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Wildenbeest JG, Lowe DM, Standing JF, Butler CC. Respiratory syncytial virus infections in adults: a narrative review. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00255-8. [PMID: 39265602 DOI: 10.1016/s2213-2600(24)00255-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 09/14/2024]
Abstract
Respiratory syncytial virus (RSV), an RNA virus spread by droplet infection that affects all ages, is increasingly recognised as an important pathogen in adults, especially among older people living with comorbidities. Distinguishing RSV from other acute viral infections on clinical grounds alone, with sufficient precision to be clinically useful, is not possible. The reference standard diagnosis is by PCR: point-of-care tests perform less well with lower viral loads. Testing samples from a single respiratory tract site could result in underdetection. RSV is identified in 6-11% of outpatient respiratory tract infection (RTI) consultations in older adults (≥60 years, or ≥65 years, depending on the study) and accounts for 4-11% of adults (≥18 years) hospitalised with RTI, with 6-15% of those hospitalised admitted to intensive care, and 1-12% of all adults hospitalised with RSV respiratory tract infection dying. Community-based studies estimate the yearly incidence of RSV infection at around 3-7% in adults aged 60 years and older in high-income countries. Although RSV accounts for a similar disease burden as influenza in adults, those hospitalised with severe RSV disease are typically older (most ≥60 years) and have more comorbidities, more respiratory symptoms, and are frequently without fever. Long-term sequelae are common and include deterioration of underlying disease (typically heart failure and COPD). There are few evidence-based RSV-specific treatments currently available, with supportive care being the main modality. Two protein subunit vaccines for protection from severe RSV in adults aged 60 years and older were licensed in 2023, and a third-an mRNA-based vaccine-recently gained market approval in the USA. The phase 3 studies in these three vaccines showed good protection against severe disease. Data on real-world vaccine effectiveness in older adults, including subgroups at high risk for RSV-associated hospitalisation, are needed to establish the best use of these newly approved RSV vaccines. New diagnostics and therapeutics are being developed, which will also need rigorous evaluation within their target populations to ensure they are used only for those in whom there is evidence of improved outcomes. There is an urgent need to reconceptualise this illness from one that is serious in children, but far less important than influenza in older people, to thinking of RSV as also a major risk to health for older people that needs targeted prevention and treatment.
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Affiliation(s)
- Joanne G Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, London, UK; Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Joseph F Standing
- Infection, Inflammation and Immunology, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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2
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Hughes L, Gard L, Fliss M, Bakker M, Hazenberg C, Zhou X, Vierdag P, von Eije K, Voss A, Lokate M, Knoester M. Molecular epidemiology of a Parainfluenza Type 3 virus outbreak: Informing infection control measures on adult hematology wards. J Clin Virol 2024; 172:105677. [PMID: 38663338 DOI: 10.1016/j.jcv.2024.105677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/30/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Parainfluenza virus type 3 (PIV3) outbreaks among hematology patients are associated with high morbidity and mortality. Prompt implementation of infection prevention (IP) measures has proven to be the most efficacious approach for controlling PIV3 outbreaks within this patient population. The most suitable IP measures can vary depending on the mode of virus transmission, which remains unidentified in most outbreaks. We describe the molecular epidemiology of an outbreak of PIV3 among hematology patients and the development of a new method that allows for the differentiation of outbreak and community strains, from which a closed outbreak could be inferred. METHODS Patients were screened for respiratory viruses using multiplex-PCR. PIV3 positive samples with a cycle threshold (Ct)-value of <31 underwent a retrospective characterization via an in-house developed sequence analysis of the hemagglutinin-neuraminidase (HN) gene. RESULTS Between July and September 2022, 31 hematology patients were identified with PIV3. Although infection control measures were implemented, the outbreak persisted for nine weeks. Sequencing the HN gene of 27 PIV3 strains from 27 patients revealed that all outbreak strains formed a distinct cluster separate from the control strains, suggestive of a nosocomial transmission route. CONCLUSIONS Sequencing the HN gene of PIV3 strains in an outbreak setting enables outbreak strains to be distinguished from community strains. Early molecular characterization of PIV3 strains during an outbreak can serve as a tool in determining potential transmission routes. This, in turn, enables rapid implementation of targeted infection prevention measures, with the goal of minimizing the outbreak's duration and reducing associated morbidity and mortality.
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Affiliation(s)
- Laura Hughes
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands.
| | - Lilli Gard
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Fliss
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Martijn Bakker
- Department of Hematology, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Carin Hazenberg
- Department of Hematology, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Xuewei Zhou
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Paulien Vierdag
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Karin von Eije
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Andreas Voss
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Mariëtte Lokate
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein Knoester
- Department of Microbiology and Infection Prevention, University of Groningen. University Medical Center Groningen, Groningen, the Netherlands
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Timsit S, Armand-Lefèvre L, Le Goff J, Salmona M. The clinical and epidemiological impacts of whole genomic sequencing on bacterial and virological agents. Infect Dis Now 2024; 54:104844. [PMID: 38101516 DOI: 10.1016/j.idnow.2023.104844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
Whole Genome Sequencing (WGS) is a molecular biology tool consisting in the sequencing of the entire genome of a given organism. Due to its ability to provide the finest available resolution of bacterial and virological genetics, it is used at several levels in the field of infectiology. On an individual scale and through application of a single technique, it enables the typological identification and characterization of strains, the characterization of plasmids, and enhanced search for resistance genes and virulence factors. On a collective scale, it enables the characterization of strains and the determination of phylogenetic links between different microorganisms during community outbreaks and healthcare-associated epidemics. The information provided by WGS enables real-time monitoring of strain-level epidemiology on a worldwide scale, and facilitates surveillance of the resistance dissemination and the introduction or emergence of pathogenic variants in humans or their environment. There are several possible approaches to completion of an entire genome. The choice of one method rather than another is essentially dictated by the matrix, either a clinical sample or a culture isolate, and the clinical objective. WGS is an advanced technology that remains costly despite a gradual decrease in its expenses, potentially hindering its implementation in certain laboratories and thus its use in routine microbiology. Even though WGS is making steady inroads as a reference method, efforts remain needed in view of so harmonizing its interpretations and decreasing the time to generation of conclusive results.
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Affiliation(s)
- Sarah Timsit
- Service de Virologie, Hôpital Saint-Louis, APHP, Paris, France; Service de Bactériologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Laurence Armand-Lefèvre
- Service de Bactériologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France; IAME UMR 1137, INSERM, Université Paris Cité, Paris, France
| | - Jérôme Le Goff
- Service de Virologie, Hôpital Saint-Louis, APHP, Paris, France; INSERM U976, Insight Team, Université Paris Cité, Paris, France
| | - Maud Salmona
- Service de Virologie, Hôpital Saint-Louis, APHP, Paris, France; INSERM U976, Insight Team, Université Paris Cité, Paris, France.
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4
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Tabatabai J, Schnitzler P, Prifert C, Schiller M, Weissbrich B, von Lilienfeld-Toal M, Teschner D, Jordan K, Müller-Tidow C, Egerer G, Giesen N. Parainfluenza virus infections in patients with hematological malignancies or stem cell transplantation: Analysis of clinical characteristics, nosocomial transmission and viral shedding. PLoS One 2022; 17:e0271756. [PMID: 35905071 PMCID: PMC9337657 DOI: 10.1371/journal.pone.0271756] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
To assess morbidity and mortality of parainfluenza virus (PIV) infections in immunocompromised patients, we analysed PIV infections in a hematology and stem cell transplantation (SCT) unit over the course of three years. Isolated PIV strains were characterized by sequence analysis and nosocomial transmission was assessed including phylogenetic analysis of viral strains. 109 cases of PIV infection were identified, 75 in the setting of SCT. PIV type 3 (n = 68) was the most frequent subtype. PIV lower respiratory tract infection (LRTI) was observed in 47 patients (43%) with a mortality of 19%. Severe leukopenia, prior steroid therapy and presence of co-infections were significant risk factors for development of PIV-LRTI in multivariate analysis. Prolonged viral shedding was frequently observed with a median duration of 14 days and up to 79 days, especially in patients after allogeneic SCT and with LRTI. Nosocomial transmission occurred in 47 patients. Phylogenetic analysis of isolated PIV strains and combination with clinical data enabled the identification of seven separate clusters of nosocomial transmission. In conclusion, we observed significant morbidity and mortality of PIV infection in hematology and transplant patients. The clinical impact of co-infections, the possibility of long-term viral shedding and frequent nosocomial transmission should be taken into account when designing infection control strategies.
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Affiliation(s)
- Julia Tabatabai
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
- Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christiane Prifert
- Institute of Virology and Immunobiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Martin Schiller
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Department of Internal Medicine, HochFranken Hospitals, Munchberg, Germany
| | - Benedikt Weissbrich
- Institute of Virology and Immunobiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marie von Lilienfeld-Toal
- Department of Internal Medicine II, University Hospital Jena, Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institut, Jena, Germany
| | - Daniel Teschner
- Department of Hematology, Medical Oncology, & Pneumology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Karin Jordan
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerlinde Egerer
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicola Giesen
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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5
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Iglói Z, van Loo IHM, Demandt AMP, Franssen K, Jonges M, van Gelder M, Erkens-Hulshof S, van Alphen LB. Controlling a human parainfluenza virus-3 outbreak in a haematology ward in a tertiary hospital: the importance of screening strategy and molecular diagnostics in relation to clinical symptoms. J Hosp Infect 2022; 126:56-63. [PMID: 35483642 DOI: 10.1016/j.jhin.2022.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Human parainfluenza 3 (HPIV-3) outbreak at the haemato-oncology ward of the Maastricht University Medical Center in the summer of 2016. AIM To describe an effective strategy to control the largest reported HPIV-3 outbreak at an adult haematology-oncology ward in the Netherlands by implementing infection control measures and molecular epidemiology investigation. METHODS Clinical, patient and diagnostic data were both pro- and retrospectively collected. HPIV-3 real-time-PCR (HPIV-3 RT-PCR) was validated using oropharyngeal rinse samples. Screening of all new and admitted patients was implemented to identify asymptomatic infection or prolonged shedding of HPIV-3 allowing cohort isolation. FINDINGS The HPIV-3 outbreak occurred between 9 July and 28 September 2016 and affected 53 patients. HPIV-3 RT-PCR on oropharyngeal rinse samples demonstrated an up to tenfold higher sensitivity compared to pharyngeal swabs. Monitoring showed that at first positive PCR, 20 patients (38%) were asymptomatic (of which 11 remained asymptomatic) and the average duration of shedding was 14 days (range 1-58). Asymptomatic patients had lower viral load, shorter period of viral shedding (≤14 days) and were mostly immune competent oncology patients. The outbreak was under control 5 weeks after implementation of screening of asymptomatic patients. CONCLUSION Implementation of a sensitive screening method identified both symptomatic and asymptomatic patients which had lower viral load and allowed early cohort isolation. This is especially important in a ward that combines patients with varying immune status, since both immunocompromised and immune competent patients are likely to spread the HPIV-3 virus, either through prolonged shedding or through asymptomatic course of disease.
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Affiliation(s)
- Zsófia Iglói
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Inge H M van Loo
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Astrid M P Demandt
- Department of Internal Medicine, Division of Hematology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karen Franssen
- Infection Control, Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marcel Jonges
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michel van Gelder
- Department of Internal Medicine, Division of Hematology, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sandra Erkens-Hulshof
- Infection Control, Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lieke B van Alphen
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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6
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Munting A, Manuel O. Viral infections in lung transplantation. J Thorac Dis 2022; 13:6673-6694. [PMID: 34992844 PMCID: PMC8662465 DOI: 10.21037/jtd-2021-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Viral infections account for up to 30% of all infectious complications in lung transplant recipients, remaining a significant cause of morbidity and even mortality. Impact of viral infections is not only due to the direct effects of viral replication, but also to immunologically-mediated lung injury that may lead to acute rejection and chronic lung allograft dysfunction. This has particularly been seen in infections caused by herpesviruses and respiratory viruses. The implementation of universal preventive measures against cytomegalovirus (CMV) and influenza (by means of antiviral prophylaxis and vaccination, respectively) and administration of early antiviral treatment have reduced the burden of these diseases and potentially their role in affecting allograft outcomes. New antivirals against CMV for prophylaxis and for treatment of antiviral-resistant CMV infection are currently being evaluated in transplant recipients, and may continue to improve the management of CMV in lung transplant recipients. However, new therapeutic and preventive strategies are highly needed for other viruses such as respiratory syncytial virus (RSV) or parainfluenza virus (PIV), including new antivirals and vaccines. This is particularly important in the advent of the COVID-19 pandemic, for which several unanswered questions remain, in particular on the best antiviral and immunomodulatory regimen for decreasing mortality specifically in lung transplant recipients. In conclusion, the appropriate management of viral complications after transplantation remain an essential step to continue improving survival and quality of life of lung transplant recipients.
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Affiliation(s)
- Aline Munting
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.,Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
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7
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Hababou Y, Taleb A, Recoing A, Moreau F, Simon I, Muller de Schongor F, Gault E, Rameix-Welti MA. Molecular investigation of a RSV outbreak in a geriatric hospital. BMC Geriatr 2021; 21:120. [PMID: 33579210 PMCID: PMC7880219 DOI: 10.1186/s12877-021-02064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acquired infections in hospitalized elderly people are a growing concern. In long-term care facilities with multiple staff and visitor contacts, virus outbreaks are a common challenge for infection prevention teams. Although several studies have reported nosocomial RSV outbreaks in long term care facilities, molecular epidemiology data are scarce. METHODS RSV RNA was detected in respiratory samples from 19 patients in a long-term care hospital for elderly in Paris in March 2019 over a 3 weeks period. Genotyping was performed using nucleotide sequencing. Sociodemographic and clinical characteristics of cases part of a unique cluster, were retrospectively reviewed. RESULTS Molecular investigation of theses RSV cases, revealed a unique cluster of 12 nosocomial cases in 2 adjacent wards. Mean age of these outbreak's cases was 89. All patients had underlying medical conditions. Seven exhibited lower respiratory symptoms and three experienced decompensation of underlying chronic heart condition. Two patients died. CONCLUSIONS This case report highlights the importance of RSV in causing substantial disease in elderly in case of nosocomial outbreak and the contributions of molecular epidemiology in investigation and management of such outbreak.
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Affiliation(s)
- Yohan Hababou
- AP-HP, Université Paris Saclay, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt, France
| | - Assia Taleb
- AP-HP, Université Paris Saclay, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt, France
| | - Amélie Recoing
- AP-HP, Université Paris Saclay, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt, France
| | - Frédérique Moreau
- AP-HP, Université Paris Saclay, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt, France
| | - Isabelle Simon
- AP-HP, Université Paris Saclay, Hôpital Sainte Perrine, Equipe opérationnelle d'hygiène, Paris, France
| | | | - Elyanne Gault
- AP-HP, Université Paris Saclay, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt, France.,Université Paris-Saclay, INSERM, Université de Versailles St. Quentin, UMR 1173 (2I), Versailles, France
| | - Marie-Anne Rameix-Welti
- AP-HP, Université Paris Saclay, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt, France. .,Université Paris-Saclay, INSERM, Université de Versailles St. Quentin, UMR 1173 (2I), Versailles, France.
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8
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Civljak R, Kosutic-Gulija T, Slovic A, Huljev E, Turcic N, Mestrovic T, Vranes J, Ljubin-Sternak S. An Outbreak of Human Parainfluenza Virus 3 (Phylogenetic Subcluster C5) Infection among Adults at a Residential Care Facility for the Disabled in Croatia, 2018. Intervirology 2019; 62:174-181. [PMID: 31661701 DOI: 10.1159/000503630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although highly pertinent for children, outbreaks of human parainfluenza virus (HPIV) may cause up to 15% of all respiratory illnesses in adults and predispose them to serious adverse outcomes, with HPIV serotype 3 (HPIV3) being the most common. This study represents the first report of an HPIV3 outbreak among adults at a long-term health-care facility in Croatia. METHODS A retrospective study was conducted to investigate an outbreak of acute respiratory infection (ARI) at a single residential care facility for the disabled in Croatia. Demographic, epidemiological, and clinical data were collected for all residents, while hospitalized patients were appraised in detail by laboratory/radiological methods. Multiplex PCR for respiratory viruses and sequencing was performed. Partial HPIV3 HN 581 nt sequences were aligned with HPIV3 sequences from the GenBank database to conduct a phylogenetic analysis, where different bioinformatic approaches were employed. RESULTS In late June 2018, 5 of the 10 units at the facility were affected by the outbreak. Among the 106 residents, 23 (21.7%) developed ARI, and 6 (26.1%) of them were hospitalized. HPIV3 was identified in 18 (73%) of the residents and 5 (83%) of the hospitalized individuals. Isolated HPIV3 strains were classified within the phylogenetic subcluster C5 but grouped on 2 separate branches of the phylogenetic tree. During the entire outbreak period, none of the institution's employees reported symptoms of ARI. CONCLUSIONS Our study has shown that this health care-associated outbreak of HPIV3 infection could have been linked to multiple importation events. Preventive measures in curbing such incidents should be enforced vigorously.
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Affiliation(s)
- Rok Civljak
- Department of Respiratory Tract Infections,Dr. Fran Mihaljevic University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tanja Kosutic-Gulija
- Center of Excellence for Virus Immunology and Vaccines, Center for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Anamarija Slovic
- Center of Excellence for Virus Immunology and Vaccines, Center for Research and Knowledge Transfer in Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Eva Huljev
- Department of Respiratory Tract Infections,Dr. Fran Mihaljevic University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Nikolina Turcic
- Department of Epidemiology, Zagreb County Institute of Public Health, Dugo Selo Branch, Dugo Selo, Croatia
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia.,University Centre Varaždin, University North, Varaždin, Croatia
| | - Jasmina Vranes
- Clinical Microbiology Department, Dr. Andrija Stampar Teaching Institute of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Suncanica Ljubin-Sternak
- Clinical Microbiology Department, Dr. Andrija Stampar Teaching Institute of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia,
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9
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Bailey ES, Lobaugh-Jin E, Smith B, Sova C, Misuraca J, Henshaw N, Gray GC. Molecular epidemiology of an outbreak of human parainfluenza virus 3 among oncology patients. J Hosp Infect 2019; 103:349-353. [PMID: 31356855 DOI: 10.1016/j.jhin.2019.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
A hospital outbreak of human parainfluenza virus type 3 (HPIV-3) in haematologic oncology patients is described in 12 patients over a four-week period. Exposure histories and molecular analysis of HPIV-3 isolates suggest that both community-acquired and nosocomially transmitted infections occurred during this outbreak. Molecular analysis of HPIV-3 isolates indicated that a chain of transmission occurred among multiple patients in an oncology ward. This transmission was later determined to be associated with the movement of fomites, visitors, and activities in the unit. The infection prevention team stopped nosocomial spread of HPIV-3 through interventions including advanced cleaning procedures.
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Affiliation(s)
- E S Bailey
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA.
| | - E Lobaugh-Jin
- Duke University Infection Prevention and Hospital Epidemiology, Duke Hospital, Durham, NC, USA
| | - B Smith
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA; Duke University Infection Prevention and Hospital Epidemiology, Duke Hospital, Durham, NC, USA
| | - C Sova
- Duke University Infection Prevention and Hospital Epidemiology, Duke Hospital, Durham, NC, USA
| | - J Misuraca
- Duke University Hospital Hematological Oncology Unit, Duke Hospital, Durham, NC, USA
| | - N Henshaw
- Department of Pathology, School of Medicine, Duke University, Durham, NC, USA
| | - G C Gray
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA; Global Health Research Center, Duke-Kunshan University, Kunshan, Jiangsu, China; Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
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10
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Khawaja F, Chemaly RF. Respiratory syncytial virus in hematopoietic cell transplant recipients and patients with hematologic malignancies. Haematologica 2019; 104:1322-1331. [PMID: 31221784 PMCID: PMC6601091 DOI: 10.3324/haematol.2018.215152] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/06/2019] [Indexed: 12/16/2022] Open
Abstract
In the USA and other western nations, respiratory syncytial virus is one of the most commonly encountered respiratory viruses among patients who have been diagnosed with a hematologic malignancy or who have undergone a stem cell transplant. Multiple studies have been performed to evaluate the complications associated with respiratory syncytial virus infections. Other studies have evaluated therapeutic agents and strategies in which these agents can be used. There have also been numerous reports of outbreaks in bone marrow transplant units and oncology wards, where infection control measures have been invaluable in controlling the spread of disease. However, despite these novel approaches, respiratory syncytial virus continues to be potentially fatal in immunocompromised populations. In this review, we discuss the incidence of respiratory syncytial viral infections, risk factors associated with progression from upper respiratory tract infection to lower respiratory tract infection, other complications and outcomes (including mortality), management strategies, and prevention strategies in patients with a hematologic malignancy and in hematopoietic cell transplant recipients.
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Affiliation(s)
- Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee Health, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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11
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Respiratory Viral Infections in Transplant Recipients. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7120918 DOI: 10.1007/978-1-4939-9034-4_40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Respiratory viral infections (RVIs) are common among the general population; however, these often mild viral illnesses can lead to serious morbidity and mortality among recipients of hematopoietic stem cell and solid organ transplantation. The disease spectrum ranges from asymptomatic or mild infections to life-threatening lower respiratory tract infection or long-term airflow obstruction syndromes. Progression to lower respiratory tract infection or to respiratory failure is determined by the intrinsic virulence of the specific viral pathogen as well as various host factors, including the type of transplantation, status of the host’s immune dysfunction, the underlying disease, and other comorbidities. This chapter focuses on the epidemiology, clinical manifestations, diagnosis, and management of RVIs in this susceptible population and includes respiratory syncytial virus, parainfluenza virus, human metapneumovirus, influenza virus, human coronavirus, and human rhinovirus. The optimal management of these infections is limited by the overall paucity of available treatment, highlighting the need for new antiviral drug or immunotherapies.
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Smielewska A, Emmott E, Ranellou K, Popay A, Goodfellow I, Jalal H. UK circulating strains of human parainfluenza 3: an amplicon based next generation sequencing method and phylogenetic analysis. Wellcome Open Res 2018; 3:118. [PMID: 30569021 PMCID: PMC6281019 DOI: 10.12688/wellcomeopenres.14730.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Human parainfluenza viruses type 3 (HPIV3) are a prominent cause of respiratory infection with a significant impact in both pediatric and transplant patient cohorts. Currently there is a paucity of whole genome sequence data that would allow for detailed epidemiological and phylogenetic analysis of circulating strains in the UK. Although it is known that HPIV3 peaks annually in the UK, to date there are no whole genome sequences of HPIV3 UK strains available. Methods: Clinical strains were obtained from HPIV3 positive respiratory patient samples collected between 2011 and 2015. These were then amplified using an amplicon based method, sequenced on the Illumina platform and assembled using a new robust bioinformatics pipeline. Phylogenetic analysis was carried out in the context of other epidemiological studies and whole genome sequence data currently available with stringent exclusion of significantly culture-adapted strains of HPIV3. Results: In the current paper we have presented twenty full genome sequences of UK circulating strains of HPIV3 and a detailed phylogenetic analysis thereof. We have analysed the variability along the HPIV3 genome and identified a short hypervariable region in the non-coding segment between the M (matrix) and F (fusion) genes. The epidemiological classifications obtained by using this region and whole genome data were then compared and found to be identical. Conclusions: The majority of HPIV3 strains were observed at different geographical locations and with a wide temporal spread, reflecting the global distribution of HPIV3. Consistent with previous data, a particular subcluster or strain was not identified as specific to the UK, suggesting that a number of genetically diverse strains circulate at any one time. A small hypervariable region in the HPIV3 genome was identified and it was shown that, in the absence of full genome data, this region could be used for epidemiological surveillance of HPIV3.
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Affiliation(s)
- Anna Smielewska
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
- Cambridge University Hospitals NHS Foundation Trust Laboratory, Public Health England, Cambridge, Cambridgeshire, CB20QQ, UK
| | - Edward Emmott
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
- Department of Bioengineering, Northeastern University, Boston, MA, 02115-5000, USA
| | - Kyriaki Ranellou
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
- Cambridge University Hospitals NHS Foundation Trust Laboratory, Public Health England, Cambridge, Cambridgeshire, CB20QQ, UK
| | - Ashley Popay
- Eastern Field Epidemiology Unit, Institute of Public Health, Public Health England, Cambridge, Cambridgeshire, CB20SR, UK
| | - Ian Goodfellow
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
| | - Hamid Jalal
- Cambridge University Hospitals NHS Foundation Trust Laboratory, Public Health England, Cambridge, Cambridgeshire, CB20QQ, UK
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Smielewska A, Pearson C, Popay A, Roddick I, Reacher M, Emmott E, He J, Thaxter R, Chenery C, Goodfellow I, Burke A, Jalal H. Unrecognised Outbreak: Human parainfluenza virus infections in a pediatric oncology unit. A new diagnostic PCR and virus monitoring system may allow early detection of future outbreaks. Wellcome Open Res 2018; 3:119. [PMID: 30687791 PMCID: PMC6338131 DOI: 10.12688/wellcomeopenres.14732.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Human parainfluenza viruses (HPIVs) are significant causes of both upper and lower respiratory tract infections with type 3 (HPIV3) causing the most severe disease in the immunocompromised cohorts. The objective of this study was to analyse the epidemiological nature of a cluster of cases of HPIV3 in a pediatric oncology unit of a major teaching hospital. Methods: In order to determine whether the activity observed represented a deviation from the norm, seasonal trends of HPIV3 in the surrounding geographical area as well as on the ward in question were analysed. The genetic link between cases was established by the phylogenetic analysis of the non-coding hypervariable region between the M (Matrix) and F (fusion) genes of HPIV3. The 15 cases involved and 15 unrelated cases were sequenced. Transmission routes were subsequently inferred and visualized using Konstanz Information Miner (KNIME) 3.3.2. Results: Of the 15 cases identified, 14 were attributed to a point source outbreak. Two out of 14 outbreak cases were found to differ by a single mutation A182C. The outbreak strain was also seen in 1 out of 15 unrelated cases, indicating that it was introduced from the community. Transmission modeling was not able to link all the cases and establish a conclusive chain of transmission. No staff were tested during the outbreak period. No deaths occurred as a result of the outbreak. Conclusion: A point source outbreak of HPIV3 was recognized post factum on an oncology pediatric unit in a major teaching hospital. This raised concern about the possibility of a future more serious outbreak. Weaknesses in existing systems were identified and a new dedicated respiratory virus monitoring system introduced. Pediatric oncology units require sophisticated systems for early identification of potentially life-threatening viral outbreaks.
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Affiliation(s)
- Anna Smielewska
- Division of Virology, Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB2 0QQ, UK
- Public Health Laboratory, Cambridge University Hospitals NHS Foundation Trust, Public Health England, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Callum Pearson
- Field Epidemiology Service East of England, Public Health England, Cambridge, Cambridgeshire, CB20SR, UK
| | - Ashley Popay
- Field Epidemiology Service East of England, Public Health England, Cambridge, Cambridgeshire, CB20SR, UK
| | - Iain Roddick
- Field Epidemiology Service East of England, Public Health England, Cambridge, Cambridgeshire, CB20SR, UK
| | - Mark Reacher
- Field Epidemiology Service East of England, Public Health England, Cambridge, Cambridgeshire, CB20SR, UK
| | - Edward Emmott
- Division of Virology, Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB2 0QQ, UK
- Department of Bioengineering, Northeastern University, Boston, MA, 02115-5000, USA
| | - Jenny He
- Infection Control, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Rachel Thaxter
- Infection Control, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Carol Chenery
- Infection Control, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Ian Goodfellow
- Division of Virology, Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Amos Burke
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Hamid Jalal
- Public Health Laboratory, Cambridge University Hospitals NHS Foundation Trust, Public Health England, Cambridge, Cambridgeshire, CB2 0QQ, UK
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Smielewska A, Emmott E, Ranellou K, Popay A, Goodfellow I, Jalal H. UK circulating strains of human parainfluenza 3: an amplicon based next generation sequencing method and phylogenetic analysis. Wellcome Open Res 2018; 3:118. [PMID: 30569021 PMCID: PMC6281019 DOI: 10.12688/wellcomeopenres.14730.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 10/05/2023] Open
Abstract
Background: Human parainfluenza viruses type 3 (HPIV3) are a prominent cause of respiratory infection with a significant impact in both pediatric and transplant patient cohorts. Currently there is a paucity of whole genome sequence data that would allow for detailed epidemiological and phylogenetic analysis of circulating strains in the UK. Although it is known that HPIV3 peaks annually in the UK, to date there are no whole genome sequences of HPIV3 UK strains available. Methods: Clinical strains were obtained from HPIV3 positive respiratory patient samples collected between 2011 and 2015. These were then amplified using an amplicon based method, sequenced on the Illumina platform and assembled using a new robust bioinformatics pipeline. Phylogenetic analysis was carried out in the context of other epidemiological studies and whole genome sequence data currently available with stringent exclusion of significantly culture-adapted strains of HPIV3. Results: In the current paper we have presented twenty full genome sequences of UK circulating strains of HPIV3 and a detailed phylogenetic analysis thereof. We have analysed the variability along the HPIV3 genome and identified a short hypervariable region in the non-coding segment between the M (matrix) and F (fusion) genes. The epidemiological classifications obtained by using this region and whole genome data were then compared and found to be identical. Conclusions: The majority of HPIV3 strains were observed at different geographical locations and with a wide temporal spread, reflecting the global distribution of HPIV3. Consistent with previous data, a particular subcluster or strain was not identified as specific to the UK, suggesting that a number of genetically diverse strains circulate at any one time. A small hypervariable region in the HPIV3 genome was identified and it was shown that, in the absence of full genome data, this region could be used for epidemiological surveillance of HPIV3.
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Affiliation(s)
- Anna Smielewska
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
- Cambridge University Hospitals NHS Foundation Trust Laboratory, Public Health England, Cambridge, Cambridgeshire, CB20QQ, UK
| | - Edward Emmott
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
- Department of Bioengineering, Northeastern University, Boston, MA, 02115-5000, USA
| | - Kyriaki Ranellou
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
- Cambridge University Hospitals NHS Foundation Trust Laboratory, Public Health England, Cambridge, Cambridgeshire, CB20QQ, UK
| | - Ashley Popay
- Eastern Field Epidemiology Unit, Institute of Public Health, Public Health England, Cambridge, Cambridgeshire, CB20SR, UK
| | - Ian Goodfellow
- Department of Pathology, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, Cambridgeshire, CB20QQ, UK
| | - Hamid Jalal
- Cambridge University Hospitals NHS Foundation Trust Laboratory, Public Health England, Cambridge, Cambridgeshire, CB20QQ, UK
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Jornist I, Muhsen K, Ram D, Lustig Y, Levy V, Orzitser S, Azar R, Weil M, Indenbaum V, Sofer D, Mendelson E, Mandelboim M, Hindiyeh M. Characterization of human parainfluenza virus-3 circulating in Israel, 2012-2015. J Clin Virol 2018; 107:19-24. [PMID: 30114677 DOI: 10.1016/j.jcv.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/03/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Human parainfluenza virus 3 (hPIV-3) causes respiratory tract infection. OBJECTIVES The objective of this study was to describe the epidemiology of hPIV-3 infection among hospitalized patients and characterize the circulating strains. STUDY DESIGN A cross-sectional study was conducted using respiratory samples of 15,946 hospitalized patients with respiratory symptoms in 2012-2015 in Israel. All samples were subjected to q-PCR and q-RT-PCR to determine the presence of hPIV-3 and other respiratory viruses. Samples positive for hPIV-3 were subjected to molecular typing and phylogenetic analysis. RESULTS Overall, 547 samples 3.4% (95% CI 3.2-3.7) were positive for hPIV-3. Of these 87 (15.9%) were mixed infections; 41.4% with adenovirus, 40.2% with RSV (40.2%) and 19.5% influenza A viruses. The prevalence of hPIV-3 was highest (5.1%) in children aged 0-4 years. Hospitalization in oncology department was associated with increased likelihood of hPIV-3 infection: adjusted odds ratio [aOR] 2.29 (95% confidence intervals [CI] 1.78-2.96), as well as hospitalization in organ transplantation department: aOR 3.65 (95% CI 2.80-4.76). The predominant lineages were C3c (62.3%) and C1b (24.6%), followed by sub-lineages C5 (8.7%) and C3b (2.9%). A new sub-lineage emerged in our analysis, named C1d, which was 17 (1.5%) nucleotide different from C1a, 25 (2.2%) nucleotide different from C1b and 24 (2.1%) nucleotide different from C1c. DISCUSSION Young children and immunocompromised patients are likely the risk groups for severe respiratory infections with hPIV-3. Strains belonging to lineages C3c and C1b, which are present worldwide, should be targeted in vaccine development. The emergence of new lineage might have public health implications and on vaccine development.
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Affiliation(s)
- Irina Jornist
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel; Department of Microbiology and Immunology, Tel-Aviv University, Tel-Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniela Ram
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Virginia Levy
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Sara Orzitser
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Roberto Azar
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Merav Weil
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Viki Indenbaum
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Danit Sofer
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Musa Hindiyeh
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Ogimi C, Xie H, Leisenring WM, Kuypers JM, Jerome KR, Campbell AP, Englund JA, Boeckh M, Waghmare A. Initial High Viral Load Is Associated with Prolonged Shedding of Human Rhinovirus in Allogeneic Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2018; 24:2160-2163. [PMID: 30009982 PMCID: PMC6239940 DOI: 10.1016/j.bbmt.2018.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/05/2018] [Indexed: 02/05/2023]
Abstract
We examined prolonged shedding of rhinovirus after stem cell transplantation. The median shedding duration of rhinovirus was similar between species. Initial high viral load was a risk factor for prolonged shedding of rhinovirus.
Recent data suggest human rhinovirus (HRV) is associated with lower respiratory tract infection and mortality in hematopoietic cell transplant (HCT) recipients. Examining risk factors for prolonged viral shedding may provide critical insight for the development of novel therapeutics and help inform infection prevention practices. Our objective was to identify risk factors for prolonged shedding of HRV post-HCT. We prospectively collected weekly nasal samples from allogeneic HCT recipients from day 0 to day 100 post-transplant, and performed real-time reverse transcriptase PCR (December 2005 to February 2010). Subjects with symptomatic HRV infection and a negative test within 2 weeks of the last positive were included. Duration of shedding was defined as time between the first positive and first negative samples. Cycle threshold (Ct) values were used as a proxy for viral load. HRV species were identified by sequencing the 5′ noncoding region. Logistic regression analyses were performed to evaluate factors associated with prolonged shedding (≥21 days). We identified 38 HCT recipients with HRV infection fulfilling study criteria (32 adults, 6 children). Median duration of shedding was 9.5 days (range, 2 to 89 days); 18 patients had prolonged shedding. Among 26 samples sequenced, 69% were species A, and species B and C accounted for 15% each; the median shedding duration of HRV did not differ among species (P = .17). Bivariable logistic regression analyses suggest that initial high viral load (low Ct value) is associated with prolonged shedding. HCT recipients with initial high viral loads are at risk for prolonged HRV viral shedding.
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Affiliation(s)
- Chikara Ogimi
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, Washington
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jane M Kuypers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Angela P Campbell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, Washington
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle, Washington; Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, Washington
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Pediatric Infectious Diseases Division, Seattle Children's Hospital, Seattle, Washington
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Diaz-Decaro J, Launer B, Mckinnell J, Singh R, Dutciuc T, Green N, Bolaris M, Huang S, Miller L. Bayesian evidence and epidemiological implications of environmental contamination from acute respiratory infection in long-term care facilities. Epidemiol Infect 2018; 146:832-838. [PMID: 29633685 PMCID: PMC9184930 DOI: 10.1017/s0950268818000729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 02/05/2018] [Accepted: 03/06/2018] [Indexed: 11/06/2022] Open
Abstract
Skilled nursing home facilities (SNFs) house a vulnerable population frequently exposed to respiratory pathogens. Our study aims to gain a better understanding of the transmission of nursing home-acquired viral respiratory infections in non-epidemic settings. Symptomatic surveillance was performed in three SNFs for residents exhibiting acute respiratory symptoms. Environmental surveillance of five high-touch areas was performed to assess possible transmission. All resident and environmental samples were screened using a commercial multiplex polymerase chain reaction platform. Bayesian methods were used to evaluate environmental contamination. Among nursing home residents with respiratory symptoms, 19% had a detectable viral pathogen (parainfluenza-3, rhinovirus/enterovirus, RSV, or influenza B). Environmental contamination was found in 20% of total room surface swabs of symptomatic residents. Environmental and resident results were all concordant. Target period prevalence among symptomatic residents ranged from 5.5 to 13.3% depending on target. Bayesian analysis quantifies the probability of environmental shedding due to parainfluenza-3 as 92.4% (95% CI: 86.8-95.8%) and due to rhinovirus/enterovirus as 65.6% (95% CI: 57.9-72.5%). Our findings confirm that non-epidemic viral infections are common among SNF residents exhibiting acute respiratory symptoms and that environmental contamination may facilitate further spread with considerable epidemiological implications. Findings further emphasise the importance of environmental infection control for viral respiratory pathogens in long-term care facilities.
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Affiliation(s)
- J.D. Diaz-Decaro
- Los Angeles County Public Health Laboratories, Downey, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - B. Launer
- LA BioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - J.A. Mckinnell
- LA BioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - R. Singh
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - T.D. Dutciuc
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - N.M. Green
- Los Angeles County Public Health Laboratories, Downey, CA, USA
| | - M. Bolaris
- LA BioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - S.S. Huang
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - L.G. Miller
- LA BioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
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Gaymard A, Bouscambert-Duchamp M, Pichon M, Frobert E, Vallee J, Lina B, Casalegno JS, Morfin F. Genetic characterization of respiratory syncytial virus highlights a new BA genotype and emergence of the ON1 genotype in Lyon, France, between 2010 and 2014. J Clin Virol 2018; 102:12-18. [PMID: 29471266 DOI: 10.1016/j.jcv.2018.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/11/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a well-recognized cause of respiratory tract infections. Based on G gene variations, 11 RSV-A and 36 RSV-B genotypes have been described to date. The ON1 genotype was detected in Ontario in 2010 and subsequently reported in several countries. OBJECTIVES The objective of the present study was to investigate for the first time the RSV epidemiology and genotype diversity in France between 2010 and 2014. STUDY DESIGN All respiratory samples received from patients with influenza-like illness or respiratory tract infection were screened for RSV infection by RT-PCR. The results were stratified according to winter season. Among the RSV-positive cases, 117 samples were further investigated for phylogenetic analysis out of 150 randomly selected for sequencing. RESULTS Among the 20,359 cases screened, 14% of the cases were RSV-positive. RSV-A was predominant during the four winter seasons. The first ON1 variant was detected during the 2010-2011 winter and reached 85% of all RSV-A-positive cases in 2013-2014. Most RSV-B was classified as BA9 and BA10 genotypes but a new genotype (BA-Ly) was described. CONCLUSION As reported in different countries, ON1 variants were firstly detected in 2011 and became the predominant RSV-A genotype in Lyon. Among RSV-B, BA9 was predominant but detected alongside BA10 or a transient genotype (BA-Ly).
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Affiliation(s)
- Alexandre Gaymard
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372 Lyon, France.
| | - Maude Bouscambert-Duchamp
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372 Lyon, France
| | - Maxime Pichon
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372 Lyon, France
| | - Emilie Frobert
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372 Lyon, France
| | - Julien Vallee
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France
| | - Bruno Lina
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372 Lyon, France
| | - Jean-Sébastien Casalegno
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372 Lyon, France
| | - Florence Morfin
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI) de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, F-69317 Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372 Lyon, France
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Inflammasome Antagonism by Human Parainfluenza Virus Type 3 C Protein. J Virol 2018; 92:JVI.01776-17. [PMID: 29187536 DOI: 10.1128/jvi.01776-17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/02/2017] [Indexed: 01/21/2023] Open
Abstract
Human parainfluenza virus type 3 (HPIV3) is a negative-sense single-stranded RNA virus belonging to the Paramyxoviridae family. HPIV3 is a lung-tropic virus causing airway diseases, including pneumonia, croup, and bronchiolitis, during infancy and childhood. The activation of the inflammasome by pathogens results in the production of proinflammatory cytokines such as interleukin-1β (IL-1β) during infection. Thus, the inflammasome-mediated proinflammatory response plays a critical role in regulating the immune response and virus clearance. The inflammasome is a multimeric protein complex triggering caspase-1 activation. Activated caspase-1 cleaves pro-IL-1β into its mature (and active) secretory form. Our study revealed inflammasome activation in macrophages following HPIV3 infection. Specifically, the activation of the NLRP3/ASC inflammasome resulted in the production of mature IL-1β from HPIV3-infected cells. Furthermore, Toll-like receptor 2 (TLR2) activation (first signal) and potassium efflux (second signal) constituted two cellular events mediating inflammasome activation following HPIV3 infection. During our studies, we surprisingly identified the HPIV3 C protein as an antagonist of inflammasome activation. The HPIV3 C protein is an accessory protein encoded by the open reading frame of the viral phosphoprotein (P) gene. The HPIV3 C protein interacted with the NLRP3 protein and blocked inflammasome activation by promoting the proteasomal degradation of the NLRP3 protein. Thus, our studies report NLRP3/ASC inflammasome activation by HPIV3 via TLR2 signaling and potassium efflux. Furthermore, we have identified HPIV3 C as a viral component involved in antagonizing inflammasome activation.IMPORTANCE Human parainfluenza virus type 3 (HPIV3) is a paramyxovirus that causes respiratory tract diseases during infancy and childhood. Currently, there is no effective vaccine or antiviral therapy for HPIV3. Therefore, in order to develop anti-HPIV3 agents (therapeutics and vaccines), it is important to study the HPIV3-host interaction during the immune response. Inflammasomes play an important role in the immune response. Inflammasome activation by HPIV3 has not been previously reported. Our studies demonstrated inflammasome activation by HPIV3 in macrophages. Specifically, HPIV3 activated the NLRP3/ASC inflammasome by TLR2 activation and potassium efflux. C proteins of paramyxoviruses are accessory proteins encoded by the viral phosphoprotein gene. The role of the C protein in inflammasome regulation was unknown. Surprisingly, our studies revealed that the HPIV3 C protein antagonizes inflammasome activation. In addition, we highlighted for the first time a mechanism utilized by paramyxovirus accessory proteins to block inflammasome activation. The HPIV3 C protein interacted with the NLRP3 protein to trigger the proteasomal degradation of the NLRP3 protein.
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Kakiuchi S, Tsuji M, Nishimura H, Wang L, Takayama-Ito M, Kinoshita H, Lim CK, Taniguchi S, Oka A, Mizuguchi M, Saijo M. Human Parainfluenza Virus Type 3 Infections in Patients with Hematopoietic Stem Cell Transplants: the Mode of Nosocomial Infections and Prognosis. Jpn J Infect Dis 2017; 71:109-115. [PMID: 29279454 DOI: 10.7883/yoken.jjid.2017.424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There have been a few prospective and comprehensive surveillance studies on the respiratory viral infections (RVIs) among patients undergoing hematopoietic stem cell transplantation (HSCT). A 2-year prospective cohort surveillance study of symptomatic and asymptomatic RVIs was performed in hospitalized HSCT patients. Oropharyngeal (OP) swab samples were serially collected each week from 1 week before and up to 100 days after HSCT and were tested for virus isolation with cell culture-based viral isolation (CC-based VI) and a multiplex PCR (MPCR). A total of 2,747 OP swab samples were collected from 250 HSCT patients (268 HSCT procedures). Among these patients, 79 had RVIs (CC-based VI, n = 63; MPCR, n = 17). The parainfluenza virus type 3 (PIV3) accounted for 71% (57/80) of the cases of RVIs. Some PIV3 infections were asymptomatic and involved a longer virus-shedding period. The PIV3 was often cultured from samples taken before the onset of a respiratory disease. The PIV3 infections were attributed to the transmission of nosocomial infections. PIV3 infections before engraftment will more likely result in the development of lower respiratory tract infections and worse outcomes. A real-time monitoring of respiratory viral infections in the HSCT ward among patients with or without respiratory symptoms is required for the prevention of nosocomial RVIs, especially of PIV3 infections.
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Affiliation(s)
- Satsuki Kakiuchi
- Department of Virology 1, National Institute of Infectious Diseases.,Department of Developmental Medical Sciences, The University of Tokyo
| | | | | | - Lixing Wang
- Department of Virology 1, National Institute of Infectious Diseases
| | | | - Hitomi Kinoshita
- Department of Virology 1, National Institute of Infectious Diseases
| | - Chang-Kweng Lim
- Department of Virology 1, National Institute of Infectious Diseases
| | | | - Akira Oka
- Department of Developmental Medical Sciences, The University of Tokyo
| | - Masashi Mizuguchi
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
| | - Masayuki Saijo
- Department of Virology 1, National Institute of Infectious Diseases.,Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
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21
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Kim T, Jin CE, Sung H, Koo B, Park J, Kim SM, Kim JY, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Lee JH, Lee JH, Lee KH, Shin Y, Kim SH. Molecular epidemiology and environmental contamination during an outbreak of parainfluenza virus 3 in a haematology ward. J Hosp Infect 2017; 97:403-413. [PMID: 28893615 PMCID: PMC7114920 DOI: 10.1016/j.jhin.2017.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
Abstract
Background Although fomites or contaminated surfaces have been considered as transmission routes, the role of environmental contamination by human parainfluenza virus type 3 (hPIV-3) in healthcare settings is not established. Aim To describe an hPIV-3 nosocomial outbreak and the results of environmental sampling to elucidate the source of nosocomial transmission and the role of environmental contamination. Methods During an hPIV-3 outbreak between May and June 2016, environmental surfaces in contact with clustered patients were swabbed and respiratory specimens used from infected patients and epidemiologically unlinked controls. The epidemiologic relatedness of hPIV-3 strains was investigated by sequencing of the haemagglutinin–neuraminidase and fusion protein genes. Findings Of 19 hPIV-3-infected patients, eight were haematopoietic stem cell recipients and one was a healthcare worker. In addition, four had upper and 12 had lower respiratory tract infections. Of the 19 patients, six (32%) were community-onset infections (symptom onset within <7 days of hospitalization) and 13 (68%) were hospital-onset infections (≥7 days of hospitalization). Phylogenetic analysis identified two major clusters: five patients, and three patients plus one healthcare worker. Therefore, seven (37%) were classified as nosocomial transmissions. hPIV-3 was detected in 21 (43%) of 49 environmental swabs up to 12 days after negative respiratory polymerase chain reaction conversion. Conclusion At least one-third of a peak season nosocomial hPIV-3 outbreak originated from nosocomial transmission, with multiple importations of hPIV-3 from the community, providing experimental evidence for extensive environmental hPIV-3 contamination. Direct contact with the contaminated surfaces and fomites or indirect transmission from infected healthcare workers could be responsible for nosocomial transmission.
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Affiliation(s)
- T Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Republic of Korea
| | - C E Jin
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - B Koo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Park
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-M Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Y Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y P Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-O Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-H Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J-H Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - K-H Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y Shin
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - S-H Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Kothari A, Burgess MJ, Crescencio JCR, Kennedy JL, Denson JL, Schwalm KC, Stoner AN, Kincaid JC, Davies FE, Dinwiddie DL. The role of next generation sequencing in infection prevention in human parainfluenza virus 3 infections in immunocompromised patients. J Clin Virol 2017; 92:53-55. [PMID: 28531552 DOI: 10.1016/j.jcv.2017.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Respiratory viral infections are a significant problem in patients with hematologic malignancies. We report a cluster of HPIV 3 infections in our myeloma patients, and describe the utility of next generation sequencing (NGS) to identify transmission linkages which can assist in infection prevention. OBJECTIVES To evaluate the utility of NGS to track respiratory viral infection outbreaks and delineate between community acquired and nosocomial infections in our cancer units. STUDY DESIGN Retrospective chart review conducted at a single site. All patients diagnosed with multiple myeloma who developed symptoms suggestive of upper respiratory tract infection (URTI) or lower respiratory tract infection (LRTI) along with a respiratory viral panel (RVP) test positive for HPIV 3 between April 1, 2016, to June 30, 2016, were included. Sequencing was performed on the Illumina MiSeq™. To gain understanding regarding community strains of HPIV 3 during the same season, we also performed NGS on HPIV3 strains isolated from pediatric cases. RESULTS We saw a cluster of 13 cases of HPIV3 infections in the myeloma unit. Using standard epidemiologic criteria, 3 cases were considered community acquired, 7 cases developed infection during treatment in the cancer infusion center, while an additional 3 developed infections during hospital stay. Seven patients required hospitalization for a median duration of 20days. NGS enabled sensitive discrimination of the relatedness of the isolates obtained during the outbreak and provided evidence for source of transmission. Two hospital onset infections could be tracked to an index case; the genome sequences of HPIV 3 strains from these 3 patients only differed by a single nucleotide. CONCLUSIONS NGS offers a significantly higher discriminatory value as an epidemiologic tool, and can be used to gather real-time information and identification of transmission linkages to assist in infection prevention in immunocompromised patients.
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Affiliation(s)
- Atul Kothari
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Mary J Burgess
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Juan Carlos Rico Crescencio
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua L Kennedy
- Division of Allergy and Immunology, Department of Medicine and Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jesse L Denson
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Kurt C Schwalm
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Ashley N Stoner
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Faith E Davies
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Darrell L Dinwiddie
- Clinical Translational Sciences Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Prolonged Rhinovirus Shedding in a Patient with Hodgkin Disease. Infect Control Hosp Epidemiol 2017; 38:500-501. [PMID: 28137315 DOI: 10.1017/ice.2016.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Epidemiology of parainfluenza infection in England and Wales, 1998-2013: any evidence of change? Epidemiol Infect 2017; 145:1210-1220. [PMID: 28095926 DOI: 10.1017/s095026881600323x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Human parainfluenza virus (HPIV) infections are one of the commonest causes of upper and lower respiratory tract infections. In order to determine if there have been any recent changes in HPIV epidemiology in England and Wales, laboratory surveillance data between 1998 and 2013 were analysed. The UK national laboratory surveillance database, LabBase, and the newly established laboratory-based virological surveillance system, the Respiratory DataMart System (RDMS), were used. Descriptive analysis was performed to examine the distribution of cases by year, age, sex and serotype, and to examine the overall temporal trend using the χ 2 test. A random-effects model was also employed to model the number of cases. Sixty-eight per cent of all HPIV detections were due to HPIV type 3 (HPIV-3). HPIV-3 infections were detected all year round but peaked annually between March and June. HPIV-1 and HPIV-2 circulated at lower levels accounting for 20% and 8%, respectively, peaking during the last quarter of the year with a biennial cycle. HPIV-4 was detected in smaller numbers, accounting for only 4% and also mainly observed in the last quarter of the year. However, in recent years, HPIV-4 detection has been reported much more commonly with an increase from 0% in 1998 to 3·7% in 2013. Although an overall higher proportion of HPIV infection was reported in infants (43·0%), a long-term decreasing trend in proportion in infants was observed. An increase was also observed in older age groups. Continuous surveillance will be important in tracking any future changes.
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25
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Abstract
Viral pneumonias in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation cause significant morbidity and mortality. Advances in diagnostic techniques have enabled rapid identification of respiratory viral pathogens from upper and lower respiratory tract samples. Lymphopenia, myeloablative and T-cell depleting chemotherapy, graft-versus-host disease, and other factors increase the risk of developing life-threatening viral pneumonia. Chest imaging is often nonspecific but may aid in diagnoses. Bronchoscopy with bronchoalveolar lavage is recommended in those at high risk for viral pneumonia who have new infiltrates on chest imaging.
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Kelly SG, Metzger K, Bolon MK, Silkaitis C, Mielnicki M, Cullen J, Rooney M, Blanke T, Tahboub A, Noskin GA, Zembower TR. Respiratory syncytial virus outbreak on an adult stem cell transplant unit. Am J Infect Control 2016; 44:1022-6. [PMID: 27430734 DOI: 10.1016/j.ajic.2016.03.075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND An increase in respiratory syncytial virus type B (RSV-B) infections was detected on an adult hematology/oncology and stem cell transplant unit during March 2015. This prompted an outbreak investigation. METHODS Nosocomial cases were defined as RSV-B-positive patients who developed respiratory virus symptoms ≥ 7 days after admission to the unit or were readmitted with symptoms ≤ 7 days since last discharge from the unit. Strict outbreak control measures were implemented to stop the outbreak. RESULTS During the outbreak, 19 cases of RSV-B were detected, 14 among patients and 5 among health care workers (HCWs). Additionally, 2 HCWs tested positive for respiratory syncytial virus type A and 1 tested positive for influenza B among the 27 symptomatic HCWs evaluated. No specific antiviral therapy was given and all cases recovered without progression to lower respiratory tract infection. After no new cases were identified for 2 weeks, the outbreak was declared over. CONCLUSIONS High vigilance for respiratory viruses on high-risk inpatient units is required for detection and prevention of potential outbreaks. Multiple respiratory viruses with outbreak potential were identified among HCWs. HCWs with respiratory virus symptoms should not provide direct patient care. Absence of lower respiratory tract infection suggests lower virulence of RSV-B, compared with respiratory syncytial virus type A, among immunocompromised adults.
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Affiliation(s)
- Sean G Kelly
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Kristen Metzger
- Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL
| | - Maureen K Bolon
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL
| | - Christina Silkaitis
- Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL
| | - Mary Mielnicki
- Oncology Services, Northwestern Memorial Hospital, Chicago, IL
| | - Jane Cullen
- Corporate Health, Northwestern Memorial Hospital, Chicago, IL
| | - Melissa Rooney
- Corporate Health, Northwestern Memorial Hospital, Chicago, IL
| | - Timothy Blanke
- Diagnostic Molecular Biology Laboratory, Northwestern Memorial Hospital, Chicago, IL
| | - AlaaEddin Tahboub
- Diagnostic Molecular Biology Laboratory, Northwestern Memorial Hospital, Chicago, IL
| | - Gary A Noskin
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Teresa R Zembower
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, IL
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27
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Sung AD, Sung JAM, Thomas S, Hyslop T, Gasparetto C, Long G, Rizzieri D, Sullivan KM, Corbet K, Broadwater G, Chao NJ, Horwitz ME. Universal Mask Usage for Reduction of Respiratory Viral Infections After Stem Cell Transplant: A Prospective Trial. Clin Infect Dis 2016; 63:999-1006. [PMID: 27481873 PMCID: PMC5036914 DOI: 10.1093/cid/ciw451] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/28/2016] [Indexed: 12/12/2022] Open
Abstract
Background. Respiratory viral infections (RVIs) are frequent complications of hematopoietic stem cell transplant (HSCT). Surgical masks are a simple and inexpensive intervention that may reduce nosocomial spread. Methods. In this prospective single-center study, we instituted a universal surgical mask policy requiring all individuals with direct contact with HSCT patients to wear a surgical mask, regardless of symptoms or season. The primary endpoint was the incidence of RVIs in the mask period (2010–2014) compared with the premask period (2003–2009). Results. RVIs decreased from 10.3% (95/920 patients) in the premask period to 4.4% (40/911) in the mask period (P < .001). Significant decreases occurred after both allogeneic (64/378 [16.9%] to 24/289 [8.3%], P = .001) and autologous (31/542 [5.7%] to 16/622 [2.6%], P = .007) transplants. After adjusting for multiple covariates including season and year in a segmented longitudinal analysis, the decrease in RVIs remained significant, with risk of RVI of 0.4 in patients in the mask group compared with the premask group (0.19–0.85, P = .02). In contrast, no decrease was observed during this same period in an adjacent hematologic malignancy unit, which followed the same infection control practices except for the mask policy. The majority of this decrease was in parainfluenza virus 3 (PIV3) (8.3% to 2.2%, P < .001). Conclusions. Requiring all individuals with direct patient contact to wear a surgical mask is associated with a reduction in RVIs, particularly PIV3, during the most vulnerable period following HSCT.
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Affiliation(s)
- Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
| | - Julia A M Sung
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - Samantha Thomas
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, North Carolina
| | - Terry Hyslop
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, North Carolina
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
| | - Gwynn Long
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
| | - David Rizzieri
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
| | - Keith M Sullivan
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
| | - Kelly Corbet
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
| | - Gloria Broadwater
- Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, North Carolina
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham
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Godoy C, Peremiquel-Trillas P, Andrés C, Gimferrer L, Uriona SM, Codina MG, Armadans L, Martín MDC, Fuentes F, Esperalba J, Campins M, Pumarola T, Antón A. A molecular epidemiological study of human parainfluenza virus type 3 at a tertiary university hospital during 2013-2015 in Catalonia, Spain. Diagn Microbiol Infect Dis 2016; 86:153-9. [PMID: 27524509 PMCID: PMC7127006 DOI: 10.1016/j.diagmicrobio.2016.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 01/13/2023]
Abstract
Human parainfluenza virus type 3 (HPIV-3) is one of the most common respiratory viruses particularly among young children and immunocompromised patients. The seasonality, prevalence and genetic diversity of HPIV-3 at a Spanish tertiary-hospital from 2013 to 2015 are reported. HPIV-3 infection was laboratory-confirmed in 102 patients (76%, under 5 years of age). Among <5 years-old patients, 9 (11.5%) were under any degree of immunosuppression, whereas this percentage was significantly higher (19; 79.2%) among patients older than 5 years. HPIV-3 was detected at varying levels, but mainly during spring and summer. All characterized HN/F sequences fell within C1b, C5 and in other two closely C3a-related groups. Furthermore, a new genetic lineage (C1c) was described. Genetic similarity and epidemiological data confirmed some nosocomial infections, highlighting the importance of the HPIV-3 surveillance, particularly in high-risk patients. This study provides valuable information on HPIV-3 diversity due to the scarce information in Europe. Children and immunosuppressed adults showed a great susceptibility to infection. Valuable information about the current genetic diversity in Europe is provided. Different lineages, including a first described, were locally circulating. Genetic similarity and epidemiological data confirmed some nosocomial infections. The present study highlights the importance of the HPIV-3 surveillance.
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Affiliation(s)
- Cristina Godoy
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Andrés
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Laura Gimferrer
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Sonia María Uriona
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - María Gema Codina
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Lluis Armadans
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - María Del Carmen Martín
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Francisco Fuentes
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Juliana Esperalba
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Tomàs Pumarola
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit, Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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29
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Jensen TO, Stelzer-Braid S, Willenborg C, Cheung C, Andresen D, Rawlinson W, Clezy K. Outbreak of respiratory syncytial virus (RSV) infection in immunocompromised adults on a hematology ward. J Med Virol 2016; 88:1827-31. [PMID: 26990584 DOI: 10.1002/jmv.24521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/07/2022]
Abstract
We describe an outbreak of respiratory syncytial virus (RSV) infection on a hematology ward without allogeneic stem cell transplant patients. Twelve patients and one staff member infected with RSV were identified from the laboratory database. Five patients had lower respiratory tract infection, seven had upper respiratory tract infection, one was asymptomatic, and there were two (15.4%) deaths. Most patients had overlapping periods of potential infectiousness on the ward. Sequencing was possible on eight specimens and five of these had identical sequences. Results were consistent with transmission occurring both on the ward and by introduction of RSV from the community. J. Med. Virol. 88:1827-1831, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tomas Ostergaard Jensen
- Department of Infectious Diseases, St. Vincent's Hospital, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Australia
| | - Sacha Stelzer-Braid
- School of Medical Sciences, University of New South Wales, Australia.,Division of Serology and Virology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia
| | - Christiana Willenborg
- Division of Serology and Virology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia
| | - Carol Cheung
- Department of Haematology, Prince of Wales Hospital, Sydney, Australia
| | - David Andresen
- Department of Infectious Diseases, St. Vincent's Hospital, Sydney, Australia
| | - William Rawlinson
- School of Medical Sciences, University of New South Wales, Australia.,Division of Serology and Virology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia.,School of Biotechnology and Biomolecular Sciences, University of New South Wales, Australia
| | - Kate Clezy
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
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Long-Term Shedding of Influenza Virus, Parainfluenza Virus, Respiratory Syncytial Virus and Nosocomial Epidemiology in Patients with Hematological Disorders. PLoS One 2016; 11:e0148258. [PMID: 26866481 PMCID: PMC4750950 DOI: 10.1371/journal.pone.0148258] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/15/2016] [Indexed: 01/25/2023] Open
Abstract
Respiratory viruses are a cause of upper respiratory tract infections (URTI), but can be associated with severe lower respiratory tract infections (LRTI) in immunocompromised patients. The objective of this study was to investigate the genetic variability of influenza virus, parainfluenza virus and respiratory syncytial virus (RSV) and the duration of viral shedding in hematological patients. Nasopharyngeal swabs from hematological patients were screened for influenza, parainfluenza and RSV on admission as well as on development of respiratory symptoms. Consecutive swabs were collected until viral clearance. Out of 672 tested patients, a total of 111 patients (17%) were infected with one of the investigated viral agents: 40 with influenza, 13 with parainfluenza and 64 with RSV; six patients had influenza/RSV or parainfluenza/RSV co-infections. The majority of infected patients (n = 75/111) underwent stem cell transplantation (42 autologous, 48 allogeneic, 15 autologous and allogeneic). LRTI was observed in 48 patients, of whom 15 patients developed severe LRTI, and 13 patients with respiratory tract infection died. Phylogenetic analysis revealed a variety of influenza A(H1N1)pdm09, A(H3N2), influenza B, parainfluenza 3 and RSV A, B viruses. RSV A was detected in 54 patients, RSV B in ten patients. The newly emerging RSV A genotype ON1 predominated in the study cohort and was found in 48 (75%) of 64 RSV-infected patients. Furthermore, two distinct clusters were detected for RSV A genotype ON1, identical RSV G gene sequences in these patients are consistent with nosocomial transmission. Long-term viral shedding for more than 30 days was significantly associated with prior allogeneic transplantation (p = 0.01) and was most pronounced in patients with RSV infection (n = 16) with a median duration of viral shedding for 80 days (range 35–334 days). Long-term shedding of respiratory viruses might be a catalyzer of nosocomial transmission and must be considered for efficient infection control in immunocompromised patients.
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Comparison of respiratory virus shedding by conventional and molecular testing methods in patients with haematological malignancy. Clin Microbiol Infect 2015; 22:380.e1-380.e7. [PMID: 26711433 PMCID: PMC4994888 DOI: 10.1016/j.cmi.2015.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/30/2015] [Accepted: 12/08/2015] [Indexed: 11/25/2022]
Abstract
Respiratory viruses (RV) are a leading cause of infection-related morbidity and mortality for patients undergoing treatment for cancer. This analysis compared duration of RV shedding as detected by culture and PCR among patients in a high-risk oncology setting (adult patients with haematological malignancy and/or stem cell transplant and all paediatric oncology patients) and determined risk factors for extended shedding. RV infections due to influenza virus, parainfluenza virus (PIV), human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) from two study periods—January 2009–September 2011 (culture-based testing) and September 2011–April 2013 (PCR-based testing)—were reviewed retrospectively. Data were collected from patients in whom re-testing for viral clearance was carried out within 5–30 days after the most recent test. During the study period 456 patients were diagnosed with RV infection, 265 by PCR and 191 by culture. The median range for duration of shedding (days) by culture and PCR, respectively, were as follows—influenza virus: 13 days (5–38 days) versus 14 days (5–58 days), p 0.5; RSV: 11 days (5–35 days) versus 16 days (5–50 days), p 0.001; PIV: 9 days (5–41 days) versus 17 days (5–45 days), p ≤0.0001; HMPV 10.5 days (5–29 days) versus 14 days (5–42 days), p 0.2. In multivariable analysis, age and underlying disease or transplant were not independently associated with extended shedding regardless of testing method. In high-risk oncology settings for respiratory illness due to RSV and PIV, the virus is detectable by PCR for a longer period of time than by culture and extended shedding is observed.
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Wong H, Eso K, Ip A, Jones J, Kwon Y, Powelson S, de Grood J, Geransar R, Santana M, Joffe AM, Taylor G, Missaghi B, Pearce C, Ghali WA, Conly J. Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review. Syst Rev 2015; 4:152. [PMID: 26546048 PMCID: PMC4636845 DOI: 10.1186/s13643-015-0131-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment. METHODS We searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality. RESULTS We included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted. CONCLUSIONS With no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.
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Affiliation(s)
- Holly Wong
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Katherine Eso
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Ada Ip
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Jessica Jones
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Yoojin Kwon
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Susan Powelson
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Jill de Grood
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Rose Geransar
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Maria Santana
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - A Mark Joffe
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Geoffrey Taylor
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Bayan Missaghi
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Craig Pearce
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9
| | - William A Ghali
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - John Conly
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9. .,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Snyder Institute for Chronic Diseases, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.
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Bhattacharyya S, Gesteland PH, Korgenski K, Bjørnstad ON, Adler FR. Cross-immunity between strains explains the dynamical pattern of paramyxoviruses. Proc Natl Acad Sci U S A 2015; 112:13396-400. [PMID: 26460003 PMCID: PMC4629340 DOI: 10.1073/pnas.1516698112] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Viral respiratory tract diseases pose serious public health problems. Our ability to predict and thus, be able to prepare for outbreaks is strained by the complex factors driving the prevalence and severity of these diseases. The abundance of diseases and transmission dynamics of strains are not only affected by external factors, such as weather, but also driven by interactions among viruses mediated by human behavior and immunity. To untangle the complex out-of-phase annual and biennial pattern of three common paramyxoviruses, Respiratory Syncytial Virus (RSV), Human Parainfluenza Virus (HPIV), and Human Metapneumovirus (hMPV), we adopt a theoretical approach that integrates ecological and immunological mechanisms of disease interactions. By estimating parameters from multiyear time series of laboratory-confirmed cases from the intermountain west region of the United States and using statistical inference, we show that models of immune-mediated interactions better explain the data than those based on ecological competition by convalescence. The strength of cross-protective immunity among viruses is correlated with their genetic distance in the phylogenetic tree of the paramyxovirus family.
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Affiliation(s)
- Samit Bhattacharyya
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802; Department of Biology, University of Utah, Salt Lake City, UT 84112;
| | - Per H Gesteland
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT 84112; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84112
| | - Kent Korgenski
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT 84112; Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, UT 84111
| | - Ottar N Bjørnstad
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA 16802; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892
| | - Frederick R Adler
- Department of Biology, University of Utah, Salt Lake City, UT 84112; Department of Mathematics, University of Utah, Salt Lake City, UT 84112
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Yu X, Kou Y, Xia D, Li J, Yang X, Zhou Y, He X. Human respiratory syncytial virus in children with lower respiratory tract infections or influenza-like illness and its co-infection characteristics with viruses and atypical bacteria in Hangzhou, China. J Clin Virol 2015. [PMID: 26209367 PMCID: PMC7185398 DOI: 10.1016/j.jcv.2015.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Human respiratory syncytial virus (RSV) is the most important viral pathogen in children. However, its epidemic patterns and co-infection characteristics are not fully understood. OBJECTIVES We attempted to determine the level of genetic variation of RSV, and describe the prevalence and co-infection characteristics of RSV in Hangzhou during two epidemic seasons. STUDY DESIGN Single respiratory samples from 1820 pediatric patients were screened for RSV and genotyped by RT-PCR and sequencing. In all RSV positive specimens, we screened for viruses and atypical bacteria. Demographic and clinical information was recorded and analyzed. RESULTS A total of 34.5% and 3.8% of samples from acute lower respiratory tract infections (ALRI) and influenza-like illness (ILI) were positive for RSV, respectively. Phylogenetic analysis revealed that 61.1% of the selected 167 RSV strains were NA1, 31.1% were BA, 3.6% were ON1, 2.4% were CB1, and 1.8% were NA3. A new genotype, BA11 was identified, which comprised 98.1% of BA strains in this study, while the rest were BA10. A total of 36.4% and 9.1% of RSV-positive children with ALRI and ILI respectively were found to be co-infected. Rhinovirus was the most common additional respiratory virus, followed by human metapneumovirus. Except for fever, no significant differences in other clinical presentation between the RSV mono-infection and co-infection groups were observed. CONCLUSIONS The circulating RSV strains had high genetic variability with RSV-B showing a more local pattern. In ALRI cases, co-infection of RSV with other viruses or atypical bacteria has no significant effect on the clinical presentation except fever.
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Affiliation(s)
- Xinfen Yu
- Microbiology Laboratory, Hangzhou Center for Disease Control and Prevention, Hangzhou, China.
| | - Yu Kou
- Microbiology Laboratory, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Daozong Xia
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jun Li
- Microbiology Laboratory, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xuhui Yang
- Microbiology Laboratory, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yinyan Zhou
- Microbiology Laboratory, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoyan He
- Microbiology Laboratory, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
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RSV Outbreak Investigation Team *. Contributing and Terminating Factors of a Large RSV Outbreak in an Adult Hematology and Transplant Unit. PLOS CURRENTS 2014; 6:ecurrents.outbreaks.3bc85b2a508d205ecc4a5534ecb1f9be. [PMID: 25687181 PMCID: PMC4169394 DOI: 10.1371/currents.outbreaks.3bc85b2a508d205ecc4a5534ecb1f9be] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In January 2012, an increase of respiratory syncytial virus (RSV) infections on an adult hematology and transplant unit in a German university hospital was detected. We investigated the outbreak to assess its timing and extent and to identify risk factors for transmission. METHODS We tested and typed patient samples pro- and retrospectively for RSV. We conducted a cohort and a case-control study. A confirmed outbreak case had laboratory-diagnosed, nosocomially-acquired RSV infection. Possible outbreak cases had pneumonia but were not laboratory-confirmed. RESULTS Of 53 outbreak cases, 36 (68%) were confirmed and 17 (32%) possible. Retrospective testing and chart review dated the beginning of the outbreak to November 2011. Patients with community-acquired RSV infection were identified when the community epidemic began in January 2012. In multivariable analysis (controlling for contact with medical personnel, hygiene behaviour and age) patients with active social behaviour were more at risk for RSV infection (odds ratio 23.8, 95% confidence interval, 1.3 to 434.9; p-value, 0.03). Confirmed outbreak cases were more likely than controls to have been accomodated together with a confirmed or possible case before their onset of illness (OR 9.3, 95%CI: 2.1-85.1; p<0.001). Control measures, including isolation of every patient in the unit, initiated until the end of January terminated the outbreak. CONCLUSIONS Epidemiological investigations revealed co-accomodation with a case-patient and active social behaviour as likely risk factors for RSV infection. Awareness of and vigorous testing for respiratory viruses in immunosuppressed hospitalised patients is necessary to timely detect cases with outbreak potential. Isolation of patients with respiratory infectious illnesses is crucial to prevent the continuation or occurrence of outbreaks.
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Seo S, Xie H, Karron RA, Thumar B, Englund JA, Leisenring WM, Stevens-Ayers T, Boeckh M, Campbell AP. Parainfluenza virus type 3 Ab in allogeneic hematopoietic cell transplant recipients: factors influencing post-transplant Ab titers and associated outcomes. Bone Marrow Transplant 2014; 49:1205-11. [PMID: 24978141 PMCID: PMC4332699 DOI: 10.1038/bmt.2014.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/07/2014] [Accepted: 05/07/2014] [Indexed: 11/09/2022]
Abstract
Parainfluenza virus type 3 (PIV-3) can cause severe respiratory illness among hematopoietic cell transplantation (HCT) recipients. Factors associated with PIV-3-specific Ab level, and the association between PIV-3 Ab levels and clinical outcomes in HCT recipients who acquire PIV-3 infection, are unknown. We evaluated PIV-3-specific hemagglutination inhibition Ab levels and clinical outcomes among 172 patients with PIV-3 infection following HCT. In a multivariable linear regression model, high post-transplantation Ab levels were independently associated with higher pre-transplantation recipient titer (mean difference 0.38 (95% confidence interval (CI), 0.26, 0.50), P<0.001). Significant associations between pre-HCT Ab titers in both patients and donors and occurrence of lower respiratory tract disease (LRD) after HCT were not observed. In conclusion, low pre-transplantation titers are associated with low Ab levels after HCT. The relationship between PIV-3 Ab levels and outcomes remain uncertain. Further study is needed to prospectively evaluate the dynamics of PIV-3-specific Ab responses and the relative contribution of PIV-3-specific Ab to protection from infection acquisition and progression to LRD.
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Affiliation(s)
- Sachiko Seo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ruth A. Karron
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bhagvanji Thumar
- Center for Immunization Research, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janet A. Englund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Pediatric Infectious Diseases, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Wendy M. Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Terry Stevens-Ayers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Angela P. Campbell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Pediatric Infectious Diseases, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- At time of submission, Dr. Campbell’s current affiliation is: Centers for Disease Control and Prevention, Atlanta, GA
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Rabenau HF, Steinmann J, Rapp I, Schwebke I, Eggers M. Evaluation of a virucidal quantitative carrier test for surface disinfectants. PLoS One 2014; 9:e86128. [PMID: 24475079 PMCID: PMC3903494 DOI: 10.1371/journal.pone.0086128] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022] Open
Abstract
Surface disinfectants are part of broader preventive strategies preventing the transmission of bacteria, fungi and viruses in medical institutions. To evaluate their virucidal efficacy, these products must be tested with appropriate model viruses with different physico-chemical properties under conditions representing practical application in hospitals. The aim of this study was to evaluate a quantitative carrier assay. Furthermore, different putative model viruses like adenovirus type 5 (AdV-5) and different animal parvoviruses were evaluated with respect to their tenacity and practicability in laboratory handling. To evaluate the robustness of the method, some of the viruses were tested in parallel in different laboratories in a multi-center study. Different biocides, which are common active ingredients of surface disinfectants, were used in the test. After drying on stainless steel discs as the carrier, model viruses were exposed to different concentrations of three alcohols, peracetic acid (PAA) or glutaraldehyde (GDA), with a fixed exposure time of 5 minutes. Residual virus was determined after treatment by endpoint titration. All parvoviruses exhibited a similar stability with respect to GDA, while AdV-5 was more susceptible. For PAA, the porcine parvovirus was more sensitive than the other parvoviruses, and again, AdV-5 presented a higher susceptibility than the parvoviruses. All parvoviruses were resistant to alcohols, while AdV-5 was only stable when treated with 2-propanol. The analysis of the results of the multi-center study showed a high reproducibility of this test system. In conclusion, two viruses with different physico-chemical properties can be recommended as appropriate model viruses for the evaluation of the virucidal efficacy of surface disinfectants: AdV-5, which has a high clinical impact, and murine parvovirus (MVM) with the highest practicability among the parvoviruses tested.
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Affiliation(s)
- Holger F. Rabenau
- Institute of Medical Virology, Hospital of the Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany
| | | | - Ingrid Rapp
- Labor Dr. Merk & Kollegen, Ochsenhausen, Germany
| | | | - Maren Eggers
- Labor Prof. G. Enders & Kollegen MVZ and Institute of Virology, Infectious Diseases and Epidemiology e.V., Stuttgart, Germany
- * E-mail:
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Berrueco R, Antón A, Rives S, Català A, Toll T, Ruiz A, Camós M, Torrebadell M, Estella J, Muñoz-Almagro C. Multiplex real-time PCR for prompt diagnosis of an outbreak of human parainfluenza 3 virus in children with acute leukemia. Infection 2013; 41:1171-5. [PMID: 23821486 PMCID: PMC7100800 DOI: 10.1007/s15010-013-0498-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/18/2013] [Indexed: 01/22/2023]
Abstract
Introduction Human parainfluenza virus type 3 (HPIV-3) causes significant morbimortality in immunocompromised patients. Outbreaks of severe pneumonitis have been previously described in this setting. Materials and methods Retrospective observational study in children diagnosed with acute leukemia and a documented HPIV-3 infection in the context of a nosocomial outbreak occurred in a single center. Result During summer 2012, an HPIV-3 infection was detected in six hospitalized children with acute leukemia. All the patients had respiratory symptoms and one of them suffered from parotitis. Conclusion Early diagnoses using multiplex real-time polymerase chain reaction (PCR) let us control this outbreak. A phylogenetic analysis confirmed person-to-person transmission of a single HPIV-3 variant.
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Affiliation(s)
- R Berrueco
- Pediatric Hematology Department, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Spain,
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Risk factors and containment of respiratory syncytial virus outbreak in a hematology and transplant unit. Bone Marrow Transplant 2013; 48:1548-53. [DOI: 10.1038/bmt.2013.94] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/10/2013] [Accepted: 05/14/2013] [Indexed: 11/08/2022]
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Khor CS, Sam IC, Hooi PS, Chan YF. Displacement of predominant respiratory syncytial virus genotypes in Malaysia between 1989 and 2011. INFECTION GENETICS AND EVOLUTION 2013; 14:357-60. [DOI: 10.1016/j.meegid.2012.12.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
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Molecular characterization of a respiratory syncytial virus outbreak in a hematology unit in Heidelberg, Germany. J Clin Microbiol 2012; 51:155-62. [PMID: 23100345 DOI: 10.1128/jcm.02151-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2011 and 2012, a large outbreak of respiratory syncytial virus (RSV) infections affecting 57 laboratory-confirmed patients occurred in an adult hematology unit in Heidelberg, Germany. During the outbreak investigation, we performed molecular genotyping of RSV strains to differentiate between single versus multiple introductions of the virus into the unit. Furthermore, we assessed the time of viral shedding of consecutive samples from the patients in order to better understand the possible impact of prolonged shedding for outbreak control management. We used subtype-specific reverse transcription-PCR on nasopharyngeal and bronchoalveolar specimens for routine diagnostics and for measuring the viral shedding period. Samples of 47 RSV-infected patients involved in the outbreak were genotyped by sequence analysis and compared to samples from RSV-infected hospitalized children representing the timing of the annual RSV epidemic in the community. Molecular investigation of the virus strains from clinical samples revealed a unique cluster with identical nucleotide sequences of RSV type A (RSV A outbreak strain) for 41 patients, while 3 patients were infected with different RSV A (nonoutbreak) strains and three other patients with RSV type B. Outbreak strains were identified in samples from November 2011 until January 2012, while nonoutbreak strains were from samples coinciding with the community epidemic in February and March 2012. Median duration of viral shedding time was 24.5 days (range, 1 to 168 days) with no difference between outbreak and nonoutbreak strains (P = 0.45). Our investigation suggests a single introduction of the RSV A outbreak strain into the unit that spread among the immunocompromised patients. Prolonged viral shedding may have contributed to nosocomial transmission and should be taken into account in the infection control management of RSV outbreaks in settings with heavily immunosuppressed patients.
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Maeng SH, Yoo HS, Choi SH, Yoo KH, Kim YJ, Sung KW, Lee NY, Koo HH. Impact of parainfluenza virus infection in pediatric cancer patients. Pediatr Blood Cancer 2012; 59:708-10. [PMID: 22095941 DOI: 10.1002/pbc.23390] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 09/15/2011] [Indexed: 11/05/2022]
Abstract
BACKGROUND Respiratory virus (RV) infection can cause significant morbidity and mortality in pediatric cancer patients. Parainfluenza virus (PIV) is a common pathogen in childhood among the respiratory viruses. The objective of this study is to evaluate the impact of parainfluenza virus infection in pediatric cancer patients. PROCEDURE A retrospective review of medical records of 1,554 children diagnosed with cancer from January 2000 through July 2008 was analyzed at Samsung Medical Center. RESULTS A total of 6.4% (137/1,554) had respiratory virus infection and 54% (74/137) of patients with RV infection had PIV infection. PIV type 3 was the predominant subtype. Among patients with PIV infection, 59 children (79.7%) had upper respiratory tract infection (URI) whereas 15 children (20.3%) had lower respiratory tract infection (LRI) at initial presentation. Among patients with URI, 12 (20.3%) progressed to pneumonia with the median interval of 4 days from URI to LRI. Mortality associated with PIV infection was 18.5% (5/27) in patients with LRI. Among patients with PIV infection, 80% (59/74) had nosocomial infection, which shows the difficulty and importance of infection control at pediatric cancer ward. CONCLUSIONS PIV infection was most commonly diagnosed among pediatric cancer patients with RV infection and PIV infection led to significant pulmonary complications and direct mortality in immunocompromised children. Since there are no effective antiviral agents for PIV infection, precautionary infection control and early diagnosis are the only methods available to prevent the infection spread.
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Affiliation(s)
- Se Hyun Maeng
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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43
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Sydnor ERM, Greer A, Budd AP, Pehar M, Munshaw S, Neofytos D, Perl TM, Valsamakis A. An outbreak of human parainfluenza virus 3 infection in an outpatient hematopoietic stem cell transplantation clinic. Am J Infect Control 2012; 40:601-5. [PMID: 22405748 DOI: 10.1016/j.ajic.2011.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 11/12/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parainfluenza viruses cause respiratory tract infections in adults and children, with peak activity during the spring and summer months. Human parainfluenza virus type 3 (hPIV-3) can contribute to significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS Automated surveillance software was used to identify an hPIV-3 outbreak in an HSCT clinic. Active surveillance for respiratory illness and infection control measures were instituted. A retrospective molecular investigation of outbreak viral strains was performed by direct sequencing. RESULTS Twelve of 196 HSCT recipients attending the clinic during the outbreak period had hPIV-3; one of these patients died. Sequencing demonstrated highly related strains in 9 of 10 patients studied. Despite the ongoing presence of hPIV-3 outside the inpatient/outpatient care continuum clinic, only 2 cases were observed after institution of respiratory season infection control measures. CONCLUSIONS This investigation demonstrates the utility of surveillance software in the identification of respiratory virus outbreaks and the importance of rapid implementation of infection control/prevention measures for containment of outbreaks.
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Affiliation(s)
- Emily R M Sydnor
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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44
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Mao N, Ji Y, Xie Z, Wang H, Wang H, An J, Zhang X, Zhang Y, Zhu Z, Cui A, Xu S, Shen K, Liu C, Yang W, Xu W. Human parainfluenza virus-associated respiratory tract infection among children and genetic analysis of HPIV-3 strains in Beijing, China. PLoS One 2012; 7:e43893. [PMID: 22937119 PMCID: PMC3429441 DOI: 10.1371/journal.pone.0043893] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 07/27/2012] [Indexed: 11/30/2022] Open
Abstract
The relevance of human parainfluenza viruses (HPIVs) to the epidemiology of acute respiratory infections (ARI) in China is unclear. From May 2008 to September 2010, 443 nasopharyngeal aspirates (NPAs) from hospitalized pediatric patients (age from 1 to 93 months) in Beijing were collected and screened for HPIVs and other common respiratory viruses by real-time RT-PCR. Sixty-two of 443 samples were positive for HPIVs with 4 positive for HPIV-2 and 58 positive for HPIV-3, indicating that HPIV-3 was the predominant virus present during the study period. A phylogenetic tree based on all the available HN (hemagglutinin-neuraminidase) sequences of HPIV-3 indicated that three distinct clusters (A,B, and C) were circulating with some temporal and regional clustering. Cluster C was further divided into sub-clusters, C1, C2, C3 and C4. HPIV-3 from Beijing isolates belonged to sub-cluster C3, and were grouped with the isolates from two Provinces of China and the neighboring country of Japan. Genetic analysis based on entire HN gene revealed that the HPIV-3 isolates from Beijing were highly similar with 97.2%-100% identity at the nucleotide level and these could be divided into two closely related lineages, C3a and C3b. These findings suggested that there was co-circulation of multiple lineages of HPIV-3 in the Beijing region during the study period. This is the first study to describe the epidemiology and molecular characterization of HPIVs in China.
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Affiliation(s)
- Naiying Mao
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yixin Ji
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengde Xie
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Huanhuan Wang
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Neurobiology, Taishan Medical College, Taian, Shandong, China
| | - Huiling Wang
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Junjing An
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinxin Zhang
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhen Zhu
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Aili Cui
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Songtao Xu
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kunling Shen
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Chunyan Liu
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Weizhong Yang
- Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenbo Xu
- World Health Organization Regional Office for the Western Pacific Regional Reference Measles Lab and State Key Laboratory for Molecular Virology and Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Harvala H, Gaunt E, McIntyre C, Roddie H, Labonte S, Curran E, Othieno R, Simmonds P, Bremner J. Epidemiology and clinical characteristics of parainfluenza virus 3 outbreak in a Haemato-oncology unit. J Infect 2012; 65:246-54. [PMID: 22546619 DOI: 10.1016/j.jinf.2012.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 04/01/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We describe molecular investigations of a large hospital outbreak of parainfluenza virus type 3 (PIV3), in which 32 patients became infected. We outline infection control measures that successfully limited further spread of PIV3 in a Haemato-oncology unit. METHODS Clinical retrospective review of infected haemato-oncology patients was undertaken. PIV3 haemagglutinin sequences from each case (n = 32) and local epidemiologically unlinked controls (n = 53) were compared to identify potential linkage. RESULTS PIV3-infected patients presented with upper (n = 18) and lower (n = 11) respiratory tract infections, 3 showed pyrexia only and one was asymptomatic. All symptomatic patients received antibiotics; bacterial co-infection was confirmed in eleven patients. PIV3 infections were associated with lower mortality than documented previously; three of the PIV3-infected patients died (3/32; 9%). All deaths were associated with relapsed malignancies, and PIV3 was not believed to be the primary cause of death in any of these patients. Sequences from 27 cases clustered closely together, consistent with nosocomial infections from PIV3 circulating within the ward. Factors favouring transmission were high patient turnaround between the day treatment unit and in-patient ward, and limited isolation facilities for immunocompromised and infected patients, especially within the day treatment unit. New infections reduced to baseline levels three days after enhanced infection control interventions were introduced. CONCLUSIONS Molecular epidemiological analysis provided evidence for nosocomial transmission of PIV3 infection that facilitated effective implementation of infection control measures. These were instrumental in restricting further spread of the virus among high-risk patients.
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Affiliation(s)
- Heli Harvala
- Specialist Virology Centre, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
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Guzmán-Suarez BB, Buckley MW, Gilmore ET, Vocca E, Moss R, Marty FM, Sanders R, Baden LR, Wurtman D, Issa NC, Fang F, Koo S. Clinical potential of DAS181 for treatment of parainfluenza-3 infections in transplant recipients. Transpl Infect Dis 2012; 14:427-33. [PMID: 22340538 DOI: 10.1111/j.1399-3062.2012.00718.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/18/2011] [Accepted: 11/06/2011] [Indexed: 11/28/2022]
Abstract
Parainfluenza virus (PIV) infections can cause serious respiratory infections and death in immunocompromised patients. No antiviral agents have proven efficacy against PIV, and therapy generally consists of supportive care. DAS181, a novel sialidase fusion protein that temporarily disables airway epithelial PIV receptors by enzymatic removal of sialic acid moieties, has been shown to inhibit infection with PIV strains in vitro and in an animal model. We describe here the clinical course of 2 immunocompromised patients with PIV-3 infection, one with a history of lung transplantation and the other neutropenic after autologous hematopoietic stem cell transplantation for multiple myeloma. Both patients had substantial clinical improvement in respiratory and systemic symptoms after a 5-day DAS181 treatment course, although the clinical improvement in the autologous stem cell transplantation patient also paralleled neutrophil engraftment.
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Affiliation(s)
- B B Guzmán-Suarez
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Schmidt AC, Schaap-Nutt A, Bartlett EJ, Schomacker H, Boonyaratanakornkit J, Karron RA, Collins PL. Progress in the development of human parainfluenza virus vaccines. Expert Rev Respir Med 2011; 5:515-26. [PMID: 21859271 DOI: 10.1586/ers.11.32] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In children under 5 years of age, human parainfluenza viruses (HPIVs) as a group are the second most common etiology of acute respiratory illness leading to hospitalization, surpassed only by respiratory syncytial virus but ahead of influenza viruses. Using reverse genetics systems for HPIV serotypes 1, 2 and 3 (HPIV1, 2 and 3), several live-attenuated HPIVs have been generated and evaluated as intranasal vaccines in adults and in children. Two vaccines against HPIV3 were found to be well tolerated, infectious and immunogenic in Phase I trials in HPIV3-seronegative infants and children and should progress to proof-of-concept trials. Vaccines against HPIV1 and HPIV2 are less advanced and have just entered pediatric trials.
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Affiliation(s)
- Alexander C Schmidt
- RNA Viruses Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Bibby DF, McElarney I, Breuer J, Clark DA. Comparative evaluation of the Seegene Seeplex RV15 and real-time PCR for respiratory virus detection. J Med Virol 2011; 83:1469-75. [PMID: 21678451 PMCID: PMC7166927 DOI: 10.1002/jmv.22125] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Respiratory virus infections contribute substantially both to hospitalizations of young children, and to morbidity in immunocompromised patients such as those with hematological malignancies. Their rapid and accurate diagnosis is essential to patient management. To evaluate the prospective utility of Seeplex® DPO technology in respiratory virus diagnosis, a panel of 99 respiratory samples positive by real‐time RT‐PCR for one or more viruses was assayed by the Seegene Seeplex® RV12 system. As well as being able to detect all 10 viruses in the real‐time RT‐PCR system with the exception of enteroviruses, RV12 can also distinguish between the two subgroups of RSV and detect two subgroups of coronaviruses. Seven of the nine viruses in common with the RT‐PCR were detected reliably by RV12. Eleven samples RT‐PCR‐positive for Metapneumovirus and five samples positive for influenza B were not detected by RV12. Seegene developed a second‐generation system, RV15, which not only allowed detection of three additional viruses, but also addressed the potential problems with RV12 specificity. To address these concerns, 84 respiratory samples positive for a range of viruses by real‐time PCR were assayed with RV15. The results of this evaluation improved significantly upon those seen with RV12. The high throughput capabilities and potential lower technical requirements afforded by the Seeplex® system may offer an alternative to real‐time RT‐PCR systems. J. Med. Virol. 83:1469–1475, 2011. © 2011 Wiley‐Liss, Inc.
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Affiliation(s)
- David F Bibby
- Department of Virology, Barts & The London NHS Trust, London, UK.
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49
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Gander JR, Schwan LM, Hoffman MA. Analysis of nucleotides 13-96 of the human parainfluenza virus type 3 antigenomic promoter reveals positive- and negative-acting replication elements. Virology 2011; 419:90-6. [PMID: 21880340 DOI: 10.1016/j.virol.2011.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 06/27/2011] [Accepted: 08/08/2011] [Indexed: 10/17/2022]
Abstract
During replication of human parainfluenza virus type 3 (HPIV3), the 96-nucleotide antigenomic promoter (AGP) of HPIV3 directs the synthesis of genomic RNA. Previous work showed that nucleotides 1-12 were critical in promoting replication of an HPIV3 minireplicon, but nucleotides 13-96 were not investigated. In this study, the role of nucleotides 13-96 in AGP function was analyzed by creating and assaying mutations in an HPIV3 minireplicon. A replication promoting element known as promoter element II (nt 79-96) was confirmed in the HPIV3 AGP. Additionally, nucleotides 13-39 were found to constitute an additional positive-acting cis-element. However, detailed analysis of the 13-39 element revealed a complicated control element with both stimulatory and repressing elements. Specifically, nucleotides 21-28 were shown to repress RNA replication, while flanking sequences had a stimulatory effect.
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Affiliation(s)
- Jill R Gander
- Department of Microbiology, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
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50
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Weigt SS, Gregson AL, Deng JC, Lynch JP, Belperio JA. Respiratory viral infections in hematopoietic stem cell and solid organ transplant recipients. Semin Respir Crit Care Med 2011; 32:471-93. [PMID: 21858751 PMCID: PMC4209842 DOI: 10.1055/s-0031-1283286] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Respiratory viral infections (RVIs) are common causes of mild illness in immunocompetent children and adults with rare occurrences of significant morbidity or mortality. Complications are more common in the very young, very old, and those with underlying lung diseases. However, RVIs are increasingly recognized as a cause of morbidity and mortality in recipients of hematopoietic stem cell transplants (HSCT) and solid organ transplants (SOTs). Diagnostic techniques for respiratory syncytial virus (RSV), parainfluenza, influenza, and adenovirus have been clinically available for decades, and these infections are known to cause serious disease in transplant recipients. Modern molecular technology has now made it possible to detect other RVIs including human metapneumovirus, coronavirus, and bocavirus, and the role of these viruses in causing serious disease in transplant recipients is still being worked out. This article reviews the current information regarding epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment of these infections, as well as the aspects of clinical significance of RVIs unique to HSCT or SOT.
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Affiliation(s)
- S Samuel Weigt
- Division of Pulmonary, Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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