An Outbreak of Respiratory Syncytial Virus in a Bone Marrow Transplant Center

Abstract

An outbreak of respiratory syncytial virus (RSV) infection occurred among 31 patients in a marrow transplant center over a 13-week period beginning in January 1990. RSV infection was also documented in 35 family members and employees. Of 18 patients with pneumonia, 14 (78%) died. None of 13 with upper respiratory infection died. Preengraftment patients tended to develop pneumonia more frequently than did engrafted patients. Early administration of ribavirin may have had a beneficial effect in patients with pneumonia. Antigenic and genomic analysis of 14 available isolates suggested that at least four different viral strains were responsible for the outbreak. One group of patients and 1 employee in spatial proximity were infected with the same strain and likely acquired their infections nosocomially. RSV infection in marrow transplant patients is a serious and life-threatening infection with a high mortality rate once pneumonia develops.

Respiratory syncytial virus immune globulin treatment of lower respiratory tract infection in pediatric patients undergoing bone marrow transplantation – a compassionate use experience

“…1-3 Many of these RSV infected patients develop pneumonia and face a high risk of mortality. [1][2][3] The reported mortality rate in BMT patients who develop RSV-LRTI approaches 100% for those not treated with antivirals and 50% to 70% for those promptly treated with ribavirin (Virazole). [3][4][5][6][7][8][9][10][11][12][13] From the literature, it appears that there are no survivors among RSV-LRTI transplant patients who progress to mechanical ventilation before antiviral therapy has been initiated.…”

“…[1][2][3] The reported mortality rate in BMT patients who develop RSV-LRTI approaches 100% for those not treated with antivirals and 50% to 70% for those promptly treated with ribavirin (Virazole). [3][4][5][6][7][8][9][10][11][12][13] From the literature, it appears that there are no survivors among RSV-LRTI transplant patients who progress to mechanical ventilation before antiviral therapy has been initiated. 2,12 Although RSV pneumonia occurring more than 100 days post-BMT has been associated with lower mortality rates, 12,13 the mortality rate of RSV pneumonia does not differ before and after engraftment during the early post-transplant period.…”

“…2,12 Although RSV pneumonia occurring more than 100 days post-BMT has been associated with lower mortality rates, 12,13 the mortality rate of RSV pneumonia does not differ before and after engraftment during the early post-transplant period. 3,14 Aerosolized ribavirin is the only Federal Drug Administration (FDA) approved drug for treatment of established RSV disease, 15 but its efficacy in BMT patients with RSV pneumonia is considered poor. The beneficial effects of immune globulin therapy on established RSV disease have been clearly demonstrated in experimental animals.…”

Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes

“…[29][30][31][32][33][34][35][36][37][38][39] A policy of influenza vaccination for all staff and the prohibition of staff working in SCT units who have symptoms of viral upper respiratory infection is appropriate. Removal of staff may, however, not be possible due to lack of availability of trained and experienced colleagues.…”

Isolation in the allogeneic transplant environment: how protective is it?

“…One such outbreak occurred among 30 patients in a 13-week period and included an additional 35 family members and healthcare workers. 21 Of the 18 patients with lower respiratory infections from RSV, the mortality was 78%. Another center reported an outbreak in which 45% of hospitalized BMT patients with acute respiratory illness in a 2-month period had RSV disease, and two-thirds were considered hospital acquired.…”