Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting

Abstract

objective. We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting.methods. Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing.results. We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died.conclusions. This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses.

Multicenter Clinical Evaluation of the Luminex Aries Flu A/B & RSV Assay for Pediatric and Adult Respiratory Tract Specimens

“…A poor sensitivity or specificity of an assay results in either inaccurate diagnoses or a lack of confidence in results. High assay costs make certain laboratory tests unfeasible and shift the financial burden to other aspects of clinical care, such as the decision to risk a potential outbreak or to isolate patients merely as a precaution (15). …”

A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control

“…Characteristics of the outbreaks are presented in Tables 2-4. Fifteen studies reported outbreaks caused by bacteria [15-17, 20, 22, 24, 27, 32-39] and 22 studies were outbreaks by viruses [14,18,19,21,23,25,26,[28][29][30][31][40][41][42][43][44][45][46][47][48][49][50]. The largest number of a single pathogen was influenza viruses [40][41][42][43][44][45], followed by group A streptococcus (GAS) [17,20,24,37,38].…”

“…In 8 studies, it was not possible to calculate the rate due to lack of information. The highest attack rate of 73.17% was reported in an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) [50], followed by Clostridium difficile (51.97%) [27] and viral gastroenteritis caused by norovirus and rotavirus (48.6%) [26]. Influenza-like illness had the median overall attack rate of 24.50%.…”

“…Causes of transmission in the eligible studies were reported as person-to-person transmission, contaminated water and food, and problems in practice (Tables 2 and 4). The following studies (n = 12) did not report or could not identify the cause of the outbreaks: 5 studies on influenza viruses, 2 on non-typeable Haemophilus influenzae, 1 on hepatitis C virus, 1 on C. difficile, 1 on adenovirus, 1 on norovirus, and 1 on RSV and HMPV [14,27,29,30,32,36,40,42,44,45,48,50]. The most commonly reported route of transmission was person-to-person [17, 22-24, 26, 31, 33, 35, 38, 41, 43, 46, 47, 49].…”

Practical Guidance for Clinical Microbiology Laboratories: Viruses Causing Acute Respiratory Tract Infections

“…In addition, illness may also occur in staff members. Challenges may arise because these environments are not thought of as primary health care environments and may not have infection control protocols that are as stringent as those in health care settings (23,24).…”