title: Evolution of an adenovirus outbreak in a multidisciplinary children's hospital.
abstract: OBJECTIVE
  To describe the course of an evolving adenovirus outbreak in a multidisciplinary children's hospital with a high-risk patient population.
  
  
  METHODS
  Observational study in a 280-bed university hospital during June 2002. Active case finding identified children with adenovirus infection. Data are median (interquartile range) or n (%). Adenovirus infection was diagnosed in 49 children, median age 12 months (4-33).
  
  
  RESULTS
  New cases were diagnosed over 26 days and peaked on day 17 (n = 15). Total infected inpatients peaked on days 17-21 (n = 36). Twenty-three infections (47%) were community-acquired and 26 (53%) hospital-acquired. Thirty-three children (67%) had a coexistent high-risk condition. Median hospital stay before and after diagnosis was 9 days (3-18) and 9 days (4-29), respectively. Twenty-two children (45%) were admitted to PICU. Overall hospital mortality was 22% (n = 11) and mortality attributed to adenoviral disease 12% (n = 6). Hospital mortality was similar between community- and hospital-acquired infections (22% compared to 23%) (P = 1.0). Twenty children (41%) received intravenous immunoglobulin (IVIG). Children treated with IVIG had a longer hospital stay (median 40 days vs 14 days) than those who did not receive IVIG (P = 0.01). Neither PICU mortality (29% vs 12%), nor hospital mortality (35% vs 14%), differed significantly between IVIG treated and untreated children (P = 0.76 and P = 0.16, respectively).
  
  
  CONCLUSIONS
  The rapid spread of hospital-acquired adenovirus underlines the importance of effective infection control measures. Despite nosocomial infection amongst high-risk patients, mortality was similar to that of community-acquired infection. Administration of immunoglobulin was not associated with demonstrable benefit. A prospective randomized trial would be required to resolve this issue.
authors.affiliation: Paediatric Intensive Care Unit, Red Cross Chidren's Hospital, Cape Town, South Africa. hatheril@ich.uct.ac.za
authors.forename: M
authors.initials: M
authors.lastname: Hatherill
authors.forename: M
authors.initials: M
authors.lastname: Levin
authors.forename: J
authors.initials: J
authors.lastname: Lawrenson
authors.forename: N-Y
authors.initials: NY
authors.lastname: Hsiao
authors.forename: L
authors.initials: L
authors.lastname: Reynolds
authors.forename: A
authors.initials: A
authors.lastname: Argent
mesh_terms: D000256:Adenoviridae / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D019085:Fluorescent Antibody Technique, Direct; D006776:Hospitals, Pediatric; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007223:Infant; D015278:Intensive Care Units, Pediatric; D011024:Pneumonia, Viral / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors
chemical_list: D007136:Immunoglobulins