Control of an outbreak of respiratory syncytial virus infection in immunocompromised adults.

Respiratory syncytial virus (RSV) is increasingly recognized as an important pathogen in immunocompromised adults, particularly those receiving bone marrow transplants, and, given the ease with which it spreads, represents a significant nosocomial problem. We describe an outbreak of RSV infection involving eight patients on a haematology/oncology ward which was controlled by early screening of patients and staff. Positive patients were cohort nursed on a separate ward and basic infection control measures including use of gowns and gloves were enforced. Children under age 12 were denied ward access. All patients with lower respiratory tract infection, and bone marrow transplant recipients with upper respiratory symptoms, were treated with nebulized ribavirin. There were no deaths. We conclude that awareness of the risk of RSV infection in immunocompromised patients coupled with rapid diagnosis and treatment, screening of symptomatic patients and staff, cohort nursing of cases and basic infection control procedures can prevent spread of RSV infection and reduce morbidity.

[1]  I. Butler,et al.  Respiratory syncytial virus. , 2001, The New England journal of medicine.

[2]  C. Osiowy Direct Detection of Respiratory Syncytial Virus, Parainfluenza Virus, and Adenovirus in Clinical Respiratory Specimens by a Multiplex Reverse Transcription-PCR Assay , 1998, Journal of Clinical Microbiology.

[3]  J. Fan,et al.  Rapid simultaneous diagnosis of infections with respiratory syncytial viruses A and B, influenza viruses A and B, and human parainfluenza virus types 1, 2, and 3 by multiplex quantitative reverse transcription-polymerase chain reaction-enzyme hybridization assay (Hexaplex). , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  M. Kundi,et al.  Improved detection of respiratory syncytial virus in nasal aspirates by seminested RT‐PCR , 1997, Journal of medical virology.

[5]  F. Galateau-Sallé,et al.  Detection of respiratory syncytial virus, parainfluenzavirus 3, adenovirus and rhinovirus sequences in respiratory tract of infants by polymerase chain reaction and hybridization. , 1997, Clinical and diagnostic virology.

[6]  J. Englund,et al.  Prevention and treatment of respiratory syncytial virus and parainfluenza viruses in immunocompromised patients. , 1997, The American journal of medicine.

[7]  R. Couch,et al.  Community respiratory virus infections among hospitalized adult bone marrow transplant recipients. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  R. Couch,et al.  Respiratory syncytial virus pneumonia in hospitalized adult patients with leukemia. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  J. Englund,et al.  Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients. , 1995, Bone marrow transplantation.

[10]  J. Englund,et al.  High-dose, short-duration ribavirin aerosol therapy compared with standard ribavirin therapy in children with suspected respiratory syncytial virus infection. , 1994, The Journal of pediatrics.

[11]  P. Madge,et al.  Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus , 1992, The Lancet.

[12]  B. Osborne,et al.  An outbreak of respiratory syncytial virus in a bone marrow transplant center. , 1992, The Journal of infectious diseases.

[13]  E. Garrity,et al.  Respiratory syncytial virus pneumonia in a lung transplant recipient: case report. , 1992, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[14]  R. Holzman,et al.  Screening for respiratory syncytial virus and assignment to a cohort at admission to reduce nosocomial transmission. , 1990, The Journal of pediatrics.

[15]  P. Deteix,et al.  Severe respiratory syncytial virus pneumonia in an adult renal transplant recipient: successful treatment with ribavirin. , 1990, Scandinavian journal of infectious diseases.

[16]  P. Bitterman,et al.  Respiratory Syncytial Virus‐Induced Acute Lung Injury in Adult Patients with Bone Marrow Transplants: A Clinical Approach and Review of the Literature , 1989, Medicine.

[17]  J. Sinnott,et al.  Respiratory syncytial virus pneumonia in a cardiac transplant recipient. , 1988, The Journal of infectious diseases.

[18]  H. Balfour,et al.  Respiratory syncytial virus infection in immunocompromised adults. , 1988, Annals of internal medicine.

[19]  J. Waner,et al.  Aerosolized ribavirin treatment of respiratory syncytial virus infection in infants hospitalized during an epidemic , 1987, The Pediatric infectious disease journal.

[20]  R. Douglas,et al.  The use of eye-nose goggles to control nosocomial respiratory syncytial virus infection. , 1986, JAMA.

[21]  John E. Bennett,et al.  Principles and practice of infectious diseases. Vols 1 and 2. , 1979 .