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Adenovirus Type 7 Outbreak in a Pediatric Chronic-Care Facility -- Pennsylvania, 1982

In July 1982, an outbreak of respiratory disease caused by adenovirus type 7 (Ad 7) occurred in a chronic-care facility in a pediatric hospital in Pennsylvania. On June 6, a physician, the presumed index case, developed injected conjunctiva; 2 days later, conjunctivitis; and on June 12, an acute upper respiratory-tract illness ((URI) coryza and/or pharyngitis). Between June 15 and July 9, four of the 14 children in the facility became ill with an acute respiratory illness characterized by either URI or lower respiratory-tract illness ((LRI) fever and respiratory distress). These four, and three other asymptomatic children, were culture-positive for Ad 7 (Table 2). Three of the four ill children had LRI and required mechanical ventilation; one with congenital heart disease and one with bronchopulmonary dysplasia died. In addition, three of the other 35 staff members (physicians, nurses, and play therapists) developed acute URI, and Ad 7 was isolated from cultures from two of them.

The chronic-care facility has a nurses' station, treatment room, playroom, and three patient rooms--with four, six, and seven beds, respectively. All 14 children remained in the facility throughout the outbreak. Culture-positive children resided in two of the three rooms.

The index case had contact with all 14 children on June 6-7 and from June 14 on. Both culture-positive staff members had contact with the first ill child as early as June 15. Ultimately, one of these staff members had contact with all seven culture-positive and three of seven culture-negative children. The other had contact with three culture-positive children and one culture-negative child. When these staff members became ill, they were excluded from patient contact. When the extent of the outbreak was recognized on June 22, children culture-positive for Ad 7 were moved into one room, and staff members with acute respiratory illness were excluded from contact with the children. Reported by MA Fee, MD, E Charney, MD, SA Plotkin, MD, HM Friedman, MD, P Pershing, A O'Hara, C Forrer, Children's Hospital of Philadelphia; Hospital Infections Program, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: This outbreak serves as a reminder of the risks of Ad 7 nosocomial infections. Of all the adenovirus types, types 7, 3, and 21 are most likely to cause serious respiratory disease, particularly in young children (1-3). Adenovirus outbreaks among infants and children have been reported from a variety of closed communities, including hospitals and children's homes (4-6). Significant mortality and long-term morbidity are sometimes associated with these infections, especially among infants and immunocompromised children (1-6). In this report, the fatalities may have been related to underlying cardiac and respiratory disease. Other respiratory viruses can also cause serious nosocomial disease resulting in significant morbidity, prolonged hospitalization, and death (7). Respiratory syncytial virus (RSV) is a particularly serious and frequent nosocomial pathogen among infants and young children (7,8).

Viral infections are increasingly recognized as important nosocomial problems, and guidelines for their prevention and control are being developed (7). Prevention and control of respiratory viruses as nosocomial pathogens are particularly difficult. These viruses are epidemic in the community during the fall, winter, and spring, and illness caused by the serious nosocomial pathogens, e.g. RSV and Ad 7, is often indistinguishable from that caused by less serious nosocomial pathogens, e.g. rhinoviruses. They can infect staff and patients alike, and in some instances, virus can be shed for long periods of time.

Because of the seriousness of some nosocomial viral respiratory infections, some authorities recommend isolation and other infection-control measures for infants and children hospitalized with symptoms of viral respiratory-tract infections (8). The "Guidelines for Prevention of Nosocomial Pneumonia" recommends that personnel with URI not be assigned to the direct care of high-risk patients, such as neonates and young children (9).

References

  1. Wright HT Jr, Beckwith JB, Gwinn JL. A fatal case of inclusion body pneumonia in an infant infected with adenovirus type 3. J Pediatr 1964;64:528-33.

  2. Simila S, Ylikorkala O, Wasz-Hockert O. Type 7 adenovirus pneumonia. J Pediatr 1971;79:605-11.

  3. Lang WR, Howden CW, Laws J, Burton JF. Bronchopneumonia with serious sequelae in children with evidence of adenovirus type 21 infection. Brit Med J 1969;1:73-9.

  4. Harris DJ, Wulff H, Ray CG, Poland JD, Chin TD, Wenner HA. Viruses and disease: III. An outbreak of adenovirus type 7A in a children's home. Am J Epidemiol 1971;93:399-402.

  5. Chany C, Lepine P, Lelong M, Le-Tan-Vanh, Satge P, Virat J. Severe and fatal pneumonia in infants and young children associated with adenovirus infections. Am J Hyg 1958;67:367-78.

  6. Herbert FA, Wilkinson D, Burchak E, Morgante O. Adenovirus type 3 pneumonia causing lung damage in childhood. Can Med Assoc J 1977;116:274-6.

  7. Valenti WM, Menegus MA, Hall CB, Pincus PH, Douglas RG Jr. Nosocomial viral infections: 1. Epidemiology and significance. Infect Control 1980;1:33-47.

  8. Hall CB. Nosocomial viral respiratory infections: perennial weeds on pediatric wards. Am J Med 1981;70:670-6.

  9. Simmons BP, Wong ES. Guidelines for prevention of nosocomial pneumonia. Infect Control 1982;3;327-33.



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