近十年国外有关NICU病毒感染暴发的文献报道

David

J Pediatr. 2008 Sep;153(3):339-44. Epub 2008 Jun 5. Links
Outbreak of necrotizing enterocolitis caused by norovirus in a neonatal intensive care unit.
NICU内诺如病毒引起的坏死性小肠结肠炎暴发感染
Turcios-Ruiz RM, Axelrod P, St John K, Bullitt E, Donahue J, Robinson N, Friss HE.
Section of Infectious Diseases, Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA.

OBJECTIVES: To investigate an outbreak of necrotizing enterocolitis (NEC) in a neonatal intensive care unit (NICU) and to identify the etiology, describe illness risk factors, and develop control measures. STUDY DESIGN: A retrospective case-control study was performed including newborns with NEC and newborns without NEC, examining demographic factors and exposures to medications, staff members, and procedures before illness. Stool samples from affected newborns were collected and tested for bacteria, parasites, and viruses. RESULTS: We confirmed a NEC outbreak in the NICU in January 1998 with 8 cases, including 2 deaths, clustered in time and space. Norovirus-like particles were identified in all available stools from cases; norovirus (NoV) was confirmed with reverse transcriptase polymerase chain reaction in 4 of 6 samples. NEC cases were younger, had lower Apgar scores, and received antibiotics longer than 25 control subjects. Three NICU health care personnel had more contact with cases than control subjects; 1 staff member recalled having gastroenteritis symptoms around the time of the outbreak. CONCLUSIONS: This report associates NoV with NEC. NoV appeared to precipitate NEC in predisposed infants. Spatial clustering and epidemiologic links between cases and a health care worker with gastroenteritis suggests that NoV should be investigated among the etiologies of NEC outbreaks and that interventions targeted to interruption of NoV transmission should be considered.

abbr_72979903dd419a1c90220826bf62edab.pdf (187.84 KB, 下载次数: 28)

2008-10-1 13:35 上传

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David

ur J Pediatr. 2008 Mar 12. [Epub ahead of print] Links
Outbreaks of human coronavirus in a paediatric and neonatal intensive care unit.
NICU内人类冠状病毒暴发感染
Gagneur A, Vallet S, Talbot PJ, Legrand-Quillien MC, Picard B, Payan C, Sizun J.
Department of Paediatrics, EA 3882 Laboratory of Biodiversity and Microbial Ecology, University Hospital, Brest, France, arnaud.gagneur@chu-brest.fr.
Human coronavirus 229E (HCoV) has been recently recognized as a potential agent of nosocomial viral respiratory infections (NRVI) in high-risk infants. We have confirmed this as fact through the study of a 1-year period of HCoV outbreaks occurring during a prospective survey of NRVI in a paediatric and neonatal intensive care unit (PNICU) using new molecular techniques for HCoV detection. Nasal samples obtained at admission and weekly thereafter for all hospitalised children, as well as monthly nasal samples from staff, were analysed using immunofluorescence for respiratory syncitial virus (RSV), influenza viruses A and B, paramyxoviruses 1, 2, 3 and adenoviruses. RT-PCR was used for HCoV detection. During the year 1998, 43 HCoV-related NRVI were detected in 152 neonates (incidence 28.3%), and 7 HCoV-related NRVI were found in 92 children (incidence 7.6%). Three HCoV-related outbreaks were observed (February, August and December), associated with a high prevalence of HCoV infection in the staff. During the August outbreak, 50% to 78% of hospitalised neonates and children were infected. Seventy-five percent of hospitalised preterm neonates with a gestational age less than 32 weeks and 52.4% of staff members were infected. Risk factors for NRVI in neonates were birth weight, gestational age, ventilation, oxygenation and hospitalisation length. Ninety-two percent of infected preterm neonates were symptomatic, mainly with bradycardia and respiratory worsening. These data provide additional evidence for a possibly significant role of HCoV in NRVI in a PNICU. The role of staff or hospitalised children in spreading HCoV is hypothesised.



Outbreaks of human coronavirus in a paediatric and neonatal intensive care unit.pdf (156.04 KB, 下载次数: 19)

2008-10-1 13:38 上传

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David

ur J Pediatr. 2008 May;167(5):587-9. Epub 2007 Jun 26. Links
An echovirus type 18 outbreak in a neonatal intensive care unit.
NICU内肠道埃可病毒18型暴发感染
Kusuhara K, Saito M, Sasaki Y, Hikino S, Taguchi T, Suita S, Hayashi J, Wakatsuki K, Hara T.
We describe an outbreak of echovirus type 18 infection involving 20 neonatal intensive care unit (NICU) patients and the results of virological investigations are presented. RT-PCR demonstrated a widespread transmission of the virus in NICU patients during the outbreak. Separation care and additional infection control measures seemed to be effective in preventing further spread of the virus.



An echovirus type 18 outbreak in a neonatal intensive care unit.pdf (65.63 KB, 下载次数: 8)

2008-10-1 13:42 上传

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David

ediatr Infect Dis J. 2005 Dec;24(12):1040-4. Links
Medical and economic impact of a respiratory syncytial virus outbreak in a neonatal intensive care unit.
NICU内呼吸道合胞病毒暴发感染
Halasa NB, Williams JV, Wilson GJ, Walsh WF, Schaffner W, Wright PF.
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232-2581, USA. natasha.halasa@vanderbilt.edu
BACKGROUND: Respiratory syncytial virus (RSV) causes frequent nosocomial outbreaks in general pediatric wards but is less commonly reported in neonatal intensive care units (NICUs). We investigated an outbreak of RSV infection in a NICU and its impact on health care delivery, outcomes and costs. METHODS: Retrospective chart review was performed after an RSV outbreak occurred in the NICU. A case was defined as an infant with a nasopharyngeal aspirate positive for RSV by viral culture. Nucleotide sequencing of the isolates was done to determine relatedness. Hospital bills for all RSV culture-positive infants were reviewed. RESULTS: Nine infants (mean age, 34 days; mean birth weight, 1757 g; and mean estimated gestational age 31 weeks and 5 days) were infected with RSV subgroup B during this outbreak. By nucleotide sequencing, the isolates were identical. Clinical manifestations included cough, congestion, increased oxygen requirement, apnea and respiratory failure. The 5 infants requiring intubation had a significantly lower mean birth weight (1301 g versus 2328 g, P = 0.027), mean estimated gestational age (28 weeks and 5 days versus 35 weeks and 2 days, P = 0.014) and mean weight at onset of symptoms (2093 g versus 2989 g, P = 0.049) than the 4 nonintubated infants. More than 1.15 million dollars in hospital charges were attributable to the outbreak. All infants survived. CONCLUSION: Infants in a NICU who develop cough, congestion or apnea should be tested for RSV and other common respiratory viruses during the winter respiratory season. Even in a closed NICU, nosocomial outbreaks of these viruses can occur and have a major effect on healthcare delivery, costs and outcomes.



abbr_6025bb9fee2c55d068536f2b4f92993b.pdf (202.9 KB, 下载次数: 10)

2008-10-1 13:46 上传

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David

Pediatr. 2005 Apr;146(4):523-7. Links
Comment in:
J Pediatr. 2005 Apr;146(4):447-8.
J Pediatr. 2005 Apr;146(4):A2.
Outbreak of adenovirus type 30 in a neonatal intensive care unit.
NICU内腺病毒30型暴发感染
Faden H, Wynn RJ, Campagna L, Ryan RM.
Department of Pediatrics, State University of New York at Buffalo, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA.
OBJECTIVES: To describe an outbreak of adenovirus, type 30, in a neonatal intensive care unit (NICU). STUDY DESIGN: This was a retrospective, observational study. RESULTS: An outbreak of adenovirus infection occurred in an NICU. It lasted 6 months and involved 21 of 333 (6.3%) infants. The introduction of infection control measures controlled the outbreak; however, premature discontinuation of the measures resulted in a second wave of cases. The virus caused pneumonia in 7 infants, conjunctivitis in 7 infants, pneumonia and conjunctivitis in 1 infant, and upper respiratory tract illness in 1 infant. Infection was asymptomatic in 5 infants. Six infants died. Death was associated with the presence of pneumonia ( P = .0001), administration of steroids ( P = .003), and mechanical ventilation ( P = .02). Investigation into the origin of the outbreak suggested that the virus may have been introduced and spread during ophthalmologic procedures. CONCLUSIONS: Adenovirus type 30 can cause severe disease among premature infants in an NICU. Infants with severe bronchopulmonary dysplasia requiring mechanical ventilation are more likely to have development of adenovirus pneumonia and die. Standard infection control measures are effective in controlling an outbreak. Ophthalmologic procedures continue to be a potential source of adenovirus outbreaks.



Outbreak of adenovirus type 30 in a neonatal intensive care unit .pdf (109.67 KB, 下载次数: 10)

2008-10-1 13:50 上传

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David

nfect Control Hosp Epidemiol. 2003 Jul;24(7):514-9. Links
An outbreak of epidemic keratoconjunctivtis in a pediatric unit due to adenovirus type 8.
NICU内腺病毒8型引起的角膜结膜炎感染暴发
Chaberny IE, Schnitzler P, Geiss HK, Wendt C.
Department of Medical Microbiology and Hygiene, Institute of Hygiene, University of Heidelberg, Germany.
OBJECTIVES: To investigate and control an outbreak of epidemic keratoconjunctivitis (EKC) occurring in a neonatal intensive care unit (NICU) and to determine signs specific for EKC in newborns. DESIGN: Outbreak investigation and case-control study. SETTING: NICU of a 1,600-bed university hospital in Heidelberg, Germany. PATIENTS: Case-patients were defined as individuals who had adenoviral antigen detected by ELISA or by PCR from conjunctival swabs or who had clinical signs of conjunctivitis. Twelve newborns from the NICU who had EKC between October and November 1998 were compared with 11 who had bacterial conjunctivitis. INTERVENTION: Control measures included cohorting patients in contact isolation, using gloves and gowns for patient care, and using a hand rub and disinfectants with virucidal activity. RESULTS: Thirteen patients, 6 healthcare and 11workers, relatives of the patients had EKC, according to our case definition. Case-patients were more likely than control-patients to develop lacrimal swelling (P < .001), eye redness (P = .004), and lacrimation (P = .037) involving both eyes (P = .002). Prior examination by an ophthalmologist was a significant risk factor for EKC (P = .004). For diagnosis or treatment of retinopathy, premature newborns were seen by an ophthalmologist from a nearby eye care center where an EKC outbreak was ongong. No new cases were diagnosed more than 10 days after the implementation of control measures. CONCLUSION: In newborns, lacrimal swelling, eye redness, and lacrimation in both eyes should evoke suspicion of EKC. Ophthalmologists who have had contact with known EKC cases should use antiseptics and disinfectants with virucidal activity before contact with newborns or abstain from examining newborns.



abbr_a3471fd9fc40b60b86bd75d8d554d318.pdf (63.73 KB, 下载次数: 8)

2008-10-1 13:54 上传

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David

Hosp Infect. 2002 Aug;51(4):275-80. Links
Clinical and epidemiological aspects of an enterovirus outbreak in a neonatal unit.
NICU肠病毒暴发感染
Syriopoulou VP, Hadjichristodoulou Ch, Daikos GL, Pirounaki M, Chatzicou V, Pavlopoulou I, Anagnostakou M, Theodoridou M, Dellagrammaticas H.
First Department of Pediatrics, Athens University, Aghia Sophia Children's Hosital, Greece. vsyriop@cc.uoa.gr
An outbreak of enterovirus infection occurred among neonates in a maternity hospital between July 7 and 22, 1999. Twenty neonates became ill (18 confirmed and two probable), an attack rate of 33%. The incubation period ranged from three to six days (mean, 4.2). The male:female ratio was 11:9 and the mean age at the onset of illness was 5.5 days. All the babies had fever, eight, a maculopapular rash, and six had symptoms of gastroenteritis, 11 developed meningitis. Nineteen neonates required hospitalization for three to seven days, but all were discharged home without sequelae. Enteroviral RNA was detected in all of 18 urines, and 14 cerebrospinal fluid specimens tested. A case-control study was conducted to determine risk factors associated with the outbreak. Rooming in the nursery ward was a significant risk factor (odds ratio=33.35; 95% confidence interval, 3.79-800; P=0.00002). No association was found between illness and other possible risk factors. Appropriate control measures resulted in resolution of the outbreak. Our findings demonstrate the potential for enteroviruses to cause widespread illness among newborns, and emphasize the usefulness of polymerase chain reaction in the early diagnosis of infection, and underline the role of effective control measures in interrupting viral transmission.



Clinical and epidemiological aspects of an enterovirus outbreak in a neonatal unit.pdf (110.6 KB, 下载次数: 11)

2008-10-1 13:56 上传

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David

Perinatol. 2002 Jun;22(4):306-7. Links
Nosocomial respiratory syncytial virus: a threat in the modern neonatal intensive care unit.
医院内呼吸道合胞病毒：NICU的一大威胁
Heerens AT, Marshall DD, Bose CL.
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7596, USA.
PMID: 12032794 [PubMed - indexed for MEDLINE]



abbr_451f47218acf64ad046cf6b4893c381b.pdf (51.62 KB, 下载次数: 10)

2008-10-1 13:59 上传

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David

Trop Pediatr. 2002 Apr;48(2):118-22. Links
Respiratory syncytial virus (RSV) outbreak in the NICU: description of eight cases.
NICU内呼吸道合胞病毒暴发感染：8个病例描述
Kilani RA.
Respiratory syncytial virus (RSV) has been recognized as a major nosocomial hazard on pediatric wards. Because of maternally acquired antibodies, symptomatic RSV infection is rare in term neonates. During an outbreak of RSV in our neonatal ICU, 12 infants (gestational age = 34 +/- 5 weeks) remained RSV negative. In contrast, eight preterm infants (gestational age = 28 +/- 2 weeks) became RSV positive. Four infants became very sick with RSV and required mechanical ventilation and support. Acute respiratory distress syndrome (ARDS) developed in two of them resulting in death of one of them. Control measures were effective in controlling the outbreak. We conclude that during an RSV outbreak in the neonatal ICU, the attack rate is higher in preterm infants born at lower gestational age resulting in significant mortality and morbidity.



Respiratory syncytial virus (RSV) outbreak in the NICU--description of eight cases.pdf (326.28 KB, 下载次数: 11)

2008-10-1 14:05 上传

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David

nfect Control Hosp Epidemiol. 2000 Jul;21(7):449-54. Links
An outbreak of influenza A in a neonatal intensive care unit.
NICU内流感病毒A型暴发感染
Cunney RJ, Bialachowski A, Thornley D, Smaill FM, Pennie RA.
Dept Microbiology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
OBJECTIVES: Investigation of an outbreak of influenza A in a neonatal intensive care unit (NICU) with examination of risk factors for infection and outcomes. DESIGN: Retrospective cohort study of infants admitted to the unit during the outbreak period. Prospective survey of NICU staff and mothers of infants in the cohort study. SETTING: Level III nursery in a university-affiliated tertiary referral center. RESULTS: Nineteen infants in the NICU were infected with influenza A There were six symptomatic cases and one death who had evidence of virus-associated hemophagocytic syndrome at autopsy. Amantadine prophylaxis was offered to the NICU staff, and amantadine therapy was given to five of the six symptomatic infants. Mechanical ventilation, gestational age, birth weight, Clinical Risk Index for Babies score, and twin pregnancy were associated with acquisition of influenza A on univariate analysis. Mechanical ventilation (odds ratio [OR], 6.2; P=.02) and twin pregnancy (OR, 7.0; P=.04) remained as significant risk factors for infection on multiple logistic regression analysis. Only 15% of respondents to the NICU staff survey were vaccinated against influenza. There was no association between a history of an influenza-like illness during pregnancy and acquisition of influenza A by infants of mothers who responded to the maternal survey (OR, 0.91; P=1.0). CONCLUSIONS: Influenza A is an important pathogen in the neonatal population and is readily transmissible in the NICU setting.



An outbreak of influenza A in a neonatal intensive care unit.pdf (79.35 KB, 下载次数: 9)

2008-10-1 14:09 上传

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缭绕

看来病毒猛于虎啊！可是，除了轮状病毒还可以用免疫法做，其他可是一般的医院做不来啊！