title: Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting.
abstract: OBJECTIVE We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting. METHODS Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing. RESULTS We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died. CONCLUSIONS This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses. Infect Control Hosp Epidemiol 2017;38:399-404.
authors.affiliation: 1Department of Medicine,Vanderbilt University School of Medicine,Nashville,Tennessee.
authors.forename: Steven Schaeffer
authors.initials: SS
authors.lastname: Spires
authors.affiliation: 1Department of Medicine,Vanderbilt University School of Medicine,Nashville,Tennessee.
authors.forename: H Keipp
authors.initials: HK
authors.lastname: Talbot
authors.affiliation: 3Division of Nursing,Tennessee Valley Healthcare Administration,Veterans Affairs,Nashville,Tennessee.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Pope
authors.affiliation: 1Department of Medicine,Vanderbilt University School of Medicine,Nashville,Tennessee.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
mesh_terms: D000369:Aged, 80 and over; D003704:Dementia / Q000451:nursing; D004196:Disease Outbreaks; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008134:Long-Term Care; D029121:Metapneumovirus; D009735:Nursing Homes; D018184:Paramyxoviridae Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D012136:Respiratory Syncytial Viruses