The clinical and phylogenetic investigation for a nosocomial outbreak of respiratory syncytial virus infection in an adult hemato‐oncology unit

Abstract

Although many reports have already shown RSV outbreaks among hemato-oncology patients, genomic studies detecting similar RSV strains prior to an outbreak in the hospital are rare. In 2014, the University of the Ryukyus hospital hemato-oncology unit experienced, and successfully managed, a respiratory syncytial virus (RSV) nosocomial outbreak. During the outbreak investigation, genotyping and phylogenetic analysis was used to identify a potential source for the outbreak. Nasopharyngeal swabs were tested for RSV using three tests: (1) rapid antigen test (RAT); (2) reverse transcriptase polymerase chain reaction (PCR); or (3) quantitative PCR (RT-qPCR); a positive PCR reaction was considered a confirmed case of RSV. Phylogenetic analysis of the G protein was performed for outbreak and reference samples from non-outbreak periods of the same year. In total, 12 confirmed cases were identified, including 8 hemato-oncology patients. Patient samples were collected weekly, until all confirmed RSV cases returned RSV negative test results. Median time of suspected viral shedding was 16 days (n = 5, range: 8-37 days). Sensitivity and specificity of the RAT compared with RT-qPCR were 30% and 91% (n = 42). Phylogenetic analysis revealed nine genetically identical strains; eight occurring during the outbreak time period and one strain was detected 1 month prior. A genetically similar RSV detected 1 month before is considered one potential source of this outbreak. As such, healthcare providers should always enforce standard precautions, especially in the hemato-oncology unit.

Contamination of hospital surfaces with respiratory pathogens in Bangladesh

“…Among the most commonly detected viral pathogens, RSV was prevalent in respiratory swab of paediatric patients and nearby surfaces. RSV has been a major nosocomial hazard on pediatric wards and has been linked with hospital outbreaks [31, 32]. With reported higher case fatality among patient with nosocomial RSV infections (OR 4.46, 95% CI 1.1–18), widespread surface contamination with RSV is concerning for low income hospitals (34, 35).…”

Molecular characteristics and successful management of a respiratory syncytial virus outbreak among pediatric patients with hemato-oncological disease

“…Molecular characterization of RSV strains, for instance by whole genome sequencing [37] or characterization of RSV G-Protein [16,38], has been used to investigate nosocomial RSV outbreaks. We were able to collect and examine selected outbreak strains by G-Protein gene sequencing.…”

“…Nevertheless, hospital (nosocomial) acquisition is possible as well and transmission may occur by other infected patients, staff or visitors [11,12]. RSV outbreaks in inpatient pediatric oncologic care facilities and in adult hematology and oncology units have been described [9,[12][13][14][15][16]]. An understanding of transmission pathways helps to guide adequate outbreak control measures and to implement prophylactic measures.…”

Update on infection control practices in cancer hospitals

“…A recent meta‐analysis by Cochrane showed that the spread of respiratory viruses can be prevented by hygienic measures, such as barrier precautions and hand washing . Different modalities of isolation by viruses are portrayed in Table , including current recommendations by the American Society of Blood and Marrow Transplantation guidelines and standard practices at our own institution. Emerging data regarding enhanced isolation precautions, including contact and droplet precautions for all respiratory viruses, showed a 39% reduction in nosocomial infections .…”