American Geriatrics Society
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/22/2008
Publication Date: 7/1/2008
Citation: Falsey, A.R., Dallal, G., Formica, M.A., Andolina, G.G., Hamer, D.H., Leka, L.S., Meydani, S. 2008. Long term care facilities: a cornucopia of viral pathogens. Journal of the American Geriatrics Society. 56:1281-1285.

Interpretive Summary: Respiratory tract infections are a major cause of illness and death in elderly in long term care facilities. A wide range of bacterial and viral microorganisms have been documented in nursing home settings. Residents of long term care facilities are also at risk for malnutrition and the importance of nutrition and immune function has been well documented. A total of 617 volunteers were from 33 long term care facilities in the Boston, MA area over a 3 year period. All participants received a capsule containing 50 percent of the RDA for essential micronutrients including zinc. Clinical data on respiratory infections was collected throughout the study period and blood was collected at various time periods. Respiratory tract infections were categorized according to standard definitions including the common cold, influenza-like illnesses, upper respiratory infections [URI], and lower respiratory infection [LRI]). Overall, a total of 204 viral infections were documented in 157 subjects. Blood tests indicate eight viruses and that several pathogens, harmful microbes that cause disease and death, were found circulating all three years. Serum zinc concentrations were measured at the beginning of the study period and were classified as having low or normal levels. Although the overall viral infection rate was not significantly different between those with low vs. normal zinc levels, significantly more of a virus known as RSV (respiratory synctial virus) were noted in those with low serum zinc levels. This report demonstrates the wide range of respiratory viruses that circulate in long term care facilities during the winter months. Although this trial was not designed to examine the specific cause of respiratory illnesses, the collection of blood at various time points gave the opportunity to examine the blood data for multiple viral infections. Of note, normal zinc concentrations in the final blood sample of each subject were associated with a decreased incidence and duration of pneumonia. The individual response to different respiratory viruses varies significantly in immune system response. Thus, it is reasonable to think that specific nutritional deficiencies may differ with the type of viral infection studied. Some data suggest a possible association between RSV infection and zinc deficiency. Because RSV is a serious pathogen in nursing home residents and no vaccines or anti-viral treatments are currently available, this finding merits further investigation. In addition, the wide range of viruses documented in this study may provide useful information in studies regarding vaccine trials and treatments as well as nutritional interventions for specific respiratory viral infections in nursing home populations, which are at high risk for serious infections.

Technical Abstract: Our study sought to determine the frequency and types of respiratory viruses circulating in 33 Boston long term care facilities during a three year period and correlate rates of infection with serum zinc levels. Participants were residents of long term care that had previously participated in a trial of vitamin E supplementation and had paired serum samples available for viral analysis. We measured serum Zinc levels and viral antibody titers to eight respiratory viruses including; influenza A & B, Respiratory Syncytial Virus (RSV), Parainfluenza virus serotype three (PIV -3), PIV-2, human metapneumovirus (hMPV), coronavirus 229E and OC43 were measured by enzyme immunoassay were measured at baseline and 53 weeks. The results were taken from a total of 617 persons were enrolled in the trial. Of these, 382 (62 percent) had sera available for viral analysis. A total of 204 viral infections were documented in 157 subjects. Serologic responses to all eight viruses were documented with hMPV and coronavirus 229E being the most common and PIV-2 the least frequent. The overall viral infection rate was not significantly different (58 percent vs. 53 percent) between those with low (less than70ug/dl) vs. normal (greater than70ug/dl) serum zinc levels. However, significantly more RSV infections (11 percent vs. 5 percent, p=.04) were noted in those with low zinc levels. We concluded that a wide range of respiratory viruses co-circulate in long term care facilities and contribute to respiratory illness morbidity in these populations. Our data also suggests a possible association between RSV infection and zinc deficiency.