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Published on: December 10, 2013
Nosocomial adenovirus infection in a paediatric respiratory unit
1Department of Paediatrics and Child Health, University of Natal, Durban, South Africa.
Insights
A nosocomial adenovirus outbreak in a pediatric respiratory unit led to a 91% mortality rate in infants. Young age and prolonged hospital stays were key risk factors for this severe hospital-acquired infection.
Area of Science:
- Infectious Diseases
- Pediatrics
- Hospital Epidemiology
Background:
- Adenovirus infections pose a significant threat in pediatric respiratory units, particularly in vulnerable populations.
- Nosocomial outbreaks can lead to high morbidity and mortality among hospitalized children.
Purpose of the Study:
- To investigate a nosocomial adenovirus outbreak in a pediatric respiratory unit.
- To identify risk factors, transmission dynamics, and outcomes of adenovirus infection in this setting.
Main Methods:
- Retrospective analysis of pediatric admissions over an eight-month period.
- Case identification, clinical data review, and genome analysis of adenovirus strains.
- Assessment of nosocomial acquisition incidence and mortality rates.
Main Results:
- Thirty-two cases of adenovirus infection were identified, with a 67% overall mortality rate.
- Nosocomial acquisition occurred in 23 children (12% incidence) with a 91% mortality rate.
- Young age (<1 year) and prolonged ventilation with endotracheal intubation were significant risk factors.
Conclusions:
- Adenovirus poses a severe risk in pediatric respiratory units, with high mortality from nosocomial infections.
- Hand hygiene and careful manipulation of respiratory equipment are critical for preventing spread.
- Continuous vigilance and control measures are necessary due to recurrent introductions of the virus.
Abstract:
We report a nosocomial outbreak due to adenovirus in a paediatric respiratory unit serving a poor socio-economic community. Of 207 children admitted during an eight-month period, 24% were neonates; the median age of the remainder was 10 months. Thirty-two cases were found to be infected with adenovirus and of these 67% died. Nine were already infected with adenovirus when admitted. Twenty-three acquired the infection after admission, giving an incidence of nosocomial acquisition of 12% with a 91% mortality rate. All but one of the adenovirus infected children were being ventilated and had an endotracheal tube in place. Nosocomial spread was likely to have been from the hands of attendants, especially those manipulating suction catheters and endotracheal tube or ventilator connections. Risk factors for acquiring nosocomial infection were young age: all but two were < 1 year of age, and a relatively prolonged ward stay necessitated by the nature of the primary condition (pneumonia, bronchiolitis, laryngotracheo bronchitis, tetanus). The measures that were taken to control spread of the virus are described. Despite these, primary cases of adenovirus infection re-introduced the virus regularly over the study period. The genome analysis showed adenovirus types to be 7c2 and 7c.
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