The nursing home in which the outbreak occurred is a 100-bed, single-story building with two wings. The members of the nursing staff frequently work on both wings. The 84 residents at the time of the outbreak ranged in age from 48 to 101 years (median, 85). Ninety-two percent were at least 65 years old; 81 percent were women, and 93 percent were white. There were 78 employees (median age, 41 years).
During the outbreak, 11 residents had illness that met the case definition, giving an attack rate of 13 percent. The 11 patients were similar to residents who were not ill in mean age, race, and sex. All 11 patients had lobar consolidation evident on chest radiography, and none had symptoms suggestive of meningitis. Multidrug-resistant S. pneumoniae, serotype 23F, was isolated from the blood of four patients and from the respiratory tract of three Three patients, all with bacteremia, died (case fatality rate, 27 percent). Only 3 residents (4 percent) had had pneumococcal vaccination, although 60 of the 84 residents (71 percent) had received influenzavirus vaccine during the fall of 1995. No cases were identified among the nursing staff.