Health Care–Acquired Viral Respiratory Diseases
Section snippets
Epidemiology
RSV is the most common cause of pneumonia and bronchiolitis in infants3 and is a common pathogen in older and high-risk adults.4 Outbreaks of RSV have occurred in a variety of pediatric and adult health care settings.5, 6, 7, 8, 9, 10, 11, 12 Secondary attack rates of 19% to 45% have been reported among patients when limited or no infection control measures are implemented.6, 7, 13 Similarly, 34% to 56% of personnel on infant wards may become infected.6, 7, 13 Most infected personnel are
Epidemiology
Influenza infects approximately 5% to 20% of the US population annually, resulting in 226,000 hospitalizations and 36000 deaths.36, 37 Transmission of influenza has been reported in a variety of pediatric and adult health care settings, and health care workers may be often implicated in the outbreaks.37 Health care workers are at an increased risk of acquiring influenza because of exposure to infection in both the health care and community settings,38 and they often fail to recognize that they
Pandemic influenza
Pandemic influenza results when a novel viral strain to which the population has little or no immunity achieves the ability to spread easily between humans, resulting in rapid spread across several continents. A novel virus emerges as a result of reassortment of human influenza genes with those of avian or swine strains. During the past century, there have been 4 major pandemics: 1918–1919 Spanish influenza (H1N1), 1957–1958 Asian influenza (H2N2), 1968–1969 Hong Kong influenza (H3N2), and 2009
Adenovirus
Health care–associated outbreaks of respiratory tract infections caused by adenovirus have been reported from pediatric and adult health care settings.101, 102, 103, 104 Attack rates among patients have ranged from 15% to 56%.101, 102 Health care workers were often infected, and many continued to provide patient care while ill.103 Similar to influenza, adenovirus is transmitted through large respiratory droplets. Transmission also occurs via self-inoculation after contact with contaminated
Summary
Transmission of viral respiratory infections occurs in a variety of pediatric and adult health care settings, resulting in increased patient morbidity and health care costs. Transmission may occur via aerosol, large respiratory droplets, or self-inoculation after touching contaminated fomites. Different viruses have different modes of transmission, and prevention of transmission requires early recognition of symptomatic patients and prompt institution of appropriate transmission-based
References (108)
Nosocomial viral respiratory infections: perennial weeds on pediatric wards
Am J Med
(1981)- et al.
A simultaneous outbreak of respiratory syncytial virus and parainfluenza virus type 3 in a newborn nursery
J Pediatr
(1984) - et al.
Respiratory syncytial virus infection among intubated adults in a university medical intensive care unit
Chest
(1991) - et al.
Modes of transmission of respiratory syncytial virus
J Pediatr
(1981) - et al.
Respiratory syncytial virus infections in infants: quantitation and duration of shedding
J Pediatr
(1976) - et al.
The use of gowns and masks to control respiratory illness in pediatric hospital personnel
J Pediatr
(1981) - et al.
Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus
Lancet
(1992) - et al.
Reducing the rate of nosocomially transmitted respiratory syncytial virus
Am J Infect Control
(1999) - et al.
Screening for respiratory syncytial virus and assignment to a cohort at admission to reduce nosocomial transmission
J Pediatr
(1990) - et al.
Experience with the use of palivizumab together with infection control measures to prevent respiratory syncytial virus outbreaks in neonatal intensive care units
J Hosp Infect
(2008)
Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease
J Pediatr
Influenza in the acute hospital setting
Lancet Infect Dis
Barriers to influenza vaccine acceptance. A survey of physicians and nurses
Am J Infect Control
Requiring influenza vaccination for health care workers: seven truths we must accept
Vaccine
The occurrence of influenza A virus on household and day care center fomites
J Infect
Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial
Lancet
Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China
Lancet
Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee
MMWR Recomm Rep
Bronchiolitis-associated hospitalizations among US children, 1980–1996
JAMA
Respiratory syncytial virus infection in elderly and high-risk adults
N Engl J Med
Virus cross-infection in paediatric wards
Br Med J
Nosocomial respiratory syncytial virus infections
N Engl J Med
Neonatal respiratory syncytial virus infection
N Engl J Med
Medical and economic impact of a respiratory syncytial virus outbreak in a neonatal intensive care unit
Pediatr Infect Dis J
Nosocomial transmission of respiratory syncytial virus in immunocompromised adults
J Clin Microbiol
Concurrent respiratory syncytial virus and influenza A infections in the institutionalized elderly and chronically ill
Ann Intern Med
Control of nosocomial respiratory syncytial viral infections
Pediatrics
Nosocomial respiratory syncytial virus infections: the “Cold War” has not ended
Clin Infect Dis
Respiratory syncytial virus: its transmission in the hospital environment
Yale J Biol Med
Infectivity of respiratory syncytial virus by various routes of inoculation
Infect Immun
Possible transmission by fomites of respiratory syncytial virus
J Infect Dis
Nosocomial respiratory syncytial viral infections. Should gowns and masks be used?
Am J Dis Child
Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions
N Engl J Med
Nosocomial respiratory syncytial virus infection in Canadian pediatric hospitals: a Pediatric Investigators Collaborative Network on Infections in Canada Study
Pediatrics
The use of eye-nose goggles to control nosocomial respiratory syncytial virus infection
JAMA
Respiratory syncytial virus (RSV) infection rate in personnel caring for children with RSV infections. Routine isolation procedure vs routine procedure supplemented by use of masks and goggles
Am J Dis Child
Nosocomial respiratory syncytial virus infections: the cost-effectiveness and cost-benefit of infection control
Pediatrics
Prevention of nosocomial transmission of respiratory syncytial virus in a newborn nursery
Infect Control Hosp Epidemiol
2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings
Evaluation of four methods for the diagnosis of respiratory syncytial virus infection in older adults
J Am Geriatr Soc
Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants
Pediatrics
Estimates of the US health impact of influenza
Am J Public Health
Influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages
Infect Control Hosp Epidemiol
Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire
BMJ
Influenza in man
Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff
Infect Control Hosp Epidemiol
Temperature-sensitive mutants of influenza virus. III. Further characterization of the ts-1[E] influenza A recombinant (H3N2) virus in man
J Infect Dis
Local and systemic cytokine responses during experimental human influenza A virus infection. Relation to symptom formation and host defense
J Clin Invest
Nosocomial influenza infection as a cause of intercurrent fevers in infants
Pediatrics
Common emergence of amantadine- and rimantadine-resistant influenza A viruses in symptomatic immunocompromised adults
Clin Infect Dis
Cited by (30)
Nosocomial COVID-19 at a comprehensive cancer center during the first year of the pandemic: Lessons learned
2023, American Journal of Infection ControlA healthy degree of suspicion: A discussion of the implementation of transmission based precautions in the emergency department
2016, Australasian Emergency Nursing JournalDelayed RSV diagnosis in a stem cell transplant population due to mutations that result in negative polymerase chain reaction
2013, Diagnostic Microbiology and Infectious DiseaseCitation Excerpt :Thus although respiratory molecular assays are a valuable unique tool, there is no single assay that is 100% sensitive. In spite of these problems, molecular testing has become an important method for detecting the respiratory viruses in HSCT patients (Goins et al., 2011; Ison, 2007) and they will continue to be used in these patient populations. The results from RVP multiplex assays support decisions for the administration of appropriate therapy as well as isolation of infected patients in high-risk areas.
Reported variability in healthcare facility policies regarding healthcare personnel working while experiencing influenza-like illnesses: An emerging infections network survey
2020, Infection Control and Hospital Epidemiology
Funding support: H.K.T. received funding support from the National Institute of Allergy and Infectious Diseases grant K23 AI074863–03 and a T. Franklin Williams Scholarship Award, which is funded by Atlantic Philanthropies, Inc, the John A. Hartford Foundation, the Association of Specialty Professors, and the Infectious Diseases Society of America.
Disclosures: W.P.G. has no disclosures. H.K.T. has received funding from Protein Sciences Corporation, Wyeth, Sanofi Pasteur, VaxInnate, the National Institutes of Health, and the Centers for Disease Control and Prevention (CDC). T.R.T. has received influenza vaccine donated by Sanofi Pasteur for a study funded by the CDC and serves as a consultant for Joint Commission Resources.