Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany.
J Clin Microbiol. 2013 Jan;51(1):155-62. doi: 10.1128/JCM.02151-12. Epub 2012 Oct 24.
In 2011 and 2012, a large outbreak of respiratory syncytial virus (RSV) infections affecting 57 laboratory-confirmed patients occurred in an adult hematology unit in Heidelberg, Germany. During the outbreak investigation, we performed molecular genotyping of RSV strains to differentiate between single versus multiple introductions of the virus into the unit. Furthermore, we assessed the time of viral shedding of consecutive samples from the patients in order to better understand the possible impact of prolonged shedding for outbreak control management. We used subtype-specific reverse transcription-PCR on nasopharyngeal and bronchoalveolar specimens for routine diagnostics and for measuring the viral shedding period. Samples of 47 RSV-infected patients involved in the outbreak were genotyped by sequence analysis and compared to samples from RSV-infected hospitalized children representing the timing of the annual RSV epidemic in the community. Molecular investigation of the virus strains from clinical samples revealed a unique cluster with identical nucleotide sequences of RSV type A (RSV A outbreak strain) for 41 patients, while 3 patients were infected with different RSV A (nonoutbreak) strains and three other patients with RSV type B. Outbreak strains were identified in samples from November 2011 until January 2012, while nonoutbreak strains were from samples coinciding with the community epidemic in February and March 2012. Median duration of viral shedding time was 24.5 days (range, 1 to 168 days) with no difference between outbreak and nonoutbreak strains (P = 0.45). Our investigation suggests a single introduction of the RSV A outbreak strain into the unit that spread among the immunocompromised patients. Prolonged viral shedding may have contributed to nosocomial transmission and should be taken into account in the infection control management of RSV outbreaks in settings with heavily immunosuppressed patients.
2011 年和 2012 年，德国海德堡的一个成人血液科病房发生了一起大规模呼吸道合胞病毒（RSV）感染疫情，涉及 57 例实验室确诊病例。在疫情调查期间，我们对 RSV 株进行了分子基因分型，以区分病毒是否单一或多次传入病房。此外，我们评估了患者连续样本的病毒脱落时间，以便更好地了解病毒脱落时间延长对疫情控制管理的可能影响。我们使用针对 RSV 亚型的逆转录-PCR 对鼻咽和支气管肺泡标本进行常规诊断和病毒脱落期检测。对 47 名感染 RSV 的参与疫情的患者样本进行基因分型，通过序列分析，并与在社区年度 RSV 流行期间感染住院的儿童的 RSV 样本进行比较。对临床样本中病毒株的分子调查显示，41 例患者的 RSV A 型（RSV A 爆发株）具有相同的核苷酸序列，3 例患者感染了不同的 RSV A（非爆发株）株，另外 3 例患者感染了 RSV B 型。爆发株于 2011 年 11 月至 2012 年 1 月在样本中被发现，而非爆发株则于 2012 年 2 月和 3 月与社区流行时间一致。病毒脱落时间的中位数为 24.5 天（范围，1 至 168 天），爆发株和非爆发株之间无差异（P=0.45）。我们的调查表明，该病房中 RSV A 爆发株单一传入，并在免疫功能低下的患者中传播。病毒脱落时间延长可能有助于医院内传播，在免疫抑制患者密集的环境中，应在 RSV 疫情的感染控制管理中加以考虑。
