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Outbreak and control of a rotaviral infection in a nursery
1Department of Pediatrics, Changhua Christian Hospital, Taiwan, ROC.
Insights
Neonatal rotavirus infection can cause significant illness in newborns, mimicking sepsis. Early discharge of uninfected infants is a key strategy to control nursery outbreaks.
Area of Science:
- Neonatal infectious diseases
- Virology
- Public health
Background:
- Neonatal rotaviral infection is often mild but difficult to eradicate in nurseries.
- Rotavirus outbreaks pose a significant challenge to neonatal intensive care units.
Purpose of the Study:
- To investigate the clinical presentation and epidemiology of a rotavirus outbreak in a neonatal nursery.
- To evaluate the effectiveness of infection control measures in eradicating the outbreak.
Main Methods:
- Prospective study of rotavirus infection in a newborn nursery from October 1994 to May 1995.
- Stool sample testing for rotavirus in neonates.
- RNA electropherotyping to identify rotavirus strains.
Main Results:
- Rotavirus was identified in 16% of 1,037 neonates.
- 57% of infected neonates developed symptoms including diarrhea, fever, vomiting, and poor feeding.
- A single rotavirus strain, distinct from strains in the pediatric ward, caused the outbreak.
Conclusions:
- Symptomatic illness and sepsis-like signs are common in rotavirus-infected neonates.
- Extended hospital stays facilitate rotavirus transmission.
- Early discharge of uninfected neonates is an effective control measure for nursery outbreaks.
Abstract:
Neonatal rotaviral infection generally causes an asymptomatic or mild illness. Once introduced into a nursery, it is very difficult to eradicate. We prospectively studied an outbreak of rotavirus infection in a normal newborn nursery from October 1994 through May 1995. Stool samples from infants more than 24 hours old were tested for rotaviral infection, either weekly, biweekly, or monthly. Rotavirus was identified in 164 (16%) of 1,037 tested neonates. Ninety-four (57%) rotavirus-positive neonates became symptomatic: 56 had diarrhea, 26 developed fever (rectal temperature > 38 degrees C), 25 experienced vomiting, 17 showed poor feeding, and 14 had an elevated core temperature. In total, 24 neonates were evaluated for suspected sepsis. RNA electropherotyping of samples from 91 neonates revealed infection by the same rotavirus strain in all cases. This strain differed from that isolated from 64 rotavirus-infected infants and toddlers in the pediatric ward during the same period. Infection control procedures (hand washing, isolation of infected neonates, and careful management of diapers) and early discharge of uninfected neonates were instituted, and the outbreak was eradicated 8 months after the onset. Our findings indicate that many rotavirus-infected term neonates become symptomatic and have signs suggestive of sepsis. Extended hospital stay may be an important factor in promoting rotaviral transmission. Thus, early discharge may be an additional effective method of controlling rotavirus outbreaks in a nursery.