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[Epidemiology of viral nosocomial infections in pediatrics]
1Service d'épidémiologie et d'hygiène hospitalières, hôpital du Bocage, CHU, BP 1542, 21034 Dijon, France. ludwig.aho@chu-dijon.fr
Abstract:
Nosocomial viral infections account for at least 5% of the total of NI and reach 23% in pediatric wards. The nosocomial infection (NI) incidence rate varies from 0.59 to 0.72 per 100 patients in pediatric wards. Many viruses have been associated with NI in pediatric wards. Rotavirus and respiratory syncytial virus (RSV) are the most frequent. Other viruses frequently identified are: calicivirus, adenovirus, astrovirus, influenza et para-influenza, rhinovirus and coronavirus. Asymptomatic infections occur frequently. The period of communicability varies and depends on the virus. It often begins before the clinical signs appear and ends after the healing. Viral shedding may be intermittent. Children and hospital environment and less frequently hospital staff are the main source for the virus. Poor handwashing results in direct spread to patient or self-inoculation even for respiratory viruses like RSV and rhinovirus. The main risk factors for NI are prolonged hospital stay, past history of prematurity and low age. Immunocompromised patients constitute a special high-risk group. Understaffing is also a risk factor. Minimal infective doses depend on the route of inoculation and the kind of virus. Low doses are for example sufficient for rotavirus, adenovirus and calicivirus. Viral inactivation is all the more easy when there is an envelope. Handwashing and appropriate isolation (technical and geographical) are the mainstay of prevention of viral NI. Vaccines are promising, especially for rotavirus.
Insights
Nosocomial viral infections are common in pediatric wards, with rotavirus and RSV being frequent culprits. Prevention relies on handwashing and isolation, with vaccines offering future promise.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Virology
Context:
- Nosocomial infections (NI) constitute a significant burden, accounting for at least 5% of all NIs and up to 23% in pediatric settings.
- The incidence rate of NI in pediatric wards ranges from 0.59 to 0.72 per 100 patients.
- Common viral agents include rotavirus, respiratory syncytial virus (RSV), calicivirus, adenovirus, and others, with asymptomatic infections frequently occurring.
Purpose:
- To review the epidemiology, sources, risk factors, and prevention strategies for viral nosocomial infections in pediatric populations.
- To highlight the significance of specific viruses like rotavirus and RSV in pediatric NI.
- To emphasize the role of environmental and behavioral factors in viral transmission within hospitals.
Summary:
- Viral NI in pediatric wards is driven by various viruses, with rotavirus and RSV being most prevalent. Transmission occurs through children, the hospital environment, and staff, often facilitated by poor hand hygiene.
- Key risk factors include prolonged hospitalization, prematurity, young age, immunocompromised status, and understaffing.
- Effective prevention strategies center on rigorous handwashing and appropriate isolation techniques, as viral inactivation is more efficient for enveloped viruses.
Impact:
- Understanding viral NI transmission and risk factors is crucial for developing targeted prevention and control measures in pediatric healthcare settings.
- Implementing robust infection control practices can significantly reduce the incidence of viral NIs, improving patient outcomes and reducing healthcare costs.
- The development and implementation of vaccines, particularly for rotavirus, hold significant promise for the future prevention of these infections.