title: Co-circulation of multiple genotypes of human rhinovirus during a large outbreak of respiratory illness in a veterans' long-term care home.
abstract: BACKGROUND
  Human rhinoviruses (HRVs) are a well-recognized cause of long-term care home (LTCH) outbreaks of respiratory illness. However, there are limited data on the molecular epidemiology of the HRV types involved.
  
  
  OBJECTIVE
  To determine whether a large respiratory outbreak in a LTCH was caused by a single type of HRV, and to describe the clinical impact of the outbreak.
  
  
  METHODS
  Nasopharyngeal swabs were collected from residents with one or more of the following: fever, cough, rhinitis, or congestion. Specimens were interrogated by multiplex PCR using the ResPlex II assay. Samples positive for HRV were then submitted for genotyping by partial sequence analysis of the 5' untranslated (UTR) and viral protein (VP) 1 capsid regions.
  
  
  RESULTS
  Of 71 screened, 56 residents were positive for a HRV during an outbreak that lasted 5.5 weeks; 27 healthcare workers also had respiratory symptoms. Three residents were transferred to hospital and 2 died. Seven units in two wings of the LTCH were affected, resulting in 3152.5 resident unit closure days. Three different HRV genotypes were identified, although HRV-A1 dominated.
  
  
  CONCLUSIONS
  This large outbreak of HRVs among residents and healthcare workers in a LTCH was associated with substantial resident and staff morbidity as well as significant unit closures. Multiple types of HRV were implicated but an HRV-A1 type dominated, warranting further investigation into viral determinants for virulence and transmission.
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite B103, Toronto, ON M4N 3M5, Canada. Electronic address: samira.mubareka@sunnybrook.ca.
authors.forename: Samira
authors.initials: S
authors.lastname: Mubareka
authors.forename: Lisa
authors.initials: L
authors.lastname: Louie
authors.forename: Henry
authors.initials: H
authors.lastname: Wong
authors.forename: Andrea
authors.initials: A
authors.lastname: Granados
authors.forename: Sylvia
authors.initials: S
authors.lastname: Chong
authors.forename: Kathy
authors.initials: K
authors.lastname: Luinstra
authors.forename: Astrid
authors.initials: A
authors.lastname: Petrich
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
authors.forename: Mary
authors.initials: M
authors.lastname: Vearncombe
authors.forename: James
authors.initials: J
authors.lastname: Mahony
authors.forename: Andrew
authors.initials: A
authors.lastname: Simor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060085:Coinfection / Q000453:epidemiology / Q000821:virology*; D003428:Cross Infection / Q000453:epidemiology / Q000821:virology*; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D009305:Nasopharynx / Q000821:virology; D010850:Picornaviridae Infections / Q000453:epidemiology / Q000821:virology*; D012367:RNA, Viral / Q000235:genetics; D012229:Rhinovirus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D017422:Sequence Analysis, DNA; D014728:Veterans
chemical_list: D012367:RNA, Viral
keywords: Genotyping; Human rhinovirus; Long-term care; Outbreak
references.citation: Can J Public Health. 1995 Mar-Apr;86(2):120-3
references.pmid: 7757890
references.citation: Emerg Infect Dis. 2009 May;15(5):719-26
references.pmid: 19402957
references.citation: Am J Epidemiol. 1982 Nov;116(5):828-33
references.pmid: 6293304
references.citation: Proc Natl Acad Sci U S A. 1994 Mar 1;91(5):1839-42
references.pmid: 8127891
references.citation: J Am Geriatr Soc. 2006 Feb;54(2):284-9
references.pmid: 16460380
references.citation: J Clin Microbiol. 2008 Nov;46(11):3736-45
references.pmid: 18753359
references.citation: Diagn Microbiol Infect Dis. 2012 Dec;74(4):384-7
references.pmid: 23017257
references.citation: Curr Opin Pediatr. 2008 Feb;20(1):67-71
references.pmid: 18197042
references.citation: J Virol. 2010 Oct;84(19):10297-310
references.pmid: 20668080
references.citation: J Clin Virol. 2012 Feb;53(2):171-3
references.pmid: 22078146
references.citation: Thorax. 2009 May;64(5):399-404
references.pmid: 19174425
references.citation: Epidemiol Rev. 1988;10:243-58
references.pmid: 2852117
references.citation: Eur J Epidemiol. 1987 Dec;3(4):327-35
references.pmid: 2446913
references.citation: Am J Respir Crit Care Med. 2012 Feb 1;185(3):281-5
references.pmid: 21960534
references.citation: PLoS One. 2010 May 11;5(5):e10588
references.pmid: 20485673
references.citation: Am J Respir Crit Care Med. 2012 Nov 1;186(9):886-91
references.pmid: 22923659
references.citation: J Infect Dis. 2008 Feb 1;197(3):382-9
references.pmid: 18248302
references.citation: J Clin Microbiol. 2009 Apr;47(4):1278-80
references.pmid: 19339481
references.citation: CMAJ. 2000 Apr 18;162(8):1133-7
references.pmid: 10789627
references.citation: J Clin Virol. 2013 Jan;56(1):41-5
references.pmid: 23078869
references.citation: Ann Intern Med. 1978 Apr;88(4):463-7
references.pmid: 205151
references.citation: J Gen Virol. 2013 Aug;94(Pt 8):1791-1806
references.pmid: 23677786
references.citation: J Clin Virol. 2010 Oct;49(2):94-9
references.pmid: 20728404
references.citation: Proc Natl Acad Sci U S A. 1989 Jul;86(13):4907-11
references.pmid: 2544880
references.citation: J Clin Virol. 2013 Aug;57(4):291-9
references.pmid: 23714395
references.citation: Am J Respir Crit Care Med. 2012 Aug 15;186(4):325-32
references.pmid: 22700859
references.citation: Virology. 1991 Feb;180(2):814-7
references.pmid: 1846502
references.citation: Clin Infect Dis. 2005 Jul 15;41(2):262-5
references.pmid: 15983926
references.citation: J Am Geriatr Soc. 2010 Oct;58(10):2036-8
references.pmid: 20929481
references.citation: J Infect Dis. 2011 Dec 1;204(11):1702-10
references.pmid: 22013207
references.citation: Respirology. 2007 Jan;12(1):100-3
references.pmid: 17207033
references.citation: Emerg Infect Dis. 2012 Nov;18(11):1886-8
references.pmid: 23092635
references.citation: Nat Rev Microbiol. 2012 Jul 16;10(8):583-8
references.pmid: 22796885
references.citation: Science. 2009 Apr 3;324(5923):55-9
references.pmid: 19213880
references.citation: J Virol. 1990 Mar;64(3):1117-23
references.pmid: 2154596
references.citation: Rev Med Virol. 2010 May;20(3):156-76
references.pmid: 20127751
references.citation: Chest. 2008 Dec;134(6):1141-1148
references.pmid: 18689592
references.citation: J Infect Dis. 1987 Sep;156(3):442-8
references.pmid: 3039011
references.citation: Clin Infect Dis. 2007 May 1;44(9):1152-8
references.pmid: 17407031
references.citation: Emerg Infect Dis. 2010 Sep;16(9):1463-5
references.pmid: 20735934
references.citation: J Clin Virol. 2007 Mar;38(3):227-37
references.pmid: 17276135
references.citation: J Pediatr. 1982 May;100(5):722-6
references.pmid: 6279812
references.citation: Influenza Other Respir Viruses. 2012 May;6(3):e11-5
references.pmid: 22353417