NICHOLS WG, ERDMAN DD, HAN A, ZUKERMAN C, COREY L, BOECKH M; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. K-1227.
Fred Hutchinson Cancer Res. Ctr., Seattle, WA.
BACKGROUND: Parainfluenza infections cause considerable morbidity and mortality after SCT; inpatient nosocomial outbreaks are common. We investigated a prolonged hPIV3 outbreak that occurred in our OPD. METHODS: Nasopharyngeal wash (NPW) was performed on patients with symptoms of upper respiratory infection (URI); patients with virologically confirmed hPIV3 were isolated until NPW was negative. Staff and visitors with URI symptoms were restricted from patient areas. Nucleotide (nt) sequences (778 nt from variable regions of the hemagglutinin-neuraminidase gene) from 36 patient and 9 community hPIV3 isolates were compared to determine epidemiologic relatedness. RESULTS: 66 cases of hPIV3 infection were diagnosed by direct fluorescent antibody and/or culture among 350 SCT recipients (19%) attending the OPD between Sep 1998 and July 1999. Peak incidence was in Sep and Oct; 30 cases were identified without a corresponding increase in community-wide prevalence. Thereafter, hPIV3 incidence fell to a mean of 5 cases per month. Sequence analysis of available isolates indicated that 18/20 isolates from Sep/Oct and 11/16 isolates from Nov 1998 - July 1999 were related; only 1/4 community isolates from Sep/Oct and 0/5 from Nov - July was related to the patient isolates. Virologic screening of patients and restriction of symptomatic individuals from patient areas failed to halt the outbreak. CONCLUSIONS: This prolonged outbreak of hPIV3 infection was associated with a single predominant genotype. Symptomatic surveillance and isolation were ineffective in terminating the outbreak, suggesting asymptomatic shedding among patients, staff or visitors and/or viral persistence on environmental surfaces as likely explanations. The concept of nosocomial transmission should be expanded to include the OPD for immunosuppressed patients.
Publication Types:
Keywords:
- Base Sequence
- Communicable Diseases
- Disease Outbreaks
- Humans
- Immunocompromised Host
- Incidence
- Parainfluenza Virus 3, Human
- Paramyxoviridae Infections
- Prevalence
- Respiratory Tract Infections
- Respirovirus Infections
- Rubulavirus Infections
- epidemiology
- genetics
- immunology
- therapy
Other ID:
UI: 102268330
From Meeting Abstracts