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Nosocomial adenovirus infection: molecular epidemiology of an outbreak
N Singh-Naz1, M Brown, M Ganeshananthan
1Department of Infectious Diseases and Epidemiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010.
Abstract:
Nosocomial transmission of adenovirus type 3 associated with fatalities in infants has not been frequently reported. This report describes the nosocomial spread of adenovirus types 2 and 3 among infants with bronchopulmonary dysplasia in a chronic (transitional) care facility. The index case developed pneumonia with a clinical deterioration in respiratory status 8 days after admission. Within the next 10 to 30 days 9 other infants and 2 health care personnel became ill with respiratory symptoms. Three of these 10 infants had progressive respiratory failure and 2 of them died. All of these infants had underlying chronic lung disease of bronchopulmonary dysplasia. The overall attack rate was 30% (10 of 33). Further spread of adenovirus was prevented by using barrier precautions and masks while performing tracheostomy care. Adenovirus isolates were serotyped as Ad3 in 4 patients and 1 staff member, as Ad2 in 3 patients, and as a combination of Ad2 and Ad3 in 1 patient. Two fatalities were associated with Ad3 infection. Three isolates from 2 patients and 1 staff member were not available for typing. Restriction endonuclease analysis was performed on all of these isolates of Ad3 and Ad2. There was no genetic heterogeneity in the isolates, suggesting a common source.
Insights
Nosocomial adenovirus types 2 and 3 spread occurred in infants with bronchopulmonary dysplasia, causing respiratory failure and fatalities. Control measures halted further transmission in the chronic care facility.
Area of Science:
- Infectious Diseases
- Pediatrics
- Public Health
Background:
- Nosocomial adenovirus transmission, particularly type 3 with infant fatalities, is infrequently documented.
- Infants with bronchopulmonary dysplasia are vulnerable to respiratory infections in healthcare settings.
Purpose of the Study:
- To describe the nosocomial outbreak of adenovirus types 2 and 3 in infants with bronchopulmonary dysplasia.
- To identify the clinical course, attack rate, and outcomes of the outbreak.
- To evaluate the effectiveness of infection control measures.
Main Methods:
- Case reporting and epidemiological investigation of respiratory illness in a chronic care facility.
- Serotyping of adenovirus isolates (Ad2 and Ad3).
- Restriction endonuclease analysis for genetic characterization of viral isolates.
Main Results:
- An outbreak of adenovirus types 2 and 3 affected 10 individuals (9 infants, 2 staff), with an overall attack rate of 30%.
- Three infants experienced progressive respiratory failure, and two died, both associated with Ad3 infection.
- Restriction endonuclease analysis indicated a common source for the Ad2 and Ad3 isolates, with no genetic heterogeneity.
Conclusions:
- Adenovirus types 2 and 3 can cause significant nosocomial transmission and severe outcomes, including fatalities, in vulnerable infants with bronchopulmonary dysplasia.
- Implementing barrier precautions and masks during tracheostomy care was effective in preventing further spread.
- Genomic analysis supports a single-source origin for the outbreak, emphasizing the importance of source identification and control.