title: Control of norovirus outbreak on a pediatric oncology unit.
abstract: BACKGROUND
  Patients undergoing treatment for cancer with chemotherapy and hematopoietic stem cell recipients are at risk for severe morbidity caused by norovirus (NV).
  
  
  METHODS
  We describe a NV outbreak on the Memorial Sloan Kettering Cancer Center's pediatric oncology unit. Stool testing for diagnosis of NV was performed by real-time polymerase chain reaction (PCR).
  
  
  RESULTS
  Twelve NV cases occurred; 7 were hospital acquired. Twenty-five health care workers reported NV compatible illness. Patient-to-patient transmission occurred once. The practices of the Centers for Disease Control and Prevention were supplemented with electronic surveillance, surrogate screening for NV, and heightened cleaning. Two additional cases occurred after implementation of interventions. Long-term shedding was detected in 2 patients.
  
  
  CONCLUSIONS
  We describe interventions for controlling NV on a pediatric oncology unit. High-risk chronic shedders pose ongoing transmission risks. PCR is a valuable diagnostic tool but may be overly sensitive. Surrogate markers to assess NV burden in stool and studies on NV screening are needed to develop guidelines for high-risk chronic shedders.
authors.affiliation: Infection Control Program and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: anna.e.dow@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Sheahan
authors.affiliation: Infection Control Program and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Copeland
authors.affiliation: Infection Control Program and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Lauren
authors.initials: L
authors.lastname: Richardson
authors.affiliation: Department of Pediatric Nursing, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Shelley
authors.initials: S
authors.lastname: McKay
authors.affiliation: Pediatric Oncology and Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Alexander
authors.initials: A
authors.lastname: Chou
authors.affiliation: Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: N Esther
authors.initials: NE
authors.lastname: Babady
authors.affiliation: Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Tang
authors.affiliation: Pediatric Oncology and Bone Marrow Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Farid
authors.initials: F
authors.lastname: Boulad
authors.affiliation: Infection Control Program and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Janet
authors.initials: J
authors.lastname: Eagan
authors.affiliation: Infection Control Program and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Kent
authors.initials: K
authors.lastname: Sepkowitz
authors.affiliation: Infection Control Program and Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Mini
authors.initials: M
authors.lastname: Kamboj
mesh_terms: D000293:Adolescent; D000328:Adult; D017250:Caliciviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005243:Feces / Q000821:virology; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods*; D008297:Male; D025202:Molecular Diagnostic Techniques; D029322:Norovirus / Q000302:isolation & purification*; D016522:Oncology Service, Hospital; D060888:Real-Time Polymerase Chain Reaction
keywords: Immunocompromised; Molecular diagnostics; Norovirus; Outbreak; Pediatric