Control of an outbreak of human parainfluenza virus 3 in hematopoietic stem cell transplant recipients

Abstract

Human parainfluenza virus 3 (HPIV3) infection can cause significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). There are no standard guidelines for the prevention and control of HPIV3 in the outpatient setting. After 2 HSCT inpatients diagnosed with HPIV3 were noted to have had multiple recent HSCT outpatient clinic (OPC) visits, an investigation of policy and procedures in the HSCT OPC was undertaken, and active surveillance for respiratory viral illness was instituted in the at-risk HSCT population. Between July 19 and August 30, 2005, 13 patients were diagnosed with HPIV3 infection. Morbidity in affected patients was significant, and mortality was high (38.5%) and not affected by antiviral therapy. Molecular typing identified several genetically distinct groups of the hemagglutinin-neuraminidase gene of the 11 available isolates. Based on sequence relatedness among the isolates and the demographic and exposure history of the patients, in many of these cases HPIV3 infection likely was acquired in the HSCT OPC. The major infection control interventions were introduced between August 20 and August 24. An epidemic curve revealed that HPIV3 infection frequency peaked between August 17 and August 26, with no cases identified after August 30. Prompt attention and focus on infection control interventions were associated with a rapid decrease in the number of incident cases. Policies and procedures regarding patients with respiratory viral illnesses in HSCT OPC populations should be formulated and universally reinforced with HSCT clinic staff to prevent the spread of these infections.

Figure 1

Maximum likelihood tree obtained from the nucleotide alignment of HPIV3 HN gene sequences (nt 1-424) from 11 patients. Three major clades are highlighted. Prototype strain Washington/47885/57 is included as an outgroup. Bootstrap values are indicated for selected nodes.

Figure 2

HPIV3 outbreak in the HSCT OPC. (A) temporal distribution of HPIV3 outbreak cases. (B) CDC NREVSS weekly percentage of HPIV3 cultures positive for Seattle surveillance sites showing the HSCT OPC outbreak in the inset.