title: The clinical and phylogenetic investigation for a nosocomial outbreak of respiratory syncytial virus infection in an adult hemato-oncology unit.
abstract: Although many reports have already shown RSV outbreaks among hemato-oncology patients, genomic studies detecting similar RSV strains prior to an outbreak in the hospital are rare. In 2014, the University of the Ryukyus hospital hemato-oncology unit experienced, and successfully managed, a respiratory syncytial virus (RSV) nosocomial outbreak. During the outbreak investigation, genotyping and phylogenetic analysis was used to identify a potential source for the outbreak. Nasopharyngeal swabs were tested for RSV using three tests: (1) rapid antigen test (RAT); (2) reverse transcriptase polymerase chain reaction (PCR); or (3) quantitative PCR (RT-qPCR); a positive PCR reaction was considered a confirmed case of RSV. Phylogenetic analysis of the G protein was performed for outbreak and reference samples from non-outbreak periods of the same year. In total, 12 confirmed cases were identified, including 8 hemato-oncology patients. Patient samples were collected weekly, until all confirmed RSV cases returned RSV negative test results. Median time of suspected viral shedding was 16 days (n = 5, range: 8-37 days). Sensitivity and specificity of the RAT compared with RT-qPCR were 30% and 91% (n = 42). Phylogenetic analysis revealed nine genetically identical strains; eight occurring during the outbreak time period and one strain was detected 1 month prior. A genetically similar RSV detected 1 month before is considered one potential source of this outbreak. As such, healthcare providers should always enforce standard precautions, especially in the hemato-oncology unit.
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.|Infection Control Team, University of the Ryukyus Hospital, Okinawa, Japan.
authors.forename: Daijiro
authors.identifier: 0000-0001-5566-7310
authors.initials: D
authors.lastname: Nabeya
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Takeshi
authors.identifier: 0000-0002-0262-0401
authors.initials: T
authors.lastname: Kinjo
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Gretchen Lynn
authors.initials: GL
authors.lastname: Parrott
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Uehara
authors.affiliation: Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Motooka
authors.affiliation: Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Saifun
authors.initials: S
authors.lastname: Nahar
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Sawako
authors.initials: S
authors.lastname: Nakachi
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.|Infection Control Team, University of the Ryukyus Hospital, Okinawa, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakamatsu
authors.affiliation: Infection Control Team, University of the Ryukyus Hospital, Okinawa, Japan.
authors.forename: Sakuko
authors.initials: S
authors.lastname: Maeshiro
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Shusaku
authors.initials: S
authors.lastname: Haranaga
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.|Infection Control Team, University of the Ryukyus Hospital, Okinawa, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Tateyama
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Tomoyose
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Masuzaki
authors.affiliation: Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Horii
authors.affiliation: Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.|Infection Control Team, University of the Ryukyus Hospital, Okinawa, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujita
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D060005:Genotyping Techniques; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009305:Nasopharynx / Q000821:virology; D016133:Polymerase Chain Reaction; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology*; D012136:Respiratory Syncytial Viruses / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies; D013997:Time Factors; D017201:Virus Shedding; D055815:Young Adult
keywords: hemato-oncology patient; outbreak; phylogenetic analysis; rapid antigen test; respiratory syncytial virus; viral shedding