Respiratory syncytial virus outbreak in a long-term care facility detected using reverse transcriptase polymerase chain reaction: an argument for real-time detection methods.
OBJECTIVE
To report an outbreak of respiratory synctyial virus (RSV) in a long-term care facility (LTCF) during ongoing routine respiratory illness surveillance.


METHODS
Rapid antigen testing, viral culture, direct fluorescent antibody (DFA) testing, and reverse transcriptase polymerase chain reaction (RT-PCR) testing for up to 15 viruses in symptomatic residents and chart review.


METHODS
A 120-bed LTCF.


METHODS
Comparison of rapid antigen testing, respiratory viral cultures, and DFA testing and RT-PCR in residents with symptoms of a respiratory tract infection.


RESULTS
Twenty-two of 52 residents developed symptoms of a respiratory tract infection between January 29, 2008, and February 26, 2008. RSV was detected using RT-PCR in seven (32%) of the 22 cases. None of the seven cases had positive RSV rapid antigen testing, and only two had positive culture or DFA results. This outbreak occurred during a time when state wide RSV rates were rapidly declining. One patient was admitted to the hospital during the infection and subsequently died.


CONCLUSIONS
RSV may cause outbreaks in LTCFs that traditional diagnostic methods do not detect. RT-PCR can provide a more timely and accurate diagnosis of outbreaks, which allows for early symptomatic treatment, rational use of antibiotics, and improved infection control.
Caram
L Brett
LB
Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. caram001@mc.duke.edu
Chen
Jodi
J
Taggart
E William
EW
Hillyard
David R
DR
She
Rosemary
R
Polage
Christopher R
CR
Twersky
Jack
J
Schmader
Kenneth
K
Petti
Cathy A
CA
Woods
Christopher W
CW
D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D005160:Facility Design and Construction; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009735:Nursing Homes; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000235:genetics / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors