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. 2021 Mar 26;10(2):118-124.
doi: 10.1093/jpids/piaa026.

Multiple Respiratory Syncytial Virus Introductions Into a Neonatal Intensive Care Unit

Erica Billig Rose  1   2 , Erica J Washington  3 , Lijuan Wang  4 , Isaac Benowitz  5 , Natalie J Thornburg  1 , Susan I Gerber  1 , Teresa C T Peret  1 , Gayle E Langley  1
Affiliations

Multiple Respiratory Syncytial Virus Introductions Into a Neonatal Intensive Care Unit

Erica Billig Rose et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Outbreaks of respiratory syncytial virus (RSV) in neonatal intensive care units (NICUs) are of concern because of the risk of severe disease in young infants. We describe an outbreak of RSV in a NICU and use whole genome sequencing (WGS) to better understand the relatedness of viruses among patients.

Methods: An investigation was conducted to identify patients and describe their clinical course. Infection control measures were implemented to prevent further spread. Respiratory specimens from outbreak-related patients and the community were tested using WGS. Phylogenetic trees were constructed to understand relatedness of the viruses.

Results: Seven patients developed respiratory symptoms within an 11-day span in December 2017 and were diagnosed with RSV; 6 patients (86%) were preterm and 1 had chronic lung disease. Three patients required additional respiratory support after symptom onset, and none died. Six of 7 patients were part of the same cluster based on > 99.99% nucleotide agreement with each other and 3 unique single-nucleotide polymorphisms were identified in viruses sequenced from those patients. The seventh patient was admitted from the community with respiratory symptoms and had a genetically distinct virus that was not related to the other 6. Implementation of enhanced infection control measures likely limited the spread.

Conclusions: Using WGS, we found 2 distinct introductions of RSV into a NICU, highlighting the risk of healthcare-associated infections during RSV season. Early recognition and infection control measures likely limited spread, emphasizing the importance of considering RSV in the differential diagnosis of respiratory infections in healthcare settings.

Keywords: RSV; RSV outbreak; respiratory syncytial virus.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Timeline of onset of symptoms of 7 neonatal intensive care unit (NICU) patients (N = 7) relative to the hospitalization of the first reported infected patient, defined as day 0.
Figure 2.
Figure 2.
Timeline of hospitalization duration (day of admission, or day of birth for all patients except patient 1, to day of discharge), onset of symptoms, and day of specimen collection. Patient 2 was hospitalized for 272 days (day −146 to day 126); the entire hospitalization is not shown in the figure.
Figure 3.
Figure 3.
Unit and room locations of the 7 respiratory syncytial virus–infected patients. Blue boxes indicate patient rooms, red boxes indicate patient room doors, and open blue lines indicate hallways between units and rooms. The grey box indicates a storage room.
Figure 4.
Figure 4.
Phylogenetic trees of respiratory syncytial virus (RSV) G gene (A) and whole genome sequencing (WGS; B) from community and cluster sequences using Bayesian analysis (Mr. Bayes version 3.2.6), applying general time reversible (GTR) substitution model and gamma rate variation. The RSV G gene and WGS from the patients are highlighted with red dots. Sequences from this study include GenBank accession numbers MJ929516-MJ929538.
See this image and copyright information in PMC

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