Infection Control & Hospital Epidemiology (2019), 40, 245–247 doi:10.1017/ice.2018.311
Research Brief
Molecular and epidemiologic investigation of a rhinovirus outbreak in a neonatal intensive care unit
Kenza Rahmouni El Idrissi1, Sandra Isabel MD, PhD2, Julie Carbonneau MSc3, Martine Lafond RN4, Caroline Quach MD, MSc5, Chelsea Caya MScPH6, Patricia S. Fontela MD, PhD6,7,8, Marc Beltempo MD, MSc6,7,
Guy Boivin MD, MSc3, Marie-Astrid Lefebvre MD, MSc4,7 and Jesse Papenburg MD, MSc6,7,8 1Faculty of Medicine, McGill University, Montreal, Quebec, Canada, 2Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada, 3Infectious Diseases Research Centre, CHU Quebec and Laval University, Quebec City, Quebec, Canada, 4Infection Prevention and Control, Montreal Children’s
Hospital, McGill University Health Centre, Montreal, Quebec, Canada, 5Department of Microbiology, Infectious Diseases & Immunology, University of Montreal, Quebec, Canada, 6Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada, 7Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada and 8Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
Abstract
We performed a molecular and epidemiologic study of a healthcare-associated rhinovirus outbreak to better understand transmission in neonatal intensive care settings. Sequencing of the 7 outbreak strains revealed 4 distinct clades, indicating multiple sources. A single clade infected 3 patients in adjacent rooms, suggesting horizontal transmission. We observed 1 rhinovirus-associated death.
(Received 23 August 2018; accepted 3 November 2018; electronically published 5 December 2018)
Molecular-based multiplex testing for respiratory viruses detects formerly underdiagnosed healthcare-associated infections (HAIs), including human rhinovirus (HRV).1,2 In neonates, HRV infections may be associated with upper and lower respiratory symptoms and apnea.2 Even though HRV is a frequent cause of pediatric viral respiratory HAIs,2 little is currently known about HRV nosocomial transmission in neonatal intensive care units (NICU).3–5 We performed a molecular and epidemiologic investigation of
an HRV outbreak at the Montreal Children’s Hospital (MCH) NICU. Our objective was to evaluate transmission of HRV within the NICU through contact investigation and viral nucleic acid sequencing.
Methods
We describe a case series of laboratory-confirmed HRV HAI in the MCH NICU during August and September 2017. This ter- tiary- and quaternary-care NICU comprises 43 single rooms, and 4 twin or triplet rooms. An HRV infection was considered an HAI if symptom onset
Results
occurred >48 hours after admission.2 Cases were defined as laboratory-confirmed HRV infection with >1 associated clinical symptom.6
Author for correspondence: Jesse Papenburg MD, MSc, Montreal Children’s
Hospital 1001 Décarie Blvd, Room E05 1905, Montreal, QC, H4A 3J1. E-mail: Jesse.
papenburg@mcgill.ca PREVIOUS PRESENTATION: These study results were presented during a poster session at the Pediatric Academic Societies Meeting onMay 6, 2018, in Toronto, Canada. Cite this article: El Idrissi KR, et al. (2019). Molecular and epidemiologic
investigation of a rhinovirus outbreak in a neonatal intensive care unit. Infection Control & Hospital Epidemiology 2019, 40, 245–247. doi: 10.1017/ice.2018.311
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
In total, 7 NICU patients tested positive for HRV during the outbreak (August–September 2017). Demographic and baseline clinical characteristics are presented in the Supplementary Material. Overall, 5 patients presented with apneic episodes, and 1
patient required escalation of care from no respiratory support to invasive mechanical ventilation. This baby had an underlying severe progressive hypertrophic cardiomyopathy of unknown etiology and died 15 days after onset of the HRV infection symptoms. Nosocomial HRV species C (HRV-C) bronchiolitis is thought to have contributed to this death. Phylogenetic analysis of the HRV outbreak strains revealed 4
distinct clades (Fig. 1). HRV-A clades 1 and 2 (color-coded red and green, respectively) comprised a single strain each. HRV-C
We extracted clinical data from patient charts and performed
HRV nucleic acid sequencing for all 7 outbreak cases and 15 community-acquired control strains randomly selected among contemporaneous HRV-positive specimens tested locally. Poly- merase chain reaction (PCR) amplification and nucleic acid sequencing of a 540-nucleotide fragment of the HRV VP4/VP2 capsid genes were performed directly on clinical specimens. Relatedness of outbreak and community strains (GenBank accession nos. MH603569–MH603590) was assessed by phylogenetic analyses using MEGA7 version 7.0.21 software.7 Further details of molecular analyses are provided in the supplementary material online. The MCH Research Ethics Board deemed this investigation exempted from review.
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