Controlling a human parainfluenza virus-3 outbreak in a haematology ward in a tertiary hospital: the importance of screening strategy and molecular diagnostics in relation to clinical symptoms

Zsófia Iglói, Inge H M van Loo, Astrid M P Demandt, Karen Franssen, Marcel Jonges, Michel van Gelder, Sandra Erkens-Hulshof, Lieke B van Alphen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Human parainfluenza 3 (HPIV-3) outbreak at the haemato-oncology ward of the Maastricht University Medical Center in the summer of 2016.

AIM: To describe an effective strategy to control the largest reported HPIV-3 outbreak at an adult haematology-oncology ward in the Netherlands by implementing infection control measures and molecular epidemiology investigation.

METHODS: Clinical, patient and diagnostic data were both pro- and retrospectively collected. HPIV-3 real-time-PCR (HPIV-3 RT-PCR) was validated using oropharyngeal rinse samples. Screening of all new and admitted patients was implemented to identify asymptomatic infection or prolonged shedding of HPIV-3 allowing cohort isolation.

FINDINGS: The HPIV-3 outbreak occurred between 9 July and 28 September 2016 and affected 53 patients. HPIV-3 RT-PCR on oropharyngeal rinse samples demonstrated an up to tenfold higher sensitivity compared to pharyngeal swabs. Monitoring showed that at first positive PCR, 20 patients (38%) were asymptomatic (of which 11 remained asymptomatic) and the average duration of shedding was 14 days (range 1-58). Asymptomatic patients had lower viral load, shorter period of viral shedding (≤14 days) and were mostly immune competent oncology patients. The outbreak was under control 5 weeks after implementation of screening of asymptomatic patients.

CONCLUSION: Implementation of a sensitive screening method identified both symptomatic and asymptomatic patients which had lower viral load and allowed early cohort isolation. This is especially important in a ward that combines patients with varying immune status, since both immunocompromised and immune competent patients are likely to spread the HPIV-3 virus, either through prolonged shedding or through asymptomatic course of disease.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalJournal of Hospital Infection
Volume126
Early online date25 Apr 2022
DOIs
Publication statusPublished - Aug 2022

Keywords

  • CELL TRANSPLANT RECIPIENTS
  • CROATIA
  • EPIDEMIOLOGY
  • Haematology
  • Human parainfluenza 3
  • INFECTION
  • NOSOCOMIAL OUTBREAK
  • Nosocomial infections
  • Outbreak
  • REAL-TIME PCR
  • RESPIRATORY-SYNCYTIAL-VIRUS
  • TYPE-3
  • The Netherlands

Cite this