Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 10, Issue 1, Pages 58-64Publisher
CARDEN JENNINGS PUBL CO LTD
DOI: 10.1016/j.bbmt.2003.09.010
Keywords
parainfluenza; stem cell transplantation; nosocomial transmission
Categories
Funding
- NCI NIH HHS [CA 18029, CA 15704] Funding Source: Medline
- NIAID NIH HHS [K23 AI 01839] Funding Source: Medline
- NATIONAL CANCER INSTITUTE [P30CA015704, P01CA018029] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [K23AI001839] Funding Source: NIH RePORTER
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Human parainfluenza virus type 3 (hPIV3) infections cause considerable morbidity and mortality after stem cell transplantation, and inpatient nosocomial outbreaks are common. From September 1998 to July 1999, 93 stem cell transplantation recipients at our institution contracted hPIV3, of which 66 (71%) were being followed up in our outpatient department (OPD). The peak incidence was in September and October, when 39 cases were identified; thereafter, hPIV3 incidence decreased to approximately 5 cases per month. Nucleotide sequences (778 nucleotides from variable regions of the hemagglutinin-neuraminidase gene) from 46 patient and 8 community hPIV3 isolates were compared to determine epidemiologic relatedness. Sequence analysis of OPD isolates revealed that 18 of 19 isolates from September and October and 11 of 15 isolates from November 1998 to July 1999 were genetically similar. In contrast, 2 of 3 community isolates from September and October and 0 of 5 from November to July were linked to this cluster. Symptomatic surveillance and isolation were ineffective in terminating the outbreak, suggesting asymptomatic shedding among patients, staff, or visitors or viral persistence on environmental surfaces as possible explanations. The concept of nosocomial transmission should be expanded to include the OPD for immunosuppressed patients. (C) 2004 American Society for Blood and Marrow Transplantation.
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