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Published on: December 11, 2013
Outbreak of adenoviral infections in a long-term paediatric facility, New Jersey, 1986/87
J D Porter1, M Teter, V Traister
1Division of Field Services, Centers for Disease Control, Atlanta, GA 30333.
Insights
An adenovirus outbreak in a pediatric facility caused 11 deaths among disabled children, with a high fatality rate. Patients with tracheostomies and nursing staff were at increased risk during this prolonged adenovirus infection event.
Area of Science:
- Infectious Diseases
- Epidemiology
- Pediatrics
Background:
- Adenovirus infections can cause severe illness and outbreaks in healthcare settings.
- Long-term care facilities for children with disabilities are vulnerable populations.
- Previous adenovirus outbreaks in similar settings have been documented.
Purpose of the Study:
- To investigate an adenovirus outbreak in a long-term care pediatric facility.
- To determine the attack rate, case fatality rate, and risk factors associated with the outbreak.
- To identify contributing factors to the outbreak's duration and inform future control strategies.
Main Methods:
- Retrospective cohort study design.
- Case investigation and laboratory confirmation of adenovirus infection.
- Calculation of attack rates, relative risks, and confidence intervals.
Main Results:
- An 8-week adenovirus outbreak occurred in winter 1986-87, resulting in 11 deaths (39% case fatality rate) among 28 ill residents.
- The attack rate among 61 resident children was 46%, with tracheostomy patients at higher risk (RR=3.2).
- Staff experienced a 22% attack rate, with nurses more affected (RR=3.0); Adenovirus 7 and 1 were identified.
Conclusions:
- Adenoviral outbreaks can be rare but highly fatal in severely disabled children.
- Prolonged transmission between patients and staff, exacerbated by lack of cohorting, likely prolonged the outbreak.
- Future investigations should consider vaccines or antiviral agents for outbreak control and mortality reduction.
Abstract:
During an 8-week period in the winter of 1986-87, there were 11 deaths from an adenovirus infection (case fatality rate = 39%, 11/28) in a long-term care paediatric facility in southern New Jersey. Among the 61 resident children, all with severe congenital and/or acquired disabilities, 28 developed a febrile respiratory illness compatible with adenovirus infection [attack rate (AR) = 46%]. Patients with tracheostomies were three times as likely to become ill [relative risk (RR) = 3.2, 95% confidence intervals (CI) = 1.8-5.6]. Twenty-three members of the staff had a similar febrile illness (AR = 22%, 23/106); nurses were more likely to be ill than other staff (RR = 3.0, 95% CI = 1.1-11.4). Adenovirus 7 was isolated from four of the case patients and adenovirus 1 from one. The findings suggest prolonged transmission between patients and nursing staff with lack of cohorting of ill patients probably contributing to the prolongation of the outbreak. This investigation indicates that adenoviral outbreaks, although rare, can have a high mortality in severely disabled children, and that future outbreak investigations should examine the use of vaccines or antiviral agents to reduce mortality and for outbreak control.
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