title: An outbreak of norovirus infection in a bone marrow transplant unit.
abstract: BACKGROUND
  Norovirus is a single-stranded RNA virus belonging to the Caliciviridae family.
  
  
  METHODS
  Our observational cohort study aimed to describe a nosocomial outbreak of norovirus on a bone marrow transplant (BMT) unit.
  
  
  RESULTS
  Six of 8 BMT patients with increased liquid stools tested positive for norovirus: 4 had new onset diarrhea; 2 had acute exacerbations of chronic diarrhea caused by graft versus host disease. Eight non-BMT inpatients had norovirus infection, but 7 of these were community acquired; cumulative incidence rates in BMT and non-BMT units were 26% and 0.16%, respectively. In BMT patients, diarrhea (increased or new onset) lasted 6 to 33 days-durations shorter than those reported in sporadic BMT cases. All patients had private rooms and bathrooms. Five of 6 patients were on the BMT unit during their presumed incubation periods. Three were in adjacent rooms. Three nurses and 1 physician had symptoms compatible with norovirus infection, and all 4 worked while ill. The outbreak ended coincident with implementation of stricter infection control practices.
  
  
  CONCLUSIONS
  Norovirus appeared to spread in a BMT unit more avidly than it did among general medical patients. Explanations include prolonged diarrhea and viral excretion, long hospital stays of infected patients, rarity of empiric contact isolation for diarrhea, routine handling of liquid stool, and a closed community of health care workers.
authors: Section of Infectious Diseases, Temple University School of Medicine, Philadelphia, PA 19104, USA.
authors: Manish
authors: M
authors: Doshi
authors: Simone
authors: S
authors: Woodwell
authors: Kimberly
authors: K
authors: Kelleher
authors: Kenneth
authors: K
authors: Mangan
authors: Peter
authors: P
authors: Axelrod
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D017250:Caliciviridae Infections / Q000453:epidemiology*; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029322:Norovirus / Q000302:isolation & purification*
keywords: Hematopoetic stem cell transplantation; Nosocomial