{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:30:12Z","timestamp":1790685012077,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Frail older persons may have an atypical presentation of coronavirus disease 2019 (COVID-19). The value of real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nursing homes (NHs) residents is not known.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To determine whether (i) atypical symptoms may predict rRT-PCR results and (ii) rRT-PCR results may predict immunisation against SARS-CoV-2 in NH residents.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A retrospective longitudinal study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Eight NHs with at least 10 rRT-PCR-positive residents.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects<\/jats:title>\n                  <jats:p>A total of 456 residents.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Typical and atypical symptoms recorded in residents\u2019 files during the 14\u00a0days before and after rRT-PCR testing were analysed. Residents underwent blood testing for IgG-SARS-CoV-2 nucleocapsid protein 6 to 8 weeks after testing. Univariate and multivariate analyses compared symptoms and immunisation rates in rRT-PCR-positive and negative residents.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 161 residents had a positive rRT-PCR (35.3%), 17.4% of whom were asymptomatic before testing. Temperature\u2009&amp;gt;37.8\u00b0C, oxygen saturation\u2009&amp;lt;90%, unexplained anorexia, behavioural change, exhaustion, malaise and falls before testing were independent predictors of a further positive rRT-PCR. Among the rRT-PCR-positive residents, 95.2% developed SARS-CoV-2 antibodies vs 7.6% in the rRT-PCR-negative residents. Among the residents with a negative rRT-PCR, those who developed SARS-CoV-2 antibodies more often had typical or atypical symptoms (P\u00a0=\u20090.02 and\u2009&amp;lt;0.01, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study supports a strategy based on (i) testing residents with typical or unexplained atypical symptoms for an early identification of the first SARS-CoV-2 cases, (ii) rT-PCR testing for identifying COVID-19 residents, (iii) repeated wide-facility testing (including asymptomatic cases) as soon as a resident is tested positive for SARS-CoV-2 and (iv) implementing SARS-CoV-2 infection control measures in rRT-PCR-negative residents when they have unexplained typical or atypical symptoms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afab050","type":"journal-article","created":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T20:08:57Z","timestamp":1613938137000},"page":"641-648","source":"Crossref","is-referenced-by-count":22,"title":["Atypical symptoms, SARS-CoV-2 test results and immunisation rates in 456 residents from eight nursing homes facing a COVID-19 outbreak"],"prefix":"10.1093","volume":"50","author":[{"given":"Hubert","family":"Blain","sequence":"first","affiliation":[{"name":"Department of Geriatrics , , Montpellier University,","place":["France"]},{"name":"Montpellier University Hospital , , Montpellier University,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Gamon","sequence":"additional","affiliation":[{"name":"Department of Medical Information , , University of Montpellier,","place":["France"]},{"name":"University Hospital of Montpellier , , University of Montpellier,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edouard","family":"Tuaillon","sequence":"additional","affiliation":[{"name":"Department of Virology , , INSERM 1058, Montpellier University,","place":["France"]},{"name":"Montpellier University Hospital , , INSERM 1058, Montpellier University,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amandine","family":"Pisoni","sequence":"additional","affiliation":[{"name":"Department of Virology , , INSERM 1058, Montpellier University,","place":["France"]},{"name":"Montpellier University Hospital , , INSERM 1058, Montpellier University,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Giacosa","sequence":"additional","affiliation":[{"name":"Department of Geriatrics , , Montpellier University,","place":["France"]},{"name":"Montpellier University Hospital , , Montpellier University,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myl\u00e8ne","family":"Albrand","sequence":"additional","affiliation":[{"name":"Department of Geriatrics , , Montpellier University,","place":["France"]},{"name":"Montpellier University Hospital , , Montpellier University,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Miot","sequence":"additional","affiliation":[{"name":"Department of Geriatrics , , Montpellier University,","place":["France"]},{"name":"Montpellier University Hospital , , Montpellier University,","place":["France"]},{"name":"CESP , INSERM U1178, , Paris,","place":["France"]},{"name":"Centre de recherche en Epidemiologie et Sant\u00e9 des Populations , INSERM U1178, , Paris,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Rolland","sequence":"additional","affiliation":[{"name":"G\u00e9rontop\u00f4le de Toulouse , ; 31059 Toulouse,","place":["France"]},{"name":"INSERM 1027 , ; 31059 Toulouse,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Christine","family":"Picot","sequence":"additional","affiliation":[{"name":"Department of Medical Information , , University of Montpellier,","place":["France"]},{"name":"University Hospital of Montpellier , , University of Montpellier,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Bousquet","sequence":"additional","affiliation":[{"name":"Charit\u00e9, Univeersit\u00e4tsmedizin Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center , Department of Dermatology and Allergy, Berlin,","place":["Germany"]},{"name":"MACVIA-France , Montpellier,","place":["France"]},{"name":"University Hospital , Montpellier,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"key":"2024103109373845600_ref1","author":"Covid-19 Nursing Homes data"},{"key":"2024103109373845600_ref2","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1093\/ageing\/afaa093","article-title":"COVID-19 in older people: a rapid clinical review","volume":"49","author":"Lithander","year":"2020","journal-title":"Age Ageing"},{"key":"2024103109373845600_ref3","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1056\/NEJMoa2005412","article-title":"Epidemiology of Covid-19 in a long-term Care Facility in King County, Washington","volume":"382","author":"McMichael","year":"2020","journal-title":"N Engl J Med"},{"key":"2024103109373845600_ref4","doi-asserted-by":"crossref","first-page":"377","DOI":"10.15585\/mmwr.mm6913e1","article-title":"Public health \u2013 Seattle & King County; CDC COVID-19 investigation team. Asymptomatic and Presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility - King County, Washington, march 2020","volume":"69","author":"Kimball","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024103109373845600_ref5","volume-title":"Preparing for COVID-19 in Nursing Homes, Updated November 20, 2020","author":"Centers for Disease Control and Prevention"},{"key":"2024103109373845600_ref6","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s41999-020-00405-z","article-title":"August 2020 interim EuGMS guidance to prepare European long-term care facilities for COVID-19","volume":"11","author":"Blain","year":"2020","journal-title":"Eur Geriatr Med"},{"key":"2024103109373845600_ref7","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1056\/NEJMoa2008457","article-title":"Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility","volume":"382","author":"Arons","year":"2020","journal-title":"N Engl J Med"},{"key":"2024103109373845600_ref8","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1093\/ageing\/afaa094","article-title":"Delirium: a missing piece in the COVID-19 pandemic puzzle","volume":"49","author":"O'Hanlon","year":"2020","journal-title":"Age Ageing"},{"key":"2024103109373845600_ref9","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s41999-020-00352-9","article-title":"Atypical clinical presentation of COVID-19 infection in residents of a long-term care facility","volume":"11","author":"Blain","year":"2020","journal-title":"Eur Geriatr Med"},{"key":"2024103109373845600_ref10","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jinf.2020.05.073","article-title":"SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes","volume":"81","author":"Graham","year":"2020","journal-title":"J Infect"},{"key":"2024103109373845600_ref11","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1007\/s41999-020-00359-2","article-title":"Clinical presentation and outcome across age categories among patients with COVID-19 admitted to a Spanish emergency department","volume":"11","author":"Mart\u00edn-S\u00e1nchez","year":"2020","journal-title":"Eur Geriatr Med"},{"key":"2024103109373845600_ref12","doi-asserted-by":"publisher","DOI":"10.1177\/0036933020962891","article-title":"Atypical presentations in the hospitalised older adult testing positive for SARS-CoV-2: a retrospective observational study in Glasgow, Scotland","author":"Davis","year":"2020","journal-title":"Scott Med J"},{"key":"2024103109373845600_ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11845-020-02372-7","article-title":"Atypical presentation of COVID-19 in hospitalised older adults","author":"Gan","year":"2020","journal-title":"Ir J Med Sci"},{"key":"2024103109373845600_ref14","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1093\/ageing\/afaa068","article-title":"Atypical presentation of COVID-19 in a frail older person","volume":"49","author":"Tay","year":"2020","journal-title":"Age Ageing"},{"key":"2024103109373845600_ref15","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jagp.2020.04.018","article-title":"Atypical presentation of Covid-19 in an older adult with severe Alzheimer disease","volume":"28","author":"Isaia","year":"2020","journal-title":"Am J Geriatr Psychiatry"},{"key":"2024103109373845600_ref16","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1111\/jgs.16536","article-title":"A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19","volume":"68","author":"Alkeridy","year":"2020","journal-title":"J Am Geriatr Soc"},{"key":"2024103109373845600_ref17","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3390\/geriatrics5020031","article-title":"COVID-19 and gastrointestinal symptoms-a case report","volume":"5","author":"Mackett","year":"2020","journal-title":"Geriatrics (Basel)"},{"key":"2024103109373845600_ref18","doi-asserted-by":"crossref","first-page":"E36","DOI":"10.1111\/jgs.16526","article-title":"Typically atypical: COVID-19 presenting as a fall in an older adult","volume":"68","author":"Norman","year":"2020","journal-title":"J Am Geriatr Soc"},{"key":"2024103109373845600_ref19","doi-asserted-by":"publisher","first-page":"afaa223","DOI":"10.1093\/ageing\/afaa223","article-title":"Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults","author":"Zazzara","year":"2020","journal-title":"Age Ageing"},{"key":"2024103109373845600_ref20","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.jamda.2020.06.013","article-title":"Efficacy of a test-retest strategy in residents and health care personnel of a nursing home facing a COVID-19 outbreak","volume":"21","author":"Blain","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"2024103109373845600_ref21","volume-title":"COVID19. Strat\u00e9gie de pr\u00e9vention des personnes \u00e2g\u00e9es","author":"Agence R\u00e9gionale de la Sant\u00e9 Occitanie"},{"key":"2024103109373845600_ref22","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s12603-020-1364-x","article-title":"Editorial: a COVID-19 support platform for long term care facilities","volume":"24","author":"Rolland","year":"2020","journal-title":"J Nutr Health Aging"},{"key":"2024103109373845600_ref23","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1016\/j.jinf.2020.05.077","volume":"81","author":"Tuaillon","year":"2020","journal-title":"J Infect"},{"key":"2024103109373845600_ref24","volume-title":"Model Selection and Model Averaging","author":"Claeskens","year":"2008"},{"key":"2024103109373845600_ref25","first-page":"31","article-title":"Chapter 2. Multiple Logistic Regression","author":"Hosmer","year":"2000","journal-title":"Wiley Series in Probability and Mathematical Statistics"},{"key":"2024103109373845600_ref26","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1007\/s10620-020-06362-8","article-title":"Clinical insights into the gastrointestinal manifestations of COVID-19","volume":"65","author":"Kopel","year":"2020","journal-title":"Dig Dis Sci"},{"key":"2024103109373845600_ref27","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1159\/000508734","article-title":"Clinical characteristics of elderly patients with COVID-19 in Hunan Province, China: a Multicenter, retrospective study","volume":"66","author":"Guo","year":"2020","journal-title":"Gerontology"},{"key":"2024103109373845600_ref28","volume-title":"Pneumonia Can Be Prevented\u2014Vaccines Can Help","author":"Centers for Disease Control and Prevention","year":"2021"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ageing\/advance-article-pdf\/doi\/10.1093\/ageing\/afab050\/36585759\/afab050.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/50\/3\/641\/60258561\/afab050.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/50\/3\/641\/60258561\/afab050.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,31]],"date-time":"2024-10-31T10:01:49Z","timestamp":1730368909000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/50\/3\/641\/6146887"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,23]]},"references-count":28,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,5,5]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afab050","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,5]]},"published":{"date-parts":[[2021,2,23]]}}}