Control of an outbreak of respiratory syncytial virus infection in immunocompromized adults

Jones, Bruce L.; Clark, Sherry; Curran, Evonne T; McNamee, Sandra; Horne, Gillian A.; Thakker, Bishan; Hood, Julia

doi:10.1053/jhin.1999.0666

Cited by 33 publications

(16 citation statements)

References 17 publications

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“…Such an outbreak of RSV and PIV-3 was reported in a newborn nursery, in which seven infants were infected with RSV, five with PIV-3, and two with both RSV and PIV-3 (20). Although outbreaks of RSV and PIV-3 on hematology units have been described previously (1,6,12,13,15,18,22,26,31), this is the first report of a concurrent PIV-3 and RSV outbreak. Three patients in the outbreak cohort were dually infected.…”

Section: Discussionmentioning

confidence: 58%

Molecular Investigations of an Outbreak of Parainfluenza Virus Type 3 and Respiratory Syncytial Virus Infections in a Hematology Unit

et al. 2007

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A large simultaneous outbreak of respiratory syncytial virus (RSV) and parainfluenza type 3 (PIV-3) infections occurred on an adult hematology unit. Implementation of enhanced infection control was complicated by cocirculation of the two different viruses, with prolonged viral shedding from infected patients, and placed great pressure on health care staff; of 27 infected hematopoietic stem cell transplant patients, 9 died, and the unit was closed for 2 months. Retrospective molecular investigation of the virus strains involved in the outbreak was performed by analyzing part of the fusion gene of PIV-3 and part of the glycoprotein gene of RSV. Reverse transcription-PCR on nasopharyngeal aspirates from patients infected before and during the simultaneous outbreak generated amplicons for sequence analysis. A single strain of RSV and a single strain of PIV-3 had spread from person to person within the unit; 7 patients were infected with RSV, 22 were infected with PIV-3, and 4 were infected with both viruses. The PIV-3 outbreak had started at the beginning of August 3 months before the RSV outbreak; it had arisen when PIV-3 was introduced from the community by a patient and passed to another patient, who became chronically infected with the identical strain and, in spite of being nursed in isolation, was most likely the source from which widespread infection occurred in November. Had these early cases been linked to a common PIV-3 strain at the time of diagnosis, enhanced infection control precautions might have prevented the eventual extensive spread of PIV-3, making it much easier to deal with the later RSV outbreak.

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Section: Discussionmentioning

confidence: 58%

Molecular Investigations of an Outbreak of Parainfluenza Virus Type 3 and Respiratory Syncytial Virus Infections in a Hematology Unit

et al. 2007

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“…Several smaller outbreaks have been reported from adult hematology or transplant units 13,[21][22][23][24][25] as well as from pediatric wards and neonatal intensive care units. [18][19][20] A unique aspect of this retrospective analysis was the fact that all inpatients were repeatedly screened for the presence of RSV infection.…”

Section: Discussionmentioning

confidence: 99%

“…However, a recent pooled analysis suggests some efficacy. 17 Several nosocomial outbreaks of RSV infections on pediatric wards [18][19][20] as well as in adult hematology and transplantation units 13,[21][22][23][24][25] have been described in the literature.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and containment of respiratory syncytial virus outbreak in a hematology and transplant unit

Lehners

Schnitzler

Geis

et al. 2013

Bone Marrow Transplant

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Respiratory syncytial virus (RSV) usually causes self-limiting upper respiratory tract infections, but can be associated with severe lower respiratory tract infection disease (LRTID) in infants and in patients with hematologic malignancies. We have analyzed the risk factors and the measures for containment within an outbreak of nosocomial RSV infections in a hematology and SCT unit. A total of 56 patients were affected (53 RSV-A and 3 RSV-B) including 32 transplant patients (16 allogeneic and 16 autologous). Forty (71%) of the 56 patients suffered from LRTID and 14 (35%) of the patients with LRTID subsequently died. However, because of concomitant infections with fungal and bacterial pathogens, the impact of RSV on the fatal outcome was difficult to assess. Multivariate analysis showed that low levels of IgG were significantly associated with fatal outcome (P ¼ 0.007), treatment with oral ribavirin represented a protective factor (P ¼ 0.02). An extremely protracted viral shedding was observed in this cohort of patients (median ¼ 30.5 days, range: 1-162 days), especially pronounced in patients after allogeneic transplantation (P ¼ 0.002). Implementation of rigorous isolation and barrier measures, although challenged by long-term viral carriers, was effective in containment of the outbreak.

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“…Prevention of nosocomial RSV infection is challenging and requires a multifaceted approach involving strict attention to handwashing, barrier precautions and continuing education of staff, patients and visitors. [17][18][19] Bone marrow or stem cell transplant recipients appear to be at higher risk of severe RSV disease. Factors associated with more severe disease include the degree of immunosuppression of the patient, particularly the preengraftment phase in bone marrow or stem cell transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

An outbreak of respiratory syncytial virus infection in a bone marrow transplant unit: effect on engraftment and outcome of pneumonia without specific antiviral treatment

Abdallah

Rowland

Schepetiuk

et al. 2003

Bone Marrow Transplant

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Summary:Immunocompromised haematological patients are at high risk for severe, often fatal, respiratory syncytial virus (RSV) pneumonia. In the 2001 winter season, 16 of 195 (8.2%) adult haematological in-patients were diagnosed with RSV infection. Eight patients had undergone stem cell transplantation. The median age was 53 years (range 20-67). A total of 11 patients had nosocomial RSV infection while the rest (five) had community-acquired infection. All patients were febrile and had upper respiratory tract infection (URTI). Eight patients (50%) developed lower RTI. Two of the 16 patients (12.5%) died of respiratory failure, due to the RSV pneumonia, despite ICU admission and supportive ventilation. None of the studied patients received ribavirin therapy or specific RSV immunoglobulin. Two patients autografted for multiple myeloma (MM) showed delayed neutrophil and platelet engraftment despite receiving an adequate dose of stem cells. A third patient undergoing a CD34+ selected HLAmatched sibling mini-allograft for relapsed MM showed graft failure shortly after RSV infection. In our series, RSV infection was concurrent with an outbreak in the community. Unlike other published series, no specific antiviral treatment for RSV pneumonia was used and yet the overall outcome in our patients was favourable. Furthermore, RSV infection in the pre-engraftment period after autologous transplantation was associated with delayed engraftment. Bone Marrow Transplantation (2003Transplantation ( ) 32, 195-203. doi:10.1038 Keywords: respiratory syncytial virus; stem cell transplantation; engraftment; immunocompromised; RSV pneumonia Respiratory syncytial virus (RSV) is the most common viral agent causing both upper and lower respiratory tract infections in children and adults. 1 The yearly incidence of RSV infection in hospitalised patients ranges between 2 and 12% and depends upon the severity of outbreaks in the community at the time. 2 RSV is a common cause of lower respiratory tract illness in immunocompromised patients. [3][4][5] Up to 70% of stem cell or bone marrow transplant (BMT) recipients who experience RSV infection in the pre-engraftment period will develop pneumonia. 6,7 Once pneumonia develops, the overall mortality has been reported to be as high as 60-80%. 3,6,[8][9] Those patients with RSV pneumonia who develop respiratory failure requiring mechanical ventilation almost invariably die from the infection. Treatment options for established RSV pneumonia are limited and treatment is often unsuccessful. 4,10,11 RSV infection in hospitalised patients usually occurs in the setting of community outbreaks and may be community-or nosocomially acquired. Transmission of RSV takes place by droplet infection or via direct contact with infected persons. The virus can survive on nonporous surfaces, skin and gloves for many hours. RSV is not stable in fine particle aerosols, and hence small-particle air transmission is not considered to be a major route of spread. 1,2 In this report, we describe the outcome of 16 adult haemat...

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Control of an outbreak of respiratory syncytial virus infection in immunocompromized adults

Cited by 33 publications

References 17 publications

Molecular Investigations of an Outbreak of Parainfluenza Virus Type 3 and Respiratory Syncytial Virus Infections in a Hematology Unit

Molecular Investigations of an Outbreak of Parainfluenza Virus Type 3 and Respiratory Syncytial Virus Infections in a Hematology Unit

Risk factors and containment of respiratory syncytial virus outbreak in a hematology and transplant unit

An outbreak of respiratory syncytial virus infection in a bone marrow transplant unit: effect on engraftment and outcome of pneumonia without specific antiviral treatment

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