Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil.
Santa Casa de São Paulo, Unidade de Infectologia Pediátrica, São Paulo, SP, Brazil.
J Pediatr (Rio J). 2020 Mar-Apr;96(2):233-239. doi: 10.1016/j.jped.2018.10.014. Epub 2018 Dec 12.
Respiratory syncytial virus is a pathogen frequently involved in nosocomial outbreaks. Although several studies have reported nosocomial outbreaks in neonatal intensive care units, molecular epidemiology data are scarce. Here, the authors describe two consecutive respiratory syncytial virus outbreaks caused by genotypes ON-1 and NA-2 in a neonatal intensive care unit in São Paulo, Brazil.
A prospective search for respiratory syncytial virus was performed after diagnosing the index case and four other symptomatic newborns in the neonatal intensive care unit. Nasopharyngeal aspirate samples of all patients in the neonatal intensive care unit were tested for 17 respiratory viruses using real-time reverse transcriptase polymerase chain reaction. Genotyping was performed using nucleotide sequencing.
From May to August 2013, two different outbreaks were detected in the neonatal intensive care unit. A total of 20 infants were infected with respiratory syncytial virus-A (ten and 14 with ON-1 and NA-2 genotypes, respectively). The mean age of the infants was 10 days, mean birth weight was 1,961g, and the mean gestational age was 33 weeks. Risk factors (heart disease, lung disease, and prematurity) were present in 80% and 85.7% of infants in the ON-1 and NA-2 groups, respectively. In total, 45.8% of infants were asymptomatic and 20.8% required mechanical ventilation. Coinfections were not detected during the outbreaks.
Infants in a neonatal intensive care unit who develop abrupt respiratory symptoms should be tested for respiratory viruses, especially respiratory syncytial virus. Even in the absence of severe symptoms, respiratory syncytial virus detection can prevent nosocomial transmission through infection control measures. A better understanding of respiratory syncytial virus molecular epidemiology is essential for developing new vaccines and antiviral drugs against respiratory syncytial virus.
呼吸道合胞病毒是一种常引起医院感染暴发的病原体。虽然有几项研究报告了新生儿重症监护病房（NICU）的医院感染暴发，但有关其分子流行病学的数据却很少。在这里，作者描述了巴西圣保罗的一家 NICU 中由 ON-1 和 NA-2 基因型引起的两起连续呼吸道合胞病毒暴发。
在 NICU 中诊断出首例病例和另外 4 例有症状的新生儿后，进行了呼吸道合胞病毒的前瞻性搜索。使用实时逆转录聚合酶链反应（RT-PCR）对 NICU 中所有患者的鼻咽抽吸物样本进行了 17 种呼吸道病毒的检测。通过核苷酸测序进行基因分型。
2013 年 5 月至 8 月，NICU 中检测到两起不同的暴发。共有 20 名婴儿感染了呼吸道合胞病毒-A（分别有 10 名和 14 名婴儿感染了 ON-1 和 NA-2 基因型）。婴儿的平均年龄为 10 天，平均出生体重为 1961g，平均胎龄为 33 周。ON-1 和 NA-2 组中分别有 80%和 85.7%的婴儿存在心脏疾病、肺部疾病和早产等危险因素。共有 45.8%的婴儿无症状，20.8%的婴儿需要机械通气。暴发期间未检测到合并感染。
出现急性呼吸症状的 NICU 婴儿应进行呼吸道病毒检测，尤其是呼吸道合胞病毒检测。即使没有严重症状，呼吸道合胞病毒的检测也可以通过感染控制措施来预防医院内传播。更好地了解呼吸道合胞病毒的分子流行病学对于开发针对呼吸道合胞病毒的新疫苗和抗病毒药物至关重要。
