title: Nosocomial transmission of respiratory syncytial virus in an outpatient cancer center.
abstract: Respiratory syncytial virus (RSV) outbreaks in inpatient settings are associated with poor outcomes in cancer patients. The use of molecular epidemiology to document RSV transmission in the outpatient setting has not been well described. We performed a retrospective cohort study of 2 nosocomial outbreaks of RSV at the Seattle Cancer Care Alliance. Subjects included patients seen at the Seattle Cancer Care Alliance with RSV detected in 2 outbreaks in 2007-2008 and 2012 and all employees with respiratory viruses detected in the 2007-2008 outbreak. A subset of samples was sequenced using semi-nested PCR targeting the RSV attachment glycoprotein coding region. Fifty-one cases of RSV were identified in 2007-2008. Clustering of identical viral strains was detected in 10 of 15 patients (67%) with RSV sequenced from 2007 to 2008. As part of a multimodal infection control strategy implemented as a response to the outbreak, symptomatic employees had nasal washes collected. Of 254 employee samples, 91 (34%) tested positive for a respiratory virus, including 14 with RSV. In another RSV outbreak in 2012, 24 cases of RSV were identified; 9 of 10 patients (90%) had the same viral strain, and 1 (10%) had another viral strain. We document spread of clonal strains within an outpatient cancer care setting. Infection control interventions should be implemented in outpatient, as well as inpatient, settings to reduce person-to-person transmission and limit progression of RSV outbreaks.
authors.affiliation: Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington. Electronic address: helenchu@uw.edu.
authors.forename: Helen Y
authors.initials: HY
authors.lastname: Chu
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, Section of Infectious Diseases, Seattle Children's Hospital, University of Washington, Seattle, Washington.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
authors.affiliation: Infection Control and Prevention Program, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Sara
authors.initials: S
authors.lastname: Podczervinski
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, Section of Infectious Diseases, Seattle Children's Hospital, University of Washington, Seattle, Washington.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Campbell
authors.affiliation: Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.affiliation: Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Infection Control and Prevention Program, Seattle Cancer Care Alliance, Seattle, Washington; Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Pergam
authors.affiliation: Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Infection Control and Prevention Program, Seattle Cancer Care Alliance, Seattle, Washington; Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission* / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D017053:Infection Control; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control / Q000706:statistics & numerical data; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009369:Neoplasms / Q000453:epidemiology / Q000821:virology*; D010045:Outpatients; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000235:genetics / Q000302:isolation & purification*; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: Health care worker; Infection control; Molecular epidemiology; Outpatient clinic; Respiratory syncytial virus