Major articleAn outbreak of norovirus infection in a bone marrow transplant unit
Section snippets
Setting
The Temple University Bone Marrow Transplant (BMT) Unit is an 18-bed facility located at Jeanes Hospital, a university-affiliated hospital in northeast Philadelphia, PA. The BMT program at Jeanes Hospital averages 80 hematopoietic stem cell transplants per year. Full reverse isolation with laminar air flow is not used; rooms are high-efficiency particulate air filtered and are positive pressure with respect to the hallways. Gloves and masks are required to enter the room of patients whose
Epidemic characteristics
Eight BMT recipients with increased stool volume or frequency had stool samples tested for norovirus. Six BMT patients had norovirus detected. A graph depicting the timing of symptom onset and remission is shown in Figure 1. Two BMT norovirus-infected patients spent time in a separate rehabilitation unit, and these periods are also depicted in Figure 1. Of 10 positive stools in 6 patients, 4 were detected by enzyme immunoassay and 6 by PCR. Two patients had PCR genogroup testing at the same
Discussion
Unlike most nosocomial infections, norovirus does not arise from a patient's endogenous microbiome or from a reservoir of endemic hospital pathogens; rather it is imported into a hospital or long-term care facility from the community by an ill patient or health care worker. Nosocomial outbreaks arise because this virus is highly contagious.10, 11, 12, 13, 14, 15, 16, 17, 20 The likelihood of a nosocomial outbreak of norovirus is enhanced when there is a community outbreak.16, 20, 21 Our
Acknowledgments
The authors thank Dr Thomas Fekete for his many helpful suggestions and aid in preparing the Figure and Constance Connell for detailed information about unit protocol.
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Cited by (27)
Chronic norovirus infection among solid organ recipients in a tertiary care hospital, the Netherlands, 2006–2014
2017, Clinical Microbiology and InfectionCitation Excerpt :Human challenge studies have shown that the median virus shedding in healthy adults is 28 days (range 13–56 days) [5]. In recent years, anecdotal reports have described norovirus as a causative agent of persisting infections in the immunocompromised host, including solid organ transplant (SOT) recipients, patients with congenital immunodeficiency, patients treated with chemotherapy, and patients infected with human immunodeficiency virus [6–10]. These patients can suffer from prolonged symptoms that may last multiple years leading to severe dehydration, malnutrition, patient discomfort, acute renal failure and eventually death [11,12].
Control of norovirus outbreak on a pediatric oncology unit
2015, American Journal of Infection ControlCitation Excerpt :The risk of secondary transmission of NV from chronic shedders is not completely understood, but it has been reported in a single retrospective study.15 No reported outbreaks among high-risk patients have been linked to an asymptomatic shedder.16,17 The duration of shedding that we noted in our patients is consistent with the longer duration of symptoms and shedding that has been noted in other studies of immunocompromised patients, including immunocompromised pediatric patients, as compared with immunocompetent patients.18-22
Prospective study on Norovirus infection among allogeneic stem cell transplant recipients: Prolonged viral excretion and viral RNA in the blood
2014, Journal of Clinical VirologyCitation Excerpt :It is also the first study to be conducted in this type of population in Brazil. The positivity rate for NoV (60%) of the patients in this study was higher than the rates reported in outbreaks of NoV described in BMTUs located in Hong Kong (16.3%) and in Philadelphia (26%) [23,25]. NoV outbreaks have also been described in hospital wards, with attack rates of up to 50%.
Norovirus infection in immunocompromised hosts
2014, Clinical Microbiology and InfectionCitation Excerpt :Infection control strategies with the most positive outcomes have been reviewed in the nosocomial setting [66], and include restricting movement of patients and staff, enhanced environmental cleaning, and attention to hand-washing. The practice of ‘presenteesim’ (a term for working while sick) should be avoided by healthcare workers managing immunocompromised patients: this practice has been linked to norovirus outbreaks in settings such as a bone marrow transplantation unit [26]. Norovirus vaccine development and evaluation is underway [69], but it will probably be several more years before licensed vaccines are available [70].
Treatment of norovirus infections: Moving antivirals from the bench to the bedside
2014, Antiviral Research
Conflicts of interest: None to report.