title: Hepatitis A outbreak in a neonatal intensive care unit: risk factors for transmission and evidence of prolonged viral excretion among preterm infants.
abstract: An outbreak of hepatitis A virus (HAV) infection in a neonatal intensive care unit (NICU) provided the opportunity to examine the duration of HAV excretion in infants and the mechanisms by which HAV epidemics are propagated in NICUs. The outbreak affected 13 NICU infants (20%), 22 NICU nurses (24%), 8 other staff caring for NICU infants, and 4 household contacts; 2 seropositive infants (primary cases) received blood transfusions from a donor with HAV infection. Risk factors for infection among nurses were care for a primary infant-case (relative risk [RR], 3.2), drinking beverages in the unit (odds ratio [OR], infinity), and not wearing gloves when taping an intravenous line (OR, 13.7). Among infants, risk factors were care by a nurse who cared for a primary infant-case during the same shift (RR, 6.1). Serial stool samples from infant-cases were tested for HAV antigen (HAV-Ag) by enzyme immunoassay and HAV RNA by nucleic acid amplification using the polymerase chain reaction. Infant-cases excreted HAV-Ag (n = 2) and HAV RNA (n = 3) 4-5 months after they were identified as being infected. Breaks in infection control procedures and possibly prolonged HAV shedding in infants propagated the epidemic in a critical care setting.
authors.affiliation: Hepatitis Branches, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: L S
authors.initials: LS
authors.lastname: Rosenblum
authors.forename: M E
authors.initials: ME
authors.lastname: Villarino
authors.forename: O V
authors.initials: OV
authors.lastname: Nainan
authors.forename: M E
authors.initials: ME
authors.lastname: Melish
authors.forename: S C
authors.initials: SC
authors.lastname: Hadler
authors.forename: P P
authors.initials: PP
authors.lastname: Pinsky
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: C E
authors.initials: CE
authors.lastname: Ott
authors.forename: H S
authors.initials: HS
authors.lastname: Margolis
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D001483:Base Sequence; D015331:Cohort Studies; D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology; D006254:Hawaii; D006506:Hepatitis A / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D006507:Hepatovirus / Q000032:analysis / Q000235:genetics / Q000276:immunology; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D007363:Intensive Care Units, Neonatal; D008969:Molecular Sequence Data; D009726:Nurses; D016273:Occupational Exposure; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000956:Antigens, Viral; D012367:RNA, Viral