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Molecular epidemiology of a parainfluenza type 3 virus outbreak on a pediatric ward
R A Karron1, K L O'Brien, J L Froehlich
1Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
Abstract:
Parainfluenza type 3 virus (PIV-3), an important cause of acute lower respiratory illness in children, can be transmitted nosocomially. To differentiate between nosocomial transmission and community-acquired infection, a polymerase chain reaction-based sequencing assay was developed for the 5' noncoding region of the PIV-3 fusion protein gene and was applied to virus specimens from 10 children infected with PIV-3 during a hospital outbreak. Four strains of PIV-3 were identified among the 10 virus isolates. Six isolates, which appeared to belong to 1 strain, were obtained from a cluster of nosocomial cases in a pediatric intermediate care unit. In contrast, the remaining 4 isolates, which appeared to belong to 3 different strains, were obtained from children infected in the community or elsewhere in the hospital. These data indicate that multiple strains of PIV-3 can be found during a single epidemic and provide evidence that infections within the intermediate care unit were probably caused by transmission of 1 strain of virus within the unit rather than reintroduction of virus by new patients or staff.
Insights
Parainfluenza type 3 virus (PIV-3) can spread in hospitals. A new sequencing assay helped identify one PIV-3 strain causing infections in a pediatric unit, suggesting within-unit transmission.
Area of Science:
- Virology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Parainfluenza type 3 virus (PIV-3) is a significant cause of acute lower respiratory illness in children.
- Nosocomial transmission of PIV-3 complicates infection control and diagnosis.
Purpose of the Study:
- To develop a molecular assay for differentiating nosocomial from community-acquired PIV-3 infections.
- To investigate the genetic diversity and transmission patterns of PIV-3 during a hospital outbreak.
Main Methods:
- Development of a polymerase chain reaction (PCR)-based sequencing assay targeting the 5' noncoding region of the PIV-3 fusion protein gene.
- Application of the assay to PIV-3 isolates from 10 pediatric patients during a hospital outbreak.
Main Results:
- Four distinct strains of PIV-3 were identified among the 10 isolates.
- Six isolates from a cluster of nosocomial cases in a pediatric intermediate care unit belonged to a single strain.
- The remaining four isolates, from community-acquired or other hospital infections, represented three different strains.
Conclusions:
- Multiple PIV-3 strains can co-circulate during a single epidemic.
- The findings provide evidence for the likely transmission of a single PIV-3 strain within the pediatric intermediate care unit, rather than reintroduction by new patients or staff.