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Safety Precautions and Operating Procedures in an ABSL-4 Laboratory: 2. General Practices
Published on: October 3, 2016
Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a
Steven Schaeffer Spires1, H Keipp Talbot1, Carolyn A Pope2
11Department of Medicine,Vanderbilt University School of Medicine,Nashville,Tennessee.
Abstract:
OBJECTIVE We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting. METHODS Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing. RESULTS We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died. CONCLUSIONS This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses. Infect Control Hosp Epidemiol 2017;38:399-404.
Insights
An outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) affected 73% of residents in a dementia ward. This highlights challenges in preventing viral transmission in older adults.
Area of Science:
- Infectious Diseases
- Epidemiology
- Geriatrics
Background:
- Respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) are significant pathogens in older adults.
- Congregate settings, such as dementia care wards, present unique infection control challenges.
Purpose of the Study:
- To report an outbreak of RSV and HMPV in a dementia care ward.
- To raise awareness of these viruses in the older adult population.
- To highlight infection prevention challenges during noninfluenza respiratory viral outbreaks.
Main Methods:
- A case definition included fever and at least two respiratory symptoms.
- Infection control measures: patient and staff cohorting, isolation precautions, cessation of group activities.
- Specimen testing: nasopharyngeal swabs analyzed by rT-PCR for viral identification.
Main Results:
- 73% of residents (30/41) were identified as cases during the 16-day outbreak.
- RSV-B, HMPV, and influenza A were identified in 14 cases.
- 50% of cases required acute care transfer, 17% died.
Conclusions:
- RSV and HMPV cause substantial disease in older adults.
- Preventing transmission of these viruses in congregate settings is challenging.
- This outbreak underscores the need for heightened awareness and robust infection control strategies.
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