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. 2018 Sep 24:13:Doc08.
doi: 10.3205/dgkh000314. eCollection 2018.

Influenza and respiratory syncytial virus screening for the detection of asymptomatically infected patients in hematology and oncology

Claas Baier  1 , Christin Linderkamp  2 , Andreas Beilken  2 , Felicitas Thol  3 , Michael Heuser  3 , Ella Ebadi  1 , Tina Ganzenmueller  4 , Albert Heim  4 , Franz-Christoph Bange  1
Affiliations

Influenza and respiratory syncytial virus screening for the detection of asymptomatically infected patients in hematology and oncology

Claas Baier et al. GMS Hyg Infect Control. .

Abstract
in English, German

Introduction: Respiratory syncytial virus (RSV) and influenza virus infections are a significant healthcare risk for immunocompromised patients. In addition to community onset, nosocomial acquisition and transmission may also occur. Detection of asymptomatic shedders (e.g., patients in the incubation period or immunosuppressed long term shedders) facilitates control of nosocomial transmission. Methods: To strengthen the existing infection control concept, a PCR-based screening for RSV and influenza virus was implemented for all patients lacking respiratory symptoms (asymptomatic patients) who were hospitalized on an adult and a pediatric hemato-oncological ward. Laboratory results of this screening were analyzed retrospectively. Results: 665 respiratory specimens were obtained for screening from 251 patients (26% were 18 years and younger) from December 2016 to April 2017. In 23 patients without respiratory symptoms, either influenza virus or RSV infection was found, resulting in a detection rate of about 9%. In 6 patients, the infection was presumably detected during the incubation period, because an increase of viral load was observed in subsequent specimens. Positive screening results facilitated timely implementation of adequate infection control precautions. Nosocomial clusters of RSV or influenza were not detected during the screening period on the two wards. Conclusion: The seasonal screening program expanded our existing infection control concept in terms of patients lacking respiratory symptoms who shed influenza virus or RSV. It enabled us to identify 23 RSV or influenza infections in patients lacking respiratory symptoms in a 4-month period and thus to rapidly take isolation precautions.

Einleitung: Infektionen mit dem Respiratory Syncytial Virus (RSV) und dem Influenzavirus stellen für immunsupprimierte Patienten ein relevantes Gesundheitsrisiko dar. Die Infektion mit diesen Viren erfolgt häufig außerhalb des Krankenhauses, jedoch sind auch ein nosokomialer Erwerb und nosokomiale Übertragungen möglich. Die rechtzeitige Detektion von asymptomatischen Virusausscheidern (z.B. Patienten in der Inkubationsphase oder asymptomatische Langzeitausscheider bei Immunsuppression) kann dazu beitragen, die nosokomiale Verbreitung dieser Erreger zu verhindern.Methoden: Es wurde ein PCR-basiertes Screening-Programm für RSV und Influenza für alle Patienten ohne Symptome einer respiratorischen Erkrankung (asymptomatische Patienten) etabliert, die auf einer pädiatrischen hämatologisch-onkologischen und einer hämatologisch-onkologischen Station für Erwachsene behandelt wurden. Die Ergebnisse dieses Screening-Programms wurden retrospektiv analysiert. Ergebnisse: Von Dezember 2016 bis April 2017 wurden insgesamt 665 respiratorische Proben von 251 asymptomatischen Patienten (davon waren 26% pädiatrische Patienten) gewonnen. Bei 23 dieser Patienten konnte entweder eine RSV- oder eine Influenzainfektion nachgewiesen werden, was einer Detektionsrate von etwa 9% entspricht. 6 der Patienten, die eine ansteigende Viruslast im Verlauf aufwiesen, befanden sich beim Screening mutmaßlich in der Inkubationsphase. Positive Screening-Ergebnisse führten zur Implementierung zusätzlicher Hygienemaßnahmen (z.B. Isolation, Barrierepflege). Influenza und/oder RSV Häufungen wurden auf den beiden Stationen im Screening-Zeitraum nicht detektiert. Schlussfolgerung: Das saisonale Screeningprogramm hat unser bestehendes Hygienekonzept in der Hämatologie und Onkologie in Hinblick auf asymptomatische Virusausscheider erweitert. Es ermöglichte in einer etwa viermonatigen Periode insgesamt 23 asymptomatisch infizierte Patienten zu detektieren und für diese adäquate Hygienemaßnahmen zu ergreifen.

Keywords: PCR; cross infection; infection control; influenza; oncology; respiratory syncytial virus; screening.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Table 1
Table 1. Overview of RT-PCR screening results of patients lacking respiratory symptoms.
From December 2016 to April 2017, altogether 251 asymptomatic patients were screened. In 23 patients either influenza or RSV was detected.
Table 2
Table 2. Course of viral load in 6 patients who showed an increase in viral load (presumed detection during the incubation period). The 6 patients showed an increase in viral load during their clinical course and were therefore presumably detected during the incubation period.
See this image and copyright information in PMC

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