Adenovirus Type 7 Outbreak in a Pediatric Chronic-Care
Facility -- Pennsylvania, 1982
In July 1982, an outbreak of respiratory disease caused by
adenovirus type 7 (Ad 7) occurred in a chronic-care facility in a
pediatric hospital in Pennsylvania. On June 6, a physician, the
presumed index case, developed injected conjunctiva; 2 days later,
conjunctivitis; and on June 12, an acute upper respiratory-tract
illness ((URI) coryza and/or pharyngitis). Between June 15 and
July
9, four of the 14 children in the facility became ill with an acute
respiratory illness characterized by either URI or lower
respiratory-tract illness ((LRI) fever and respiratory distress).
These four, and three other asymptomatic children, were
culture-positive for Ad 7 (Table 2). Three of the four ill
children
had LRI and required mechanical ventilation; one with congenital
heart
disease and one with bronchopulmonary dysplasia died. In addition,
three of the other 35 staff members (physicians, nurses, and play
therapists) developed acute URI, and Ad 7 was isolated from
cultures
from two of them.
The chronic-care facility has a nurses' station, treatment
room,
playroom, and three patient rooms--with four, six, and seven beds,
respectively. All 14 children remained in the facility throughout
the
outbreak. Culture-positive children resided in two of the three
rooms.
The index case had contact with all 14 children on June 6-7 and
from June 14 on. Both culture-positive staff members had contact
with the first ill child as early as June 15. Ultimately, one of
these staff members had contact with all seven culture-positive and
three of seven culture-negative children. The other had contact
with
three culture-positive children and one culture-negative child.
When
these staff members became ill, they were excluded from patient
contact. When the extent of the outbreak was recognized on June
22,
children culture-positive for Ad 7 were moved into one room, and
staff
members with acute respiratory illness were excluded from contact
with
the children.
Reported by MA Fee, MD, E Charney, MD, SA Plotkin, MD, HM Friedman,
MD, P Pershing, A O'Hara, C Forrer, Children's Hospital of
Philadelphia; Hospital Infections Program, Div of Viral Diseases,
Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: This outbreak serves as a reminder of the risks of
Ad
7 nosocomial infections. Of all the adenovirus types, types 7, 3,
and
21 are most likely to cause serious respiratory disease,
particularly
in young children (1-3). Adenovirus outbreaks among infants and
children have been reported from a variety of closed communities,
including hospitals and children's homes (4-6). Significant
mortality
and long-term morbidity are sometimes associated with these
infections, especially among infants and immunocompromised children
(1-6). In this report, the fatalities may have been related to
underlying cardiac and respiratory disease. Other respiratory
viruses
can also cause serious nosocomial disease resulting in significant
morbidity, prolonged hospitalization, and death (7). Respiratory
syncytial virus (RSV) is a particularly serious and frequent
nosocomial pathogen among infants and young children (7,8).
Viral infections are increasingly recognized as important
nosocomial problems, and guidelines for their prevention and
control
are being developed (7). Prevention and control of respiratory
viruses as nosocomial pathogens are particularly difficult. These
viruses are epidemic in the community during the fall, winter, and
spring, and illness caused by the serious nosocomial pathogens,
e.g.
RSV and Ad 7, is often indistinguishable from that caused by less
serious nosocomial pathogens, e.g. rhinoviruses. They can infect
staff and patients alike, and in some instances, virus can be shed
for
long periods of time.
Because of the seriousness of some nosocomial viral respiratory
infections, some authorities recommend isolation and other
infection-control measures for infants and children hospitalized
with
symptoms of viral respiratory-tract infections (8). The
"Guidelines
for Prevention of Nosocomial Pneumonia" recommends that personnel
with
URI not be assigned to the direct care of high-risk patients, such
as
neonates and young children (9).
References
Wright HT Jr, Beckwith JB, Gwinn JL. A fatal case of inclusion
body pneumonia in an infant infected with adenovirus type 3. J
Pediatr 1964;64:528-33.
Simila S, Ylikorkala O, Wasz-Hockert O. Type 7 adenovirus
pneumonia. J Pediatr 1971;79:605-11.
Lang WR, Howden CW, Laws J, Burton JF. Bronchopneumonia with
serious sequelae in children with evidence of adenovirus type
21
infection. Brit Med J 1969;1:73-9.
Harris DJ, Wulff H, Ray CG, Poland JD, Chin TD, Wenner HA.
Viruses and disease: III. An outbreak of adenovirus type 7A
in a
children's home. Am J Epidemiol 1971;93:399-402.
Chany C, Lepine P, Lelong M, Le-Tan-Vanh, Satge P, Virat J.
Severe and fatal pneumonia in infants and young children
associated with adenovirus infections. Am J Hyg
1958;67:367-78.
Herbert FA, Wilkinson D, Burchak E, Morgante O. Adenovirus
type 3
pneumonia causing lung damage in childhood. Can Med Assoc J
1977;116:274-6.
Valenti WM, Menegus MA, Hall CB, Pincus PH, Douglas RG Jr.
Nosocomial viral infections: 1. Epidemiology and
significance.
Infect Control 1980;1:33-47.
Hall CB. Nosocomial viral respiratory infections: perennial
weeds
on pediatric wards. Am J Med 1981;70:670-6.
Simmons BP, Wong ES. Guidelines for prevention of nosocomial
pneumonia. Infect Control 1982;3;327-33.
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