Infection Control & Hospital Epidemiology (2019), 40, 238–241 doi:10.1017/ice.2018.330
Concise Communication
Aerosol transmission of severe fever with thrombocytopenia syndrome virus during resuscitation
Jaeyoung Moon MD1,a, Hyeokjin Lee PhD2, Ji Hoon Jeon MD3, Yejin Kwon MD1, Hojin Kim MD1, Eun Byeol Wang2, Choong Won Seo PhD4, Sul A. Sung RN5, Su-Hyun Kim RN5, Hyeri Seok MD3,5, Won Suk Choi MD, PhD3,5,
WooYoung Choi PhD2 and Dae Won Park MD, PhD3,5 1Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea, 2Division of Viral Diseases, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea, 3Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea, 4Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Republic of Korea and 5Department of Hospital Infection Control, Korea University Ansan Hospital, Ansan, Republic of Korea
Abstract
We investigated potential nosocomial aerosol transmission of severe fever with thrombocytopenia syndrome virus (SFTSV) with droplet precautions. During aerosol generating procedures, SFTSV was be transmitted from person to person through aerosols. Thus, airborne precautions should be added to standard precautions to avoid direct contact and droplet transmission.
(Received 24 June 2018; accepted 19 November 2018)
Severe fever with thrombocytopenia syndrome (SFTS) caused by SFTS virus (SFTSV), a newly discovered emerging infectious disease with a high case-fatality rate recognized in central China in 2007, has recently been reported in China, Japan, and Korea.1 Although most SFTS cases occur through tick bites, clusters of SFTS in family members and healthcare personnel (HCP) between people in several routes have been reported.1–5 Themajor routeofhuman-to-human transmission is direct blood exposure without proper personal protection equipment (PPE).1,3 For this reason, contact precautions are recommended when caring for suspected or confirmed SFTS patients.1,6 A recent outbreak of SFTS in a Korean hospital suggests possible droplet transmission.2 In China, probable aerosol trans- mission in a family cluster has also been reported.4 Considering the increasing incidence and high overall case
fatality ratio (~32.6%) of SFTS in Korea,7 better understanding the mode of SFTS transmission is essential for infection control. We report a cluster of nosocomial person-to-person transmission of SFTSV probably by aerosol and contact routes.
Methods Case definition and epidemiologic investigations
In September 2017, a SFTS-confirmed patient died at a tertiary- care hospital in Ansan, Korea. Thereafter, a cluster of 2 confirmed
Author for correspondence: Dae Won Park MD, PhD, Division of Infectious Dis- eases, Korea University Ansan Hospital, 123 Jeukgeum-ro, Danwon-gu, Ansan 15355,
Republic of Korea. E-mail:
pugae1@korea.ac.kr aAuthors of equal contribution.
Cite this article: Moon J, et al. (2019). Aerosol transmission of severe fever with
thrombocytopenia syndrome virus during resuscitation. Infection Control & Hospital Epidemiology 2019, 40, 238–241. doi: 10.1017/ice.2018.330
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
or suspected SFTS cases occurred among people exposed to the index case. With suspicion of nosocomial transmission of SFTSV, epidemiologic investigations were performed in all people exposed to the index patient during hospitalization. Epidemiological interviews included demographic data, clinical symptoms, signs of SFTS, history of tick bites, animal contacts, routes of possible exposure to risk factors, the use of protective devices, and protective behaviors. Paired sera 2 weeks apart were collected for confirmatory tests.
Laboratory tests
Confirmatory tests of SFTSV infection were (1) 1-step, real-time, or conventional reverse-transcription polymerase chain reaction (RT-PCR) for detecting M and S segments of SFTSV RNA, (2) immunofluorescence assay (IFA) for detecting anti-SFTSV immuno- globulin G (IgG), and (3) isolation of SFTSV in Vero E6 cell culture.8 Genome sequences covering partial M (560-bp) and S (563-bp) segments were generated using de novo assembly with DNAStar version 5.06 software (Madison, WI). MEGA 6 software was used for genomic sequence alignment and phylogenetic analysis using the maximum-likelihoodmethod.8 All confirmatory tests were performed at the Korea Centers for Disease Control and Prevention (KCDC).
Results
The index patient was a 57-year-old man with onset of illness on September 22, 2017, after collecting mushrooms on a mountain to 10 days previously. He visited a local clinic on September 24 with high fever above 38°C, myalgia, watery diarrhea, and decreased urine output. He was transferred to our hospital and admitted to general ward on September 27. Physical examination revealed eschar on his back suggesting a tick bite. The laboratory tests
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