Respiratory Syncytial Virus Outbreak in a Veterans Affairs Long-term Care Facility

Abstract

Background Respiratory syncytial virus (RSV) is increasingly becoming an important cause of respiratory infections in adults, especially those living in long-term care facilities (LTCFs). Seasonal outbreaks peaking from October to April are common. We report an outbreak of RSV involving 2 LTCFs with total capacity of 80 beds in 2019. Methods Retrospective chart review of cases identified with positive RSV infection via DNA polymerase chain reaction (PCR) from January 24 to February 24, 2019, at 2 LTCF units, in close proximity to each other, at Northport Affairs Medical Center. Results Twenty veterans (18 men and 2 women) tested positive for RSV by rapid PCR. The median age was 73 (47–89) years, 85% are Caucasian, and 5 patients had temperature of greater than 100°F (100°F–102.4°F). All had rhinorrhea and 65% had cough. Medical history shows 45% with dementia, 30% with stroke, and 35% with diabetes; 2 patients on hemodialysis; and 2 patients with chronic obstructive pulmonary disease (COPD). Four patients required hospitalization, and 2 of them required admission to intensive care unit. Length of stay ranged from 1 to 9 days. One patient with COPD required mechanical ventilation. One patient with computed tomography finding of airway impaction had antibiotics stopped by infectious diseases consult, yet he developed Clostridium difficile diarrhea. No deaths were observed, and all patients recovered. Aggressive infection control measures were implemented. Conclusions Respiratory syncytial virus is highly infectious and can easily cause an outbreak in an LTCF. Polymerase chain reaction testing was contributory to identify cases rapidly. Rapid PCR results and intensified infection control measures were instrumental to halt the outbreak.

Burden of Respiratory syncytial virus (RSV) infection among adults in nursing and care homes: a systematic review

“…Studies were published between 18 April 2000 and 1 March 2023. Of the 20 included studies, nine were conducted in the USA [17][18][19][20][21][22][23][24][25], two in Canada [26,27], one each in Japan [28], Netherlands [29], England [30], Czech Republic [31], Portugal [32], Hong Kong [33], France [34], Slovenia [35], and one multi-country (Belgium, Estonia, Germany, Spain, United Kingdom and USA) [6].…”

“…Overall case fatality rate ranged from 7.7-23.1% [17,19,[30][31][32][33] (Table 2). Only one study reported populationbased mortality rates [21].…”

“…The medical history and clinical characteristics of RSV disease case-patients included current or a history of smoking, mobility limitations (bed or wheelchair-bound), clinical characteristics [fever (37.7°C -40.0°C), wheezing, rhinorrhoea, sore throat, malaise, change in sputum production, new or increased cough, myalgia, hoarseness, sneezing], pleuritic chest and pneumonia [17,18,26,28,29]. Tube feeding [33] and polypharmacy (5 medications or more) [27] were other patient characteristics described among individuals with RSVpositive tests.…”

“…Two studies [17,30] reported RSV cases that required hospitalisation (Table 2). Four out of 20 (20%) and 3/13 (23.1%) RSV cases required hospitalisation respectively [17,30].…”

“…Older adults with chronic respiratory diseases, heart failure, and immunosuppressing conditions are at higher risk from severe or fatal RSV infections [6][7][8]. Immunosenescence and decreased levels of RSV-specific neutralizing antibodies in the serum also contribute to higher susceptibility to severe RSV infections [14][15][16][17].…”