Nosocomial Respiratory Syncytial Virus: A Threat in the Modern Neonatal Intensive Care Unit

Heerens, Ann T.; Marshall, Diane D.; Bose, Carl

doi:10.1038/sj.jp.7210696

Cited by 27 publications

(12 citation statements)

References 12 publications

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“…Of great concern is the high rate of nosocomial infections [41] in the preterm group, which may result in severe complications, in particular in preterms with severe CLD on prolonged mechanical ventilation or CPAP via a tracheostomy [31] (grade 4) or in postoperative patients [1,10,22,24]. Although preterms with CLD plus face the greatest relative risk, the majority of all patients admitted to the ICU with RSV infection are not candidates for palivizumab prophylaxis [34].…”

Section: Discussionmentioning

confidence: 98%

Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database

et al. 2007

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Premature birth, chronic lung disease of prematurity (CLD), congenital heart disease and immunodeficiency predispose to a higher morbidity and mortality in respiratory syncytial virus (RSV) infection. This study describes the preterms hospitalised with RSV infection from the prospective German DSM RSV Paed database. The DMS RSV Paed database was designed for the prospective multicentre documentation and analysis of clinically relevant aspects of the management of inpatients with RSV infection. This study covers six consecutive RSV seasons (1999-2005); the surveillance took place in 14 paediatric hospitals in Germany. Of the 1,568 prospectively documented RSV infections, 26% (n=406) were observed in preterms [vs. 1,162 children born at term (74%)] and 3% (n=50) had CLD, of which 49 had received treatment in the last 6 months ('CLDplus'). A significantly higher proportion in the preterm group had congenital heart disease, nosocomial infection, and neuromuscular impairment. There were significantly more children older than 24 months in the preterm group. The attributable mortality was 0.2% (n=2) in children born at term vs. 1.2% (n=5) in the preterm group (p=0.015) [preterm plus CLD 8.0% (n=4 of 50); McIntosh grade 1, 8.6% (n=3 of 35) and McIntosh Grade 4, 15% (n=3 of 20)]. Eight patients were categorized as 'palivizumab failures'. In the multivariate analysis, premature birth, CLD(plus), and nosocomial infection were significantly and independently associated with the combined outcome 'complicated course of disease'. In conclusion, this is the first prospective multicentre study from Germany that confirms the increased risk for severe RSV disease in preterms, in particular in those with CLD treated in the last 6 months before the onset of the infection. From the perspective of our results, the statements of the German Society of Paediatric Infectious Diseases considering the use of passive immunisation (2003) seem reasonable.

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Section: Discussionmentioning

confidence: 98%

Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database

et al. 2007

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“…Eight reported no further RSV cases following palivizumab prophylaxis,10, 11, 28, 32, 33, 38, 67, 68 and one reported no further cases after day 14 of the outbreak having instigated control measures on day nine 30. Two reported the occurrence of two further cases after palivizumab administration 19, 69. Meanwhile, Silva et al .…”

Section: Discussionmentioning

confidence: 99%

Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

French¹,

McKenzie

Coope³

et al. 2016

Influenza Resp Viruses

107

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Respiratory syncytial virus (RSV) causes a significant public health burden, and outbreaks among vulnerable patients in hospital settings are of particular concern. We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control measures. We searched the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, together with key websites, journals and grey literature, to end of 2012. Risk of bias was assessed using the Cochrane risk of bias tool or Newcastle–Ottawa scale. A narrative synthesis was conducted. Forty studies were included (19 addressing research question one, 21 addressing question two). RSV transmission risk varied by hospital setting; 6–56% (median: 28·5%) in neonatal/paediatric settings (n = 14), 6–12% (median: 7%) in adult haematology and transplant units (n = 3), and 30–32% in other adult settings (n = 2). For question two, most studies (n = 13) employed multi‐component interventions (e.g. cohort nursing, personal protective equipment (PPE), isolation), and these were largely reported to be effective in reducing nosocomial transmission. Four studies examined staff PPE; eye protection appeared more effective than gowns and masks. One study reported on RSV prophylaxis for patients (RSV‐Ig/palivizumab); there was no statistical evidence of effectiveness although the sample size was small. Overall, risk of bias for included studies tended to be high. We conclude that RSV transmission risk varies widely during hospital outbreaks. Although multi‐component control strategies appear broadly successful, further research is required to disaggregate the effectiveness of individual components including the potential role of palivizumab prophylaxis.

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“…Heerens et al 47 described sporadic cases of RSV NI in the NICU and noted the difficulty in diagnosis due to the lack of specific symptoms in some patients. In addition to routine infection control measures, they selectively administer palivizumab to patients at greatest risk of RSV and recognize the need for further prospective trials in the NICU setting.…”

Section: Palivizumabmentioning

confidence: 99%

“…31 Although death is usually a rare occurrence, 8,[32][33][34] an overall mortality rate of 15% was reported in one study with congenital heart disease (CHD) being the major underlying condition in patients who died. 28 Potential contributing risk factors for development of RSV NI included prematurity, lung disease, heart disease and immunosuppression.…”

Section: Clinical Featuresmentioning

confidence: 99%

Strategies for prevention of RSV nosocomial infection

Groothuis¹,

Bauman²,

Malinoski³

et al. 2008

J Perinatol

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Objective: To review the literature on respiratory syncytial virus (RSV) as a cause of nosocomial infections (NI) on neonatal intensive care units (NICUs) and pediatric wards, and the effectiveness of various containment strategies.Study Design: We conducted a literature review to define characteristics of RSV NI, and to evaluate the relative effectiveness of various infection containment programs, including the use of palivizumab on the reported incidence of RSV NI on NICUs and pediatric wards.Result: Highly variable rates of RSV NI have not significantly changed since RSV was first identified. The evaluation of the effectiveness of containment strategies has relied on before/after study designs. Focus on rapid patient diagnosis, compliance of acceptable handwashing techniques and cohorting of patients and staff appears to form the backbone of most prevention and containment programs. When these or other measures have failed, the administration of palivizumab has been useful in halting the spread of RSV NI in children.

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Nosocomial Respiratory Syncytial Virus: A Threat in the Modern Neonatal Intensive Care Unit

Cited by 27 publications

References 12 publications

Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database

Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database

Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review

Strategies for prevention of RSV nosocomial infection

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