Long-Term Shedding of Influenza Virus, Parainfluenza Virus, Respiratory Syncytial Virus and Nosocomial Epidemiology in Patients with Hematological Disorders
Creators: name: Lehners, Nicola
name: Tabatabai, Julia
name: Prifert, Christiane
name: Wedde, Marianne
name: Puthenparambil, Joe
name: Weissbrich, Benedikt
name: Biere, Barbara
name: Schweiger, Brunhilde
name: Egerer, Gerlinde
name: Schnitzler, Paul
Publisher: name: Robert Koch-Institut, Infektionskrankheiten / Erreger
Year: 2016
Subjects: subject: Humans
subject: Female
subject: Male
subject: Adult
subject: Aged
subject: Middle Aged
subject: Young Adult
subject: Time Factors
subject: Cohort Studies
subject: Genotype
subject: Phylogeny
subject: Sequence Analysis DNA
subject: Mutation
subject: Aged 80 and over
subject: Influenza Human/virology
subject: Polymerase Chain Reaction
subject: Retrospective Studies
subject: Communicable Disease Control
subject: Cross Infection/epidemiology
subject: Cross Infection/virology
subject: Hematologic Diseases/virology
subject: Nose/virology
subject: Orthomyxoviridae/metabolism
subject: Parainfluenza Virus 3 Human/metabolism
subject: Paramyxoviridae Infections/virology
subject: Respiratory Syncytial Virus Infections/virology
subject: Respiratory Syncytial Viruses/metabolism
subject: Transplantation Homologous
subject: Virus Shedding
subject: 610 Medizin

description: Respiratory viruses are a cause of upper respiratory tract infections (URTI), but can be associated with severe lower respiratory tract infections (LRTI) in immunocompromised patients. The objective of this study was to investigate the genetic variability of influenza virus, parainfluenza virus and respiratory syncytial virus (RSV) and the duration of viral shedding in hematological patients. Nasopharyngeal swabs from hematological patients were screened for influenza, parainfluenza and RSV on admission as well as on development of respiratory symptoms. Consecutive swabs were collected until viral clearance. Out of 672 tested patients, a total of 111 patients (17%) were infected with one of the investigated viral agents: 40 with influenza, 13 with parainfluenza and 64 with RSV; six patients had influenza/RSV or parainfluenza/RSV co-infections. The majority of infected patients (n = 75/111) underwent stem cell transplantation (42 autologous, 48 allogeneic, 15 autologous and allogeneic). LRTI was observed in 48 patients, of whom 15 patients developed severe LRTI, and 13 patients with respiratory tract infection died. Phylogenetic analysis revealed a variety of influenza A(H1N1)pdm09, A(H3N2), influenza B, parainfluenza 3 and RSV A, B viruses. RSV A was detected in 54 patients, RSV B in ten patients. The newly emerging RSV A genotype ON1 predominated in the study cohort and was found in 48 (75%) of 64 RSV-infected patients. Furthermore, two distinct clusters were detected for RSV A genotype ON1, identical RSV G gene sequences in these patients are consistent with nosocomial transmission. Long-term viral shedding for more than 30 days was significantly associated with prior allogeneic transplantation (p = 0.01) and was most pronounced in patients with RSV infection (n = 16) with a median duration of viral shedding for 80 days (range 35–334 days). Long-term shedding of respiratory viruses might be a catalyzer of nosocomial transmission and must be considered for efficient infection control in immunocompromised patients.