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2.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32267098

RESUMO

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Assuntos
Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Doenças do Sistema Digestório , Endoscopia do Sistema Digestório/normas , Gastroenterologia/normas , Controle de Infecções/normas , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/virologia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/etiologia , Doenças do Sistema Digestório/microbiologia , Doenças do Sistema Digestório/virologia , Unidades Hospitalares/normas , Humanos , Pandemias , Equipamento de Proteção Individual/normas , Pneumonia Viral/complicações , Pneumonia Viral/virologia
3.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(4): 288-296, 2020 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-32294813

RESUMO

Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1 700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1)Standard prevention and protection, and patient isolation; (2)Patient wearing mask during HFNC treatment; (3)Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4)Placing filter between resuscitator and mask or artificial airway; (5)For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6)Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O(1 cmH(2)O=0.098 kPa); (7)In-line suction catheter is recommended and it can be used for one week; (8)Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9)For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10)PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11)Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Infecção Hospitalar/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Terapia Respiratória/normas , Betacoronavirus , Broncoscopia , Consenso , Infecções por Coronavirus/transmissão , Estado Terminal , Infecção Hospitalar/virologia , Filtração , Humanos , Máscaras , Pneumonia Viral/transmissão , Ventiladores Mecânicos
5.
Surg Infect (Larchmt) ; 21(4): 301-308, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32310715

RESUMO

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Operatórios/normas , Adulto , Aerossóis/efeitos adversos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/virologia , Procedimentos Cirúrgicos Eletivos/legislação & jurisprudência , Instalações de Saúde/normas , Humanos , Controle de Infecções/métodos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/normas , Intubação Intratraqueal/efeitos adversos , Segurança do Paciente/normas , Assistência Perioperatória/métodos , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos
6.
Can J Anaesth ; 67(5): 568-576, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32052373

RESUMO

A global health emergency has been declared by the World Health Organization as the 2019-nCoV outbreak spreads across the world, with confirmed patients in Canada. Patients infected with 2019-nCoV are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to healthcare workers providing care. Although the exact mechanisms of transmission are currently unclear, human-to-human transmission can occur, and the risk of airborne spread during aerosol-generating medical procedures remains a concern in specific circumstances. This paper summarizes important considerations regarding patient screening, environmental controls, personal protective equipment, resuscitation measures (including intubation), and critical care unit operations planning as we prepare for the possibility of new imported cases or local outbreaks of 2019-nCoV. Although understanding of the 2019-nCoV virus is evolving, lessons learned from prior infectious disease challenges such as Severe Acute Respiratory Syndrome will hopefully improve our state of readiness regardless of the number of cases we eventually manage in Canada.


Assuntos
Anestesiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Infecção Hospitalar/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Betacoronavirus , Canadá , Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/virologia , Programas de Triagem Diagnóstica , Humanos , Controle de Infecções/métodos , Intubação , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Ressuscitação
7.
Arch Virol ; 164(12): 2919-2930, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520220

RESUMO

Human bocavirus (HBoV) has been detected primarily in children with acute lower respiratory tract disease (LRTD), but its occurrence, clinical profile, and role as a causative agent of RTD are not clear. The aim of this study was to investigate the prevalence and the potential clinical relevance of HBoV. Using molecular tests, we tested 1352 nasopharyngeal samples obtained between October 1, 2017 and April 30, 2018 from children up to the age of 16 with RTD for the presence of HBoV DNA and 20 other respiratory pathogens at three different hospitals in Belgium. HBoV was detected in 77 children with a median age of 10.6 months. Consecutive samples were available for 15 HBoV-positive children and showed persistent HBoV positivity in four of them. Monoinfection was observed in six infants. Four of them were born prematurely and were infected during hospitalization at the neonatal intensive care unit (NICU). Only one of these six monoinfected children was diagnosed with recurrent wheezing due to HBoV. This child was carried to term and had a high viral load. Coinfections, most frequently with rhinovirus (52.1%) and adenovirus (49.3%), were observed in 72 patients. In seventeen of them in which HBoV was present at high viral load or higher viral load than its copathogens, bronchi(oli)tis (n = 8), recurrent wheezing (n = 8) or episodic wheezing (n = 1) were diagnosed. Our results suggest that HBoV infection at high viral load in infants is associated with wheezing (P = 0.013, Cramer's V = 0.613).


Assuntos
Bocavirus Humano/isolamento & purificação , Infecções por Parvoviridae/diagnóstico , Infecções Respiratórias/virologia , Adolescente , Bélgica/epidemiologia , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , DNA Viral/genética , Feminino , Bocavirus Humano/genética , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Nasofaringe/virologia , Infecções por Parvoviridae/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Prevalência , Estudos Retrospectivos , Carga Viral
8.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31420369

RESUMO

BACKGROUND: The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in the United States in 2010. We describe invasive pneumococcal disease (IPD) in children at 8 children's hospitals in the US from 2014 to 2017. METHODS: Children with IPD occurring from 2014 to 2017 were identified from a prospective study. Demographic and clinical data, including results of any immune evaluation along with the number and dates of previous pneumococcal conjugate vaccines administered, were recorded on case report forms. Isolate serotypes were determined in a central laboratory. Pneumococcal conjugate vaccine doses were counted if IPD occurred ≥2 weeks after a dose. RESULTS: PCV13 serotypes accounted for 23.9% (115 out of 482) of IPD isolates from 2014 to 2017. Serotypes 3, 19A, and 19F accounted for 91% of PCV13 serotypes. The most common non-PCV13 serotypes were 35B, 23B, 33F, and 22F. An underlying condition was significantly (P < .0001) more common in children with IPD due to non-PCV13 serotypes (200 out of 367, 54.5%) than for children with PCV13 serotypes (27 out of 115, 23.5%). An immune evaluation was undertaken in 28 children who received ≥2 PCV13 doses before IPD caused by a PCV13 serotype. Only 1 was found to have an immunodeficiency. CONCLUSIONS: PCV13 serotypes (especially serotypes 3, 19A, and 19F) continue to account for nearly a quarter of IPD in US children 4 to 7 years after PCV13 was introduced. Underlying conditions are more common in children with non-PCV13 serotype IPD. Immune evaluations in otherwise healthy children with PCV13 serotype IPD despite receiving ≥2 PCV13 doses did not identify an immunodeficiency.


Assuntos
Infecção Hospitalar/epidemiologia , Hospitais Pediátricos/estatística & dados numéricos , Infecções Pneumocócicas/epidemiologia , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/imunologia , Infecção Hospitalar/virologia , Suscetibilidade a Doenças/virologia , Humanos , Esquemas de Imunização , Hospedeiro Imunocomprometido , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/virologia , Vacinas Pneumocócicas/classificação , Estudos Retrospectivos , Sorogrupo , Estados Unidos/epidemiologia , Vacinas Conjugadas/classificação
9.
Cells ; 8(7)2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31269695

RESUMO

Background: The aim of the study was to investigate the intra-host variability through next-generation-sequencing (NGS) of the NS5A-gene in nosocomial transmission-clusters observed in two Italian hospitals among hepatitis C virus (HCV)-genotype-1b infected patients. Methods: HCV-sequencing was performed by Sanger-sequencing (NS3 + NS5A + NS5B) and by NGS (NS5A, MiSeq-Illumina) in 15 HCV-1b infected patients [five acute with onco-hematologic-disease and 10 (4/6 acute/chronic) with ß-thalassemia]. Resistance-associated-substitutions (RAS) were analysed by Geno2pheno-algorithm. Nucleotide-sequence-variability (NSV, at 1%, 2%, 5%, 10% and 15% NGS-cutoffs) and Shannon entropy were estimated. Phylogenetic analysis was performed by Mega6-software and Bayesian-analysis. Results: Phylogenetic analysis showed five transmission-clusters: one involving four HCV-acute onco-hematologic-patients; one involving three HCV-chronic ß-thalassemia-patients and three involving both HCV-acute and chronic ß-thalassemia-patients. The NS5A-RAS Y93H was found in seven patients, distributed differently among chronic/acute patients involved in the same transmission-clusters, independently from the host-genetic IL-28-polymorphism. The intra-host NSV was higher in chronic-patients versus acute-patients, at all cutoffs analyzed (p < 0.05). Even though Shannon-entropy was higher in chronic-patients, significantly higher values were observed only in chronic ß-thalassemia-patients versus acute ß-thalassemia-patients (p = 0.01). Conclusions: In nosocomial HCV transmission-clusters, the intra-host HCV quasispecies divergence in patients with acute-infection was very low in comparison to that in chronic-infection. The NS5A-RAS Y93H was often transmitted and distributed differently within the same transmission-clusters, independently from the IL-28-polymorphism.


Assuntos
Infecção Hospitalar/virologia , Hepacivirus/genética , Hepatite C/virologia , Proteínas não Estruturais Virais/genética , Talassemia beta/terapia , Doença Aguda , Adulto , Substituição de Aminoácidos , Antivirais/farmacologia , Antivirais/uso terapêutico , Transfusão de Sangue , Doença Crônica , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/transmissão , Farmacorresistência Viral/genética , Feminino , Genótipo , Hepacivirus/patogenicidade , Hepatite C/tratamento farmacológico , Hepatite C/transmissão , Sequenciamento de Nucleotídeos em Larga Escala , Interações Hospedeiro-Patógeno/genética , Interações Hospedeiro-Patógeno/imunologia , Humanos , Interferons/genética , Interferons/imunologia , Masculino , Pessoa de Meia-Idade , Filogenia , Polimorfismo de Nucleotídeo Único , Talassemia beta/genética , Talassemia beta/imunologia
10.
J Hosp Infect ; 103(3): 349-353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356855

RESUMO

A hospital outbreak of human parainfluenza virus type 3 (HPIV-3) in haematologic oncology patients is described in 12 patients over a four-week period. Exposure histories and molecular analysis of HPIV-3 isolates suggest that both community-acquired and nosocomially transmitted infections occurred during this outbreak. Molecular analysis of HPIV-3 isolates indicated that a chain of transmission occurred among multiple patients in an oncology ward. This transmission was later determined to be associated with the movement of fomites, visitors, and activities in the unit. The infection prevention team stopped nosocomial spread of HPIV-3 through interventions including advanced cleaning procedures.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Surtos de Doenças , Vírus da Parainfluenza 3 Humana/classificação , Vírus da Parainfluenza 3 Humana/genética , Infecções por Respirovirus/epidemiologia , Infecções por Respirovirus/virologia , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Técnicas de Genotipagem , Neoplasias Hematológicas/complicações , Humanos , Controle de Infecções/métodos , Epidemiologia Molecular , Vírus da Parainfluenza 3 Humana/isolamento & purificação , Infecções por Respirovirus/transmissão
11.
BMC Res Notes ; 12(1): 332, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186058

RESUMO

OBJECTIVE: Arboviruses, Dengue and Chikungunya have become major international public health concerns due to their epidemics and introduction in new areas. In Ghana, little is known is about Dengue and Chikungunya viruses though the country has been listed as part of the 34 countries in which the viruses are endemic. This has been attributed partly to the lack of diagnostic tools for these viruses in several health facilities and institutions across the country. The purpose of this study was to detect and characterize these viral pathogens among febrile patients in Accra Ghana. RESULTS: This hospital-based cross-sectional study enrolled 260 suspected Dengue and/or Chikungunya febrile patients who submitted their clinical specimens of serum. Out of the total number tested with both molecular and serological tools, Chikungunya and Dengue specific total antibodies were detected from 72 (27.69%) and 180 (69.23%) respectively. None of the participants tested positive for Dengue and Chikungunya by reverse transcription-polymerase chain reaction (RT-PCR) and with the Dengue-specific NS1 antigen strip kits. Our findings suggested that Dengue and Chikungunya viruses may be circulating but are being missed among febrile patients. Differential diagnosis work-up in febrile patients should be made to include Dengue and Chikungunya infections.


Assuntos
Febre de Chikungunya/epidemiologia , Coinfecção/epidemiologia , Infecção Hospitalar/epidemiologia , Dengue/epidemiologia , Adolescente , Adulto , Idoso , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Arbovirus/classificação , Arbovirus/imunologia , Arbovirus/fisiologia , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/virologia , Vírus Chikungunya/imunologia , Vírus Chikungunya/fisiologia , Criança , Pré-Escolar , Coinfecção/diagnóstico , Coinfecção/virologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/virologia , Estudos Transversais , Dengue/diagnóstico , Dengue/virologia , Vírus da Dengue/imunologia , Vírus da Dengue/fisiologia , Feminino , Gana/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Arch Virol ; 164(8): 2049-2059, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31123965

RESUMO

Avipoxviruses (APVs) are large DNA viruses that are detected widely in many species of birds. Little information is available regarding genetic variations in these host-specific viruses. In the present study, nine canarypox virus and five pigeonpox virus isolates were collected from northeastern Iran and isolated via the chorioallantoic membrane of chicken embryos. Further investigations were conducted using analysis of virus growth in chicken embryo fibroblasts, histopathology, electron microscopy, and molecular techniques such as polymerase chain reaction (PCR) combined with sequencing and phylogenetic analysis to investigate variations in the highly conserved P4b gene of poxviruses. Virus replication and pock lesions were evident, and microscopic examination revealed eosinophilic intracytoplasmic inclusion bodies and biconcave enveloped virus particles with randomly arranged surface filaments, which are characteristic features of poxviruses. PCR results confirmed the presence of an APV-specific 578-bp fragment in all of the samples. Sequence analysis and phylogenetic analysis of 578-bp P4b fragments of eight isolates confirmed that our canary and pigeon isolates clustered with previously reported isolates. The similarity between the nucleotide sequences of most of our isolates and those isolated previously in other countries could be due to the high degree of conservation of these fragments. However, the FZRC6V isolate from a canary in this study did not have a canarypox virus origin according to the sequence analysis, and might have originated from cross-infection with different strains of avipoxviruses.


Assuntos
Avipoxvirus/genética , Vírus da Varíola dos Canários/genética , Infecções por Poxviridae/virologia , Animais , Doenças das Aves/virologia , Células Cultivadas , Galinhas/virologia , Sequência Conservada/genética , Infecção Hospitalar/virologia , Fibroblastos/virologia , Genes Virais/genética , Variação Genética/genética , Irã (Geográfico) , Filogenia , Doenças das Aves Domésticas/virologia , Poxviridae/genética
13.
BMC Pulm Med ; 19(1): 79, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991976

RESUMO

BACKGROUND: In 2017, Australia experienced its highest levels of influenza virus activity since the 2009 pandemic. This allowed detailed comparison of the characteristics of patients with community and hospital-acquired influenza, and infection control factors that contributed to influenza spread. METHODS: A surveillance based study was conducted on hospitalised patients with laboratory-confirmed influenza at the Canberra Hospital during April-October 2017. Differences between the hospital-acquired and community-acquired patient characteristics and outcomes were assessed by univariate analysis. Epidemiologic curves were developed and cluster distribution within the hospital was determined. RESULTS: Two hundred and ninety-two patients were included in the study. Twenty-eight (9.6%) acquired influenza in hospital, representing a higher proportion than any of the previous 5 years (range 0.9-5.8%). These patients were more likely to have influenza A (p = 0.021), had higher rates of diabetes (p = 0.015), malignancy (p = 0.046) and chronic liver disease (p = 0.043). Patients acquiring influenza in hospital met clinical criteria for influenza like illness in 25% of cases, compared with 64.4% for community-acquired cases (p < 0.001). Hospital-acquired influenza cases occurred in two distinct clusters. Patients were moved an average of 5 times after diagnosis. Mean length of stay following diagnosis was 13 days compared to 5 days for community-acquired cases (p < 0.001). Of the patients with hospital-acquired influenza, 22 were in shared rooms during their incubation period and 9 were not isolated in single rooms following diagnosis. Treatment was initiated within the recommended 48 h period following symptom onset for 62.5% of hospital-acquired cases compared with 39.8% of community-acquired cases (p = 0.033). CONCLUSIONS: Our results show that clinical presentation differed between patients with hospital-acquired influenza compared with those who acquired influenza in the community. Cases occurred in two clusters suggesting intra-hospital transmission rather than random importation from the community, highlighting the importance of infection control measures to limit influenza spread. Patients with hospital-acquired influenza may present without classical features of an influenza-like illness and this should promote earlier diagnostic testing and isolation to limit spread. Movement of patients after diagnosis is likely to facilitate spread within the hospital.


Assuntos
Infecção Hospitalar/epidemiologia , Influenza Humana/epidemiologia , Vacinação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Comorbidade , Infecção Hospitalar/virologia , Feminino , Hospitalização , Humanos , Controle de Infecções/métodos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Influenza Humana/transmissão , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Estações do Ano , Vigilância de Evento Sentinela
14.
Infection ; 47(3): 425-433, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30649684

RESUMO

PURPOSE: We studied the incidence, morbidity and mortality of all patients presenting in our teaching hospital with proven influenza virus and/or respiratory syncytial virus (RSV) infection during the influenza epidemic season 2018 which was characterized by a predominant incidence of influenza virus B type B of the Yamagata line. METHODS: In the fall of 2017, specific precaution measures in addition to standard measures were implemented, including standardized testing for influenza virus A,B and RSV by multiplex PCR of pharyngeal swabsData from all consecutive patients were analyzed retrospectively. RESULTS: Overall 651 patients were examined for the presence of influenza virus and RSV; 214 patients had influenza virus A (n = 36), B (n = 152), and/or RSV (n = 30), including four patients with dual infection. 86% of cases had influenza virus (80% B), and 14% RSV infection. N = 23 cases were treated as outpatients. The rate of acute viral respiratory infections (influenza virus and RSV) was 191 of 2776 (6.9%) admissions to medical wards. Of n = 191 hospitalized cases, n = 44 cases (20.6%) had nosocomial infection. Viral infections were associated with a high morbidity (pneumonia 28.5%, mortality 4.7%). Independent predictors of prolonged hospitalization were the presence of pneumonia, NIV and renal complications, and independent predictors of pneumonia were age ≥ 65 years, bedridden status and CRP ≥ 2.9 mg/dL. CONCLUSIONS: The rate of nosocomial cases was high despite established precaution measures. RSV was associated with morbidity and mortality comparable to influenza. Pneumonia remains the main complication of acute viral respiratory infections, and antimicrobial treatment should include both antiviral as well as antibacterial agents.


Assuntos
Coinfecção/epidemiologia , Epidemias , Influenza Humana/epidemiologia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Doença Aguda/epidemiologia , Doença Aguda/mortalidade , Adulto , Idoso , Coinfecção/mortalidade , Coinfecção/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/virologia , Feminino , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Vírus da Influenza A/fisiologia , Vírus da Influenza B/fisiologia , Influenza Humana/mortalidade , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Morbidade , Infecções por Vírus Respiratório Sincicial/mortalidade , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sinciciais Respiratórios/fisiologia , Estudos Retrospectivos , Adulto Jovem
15.
PLoS One ; 14(1): e0210173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30645600

RESUMO

BACKGROUND & AIMS: Acute hepatitis C (AHC) is not frequently identified because patients are usually asymptomatic, although may be recognized after iatrogenic exposures such as needle stick injuries, medical injection, and acupuncture. We describe an outbreak of AHC among 12 patients who received IV saline flush from a single multi-dose vial after intravenous contrast administration for a computerized tomography (CT) scan. The last patient to receive IV contrast with saline flush from a multi-dose vial at the clinic on the previous day was known to have chronic HCV genotype 1b (termed potential source, PS). Here we sought to confirm (via genetic analysis) the source of infection and to predict the minimal contaminating level of IV saline flush needed to transmit infectious virus to all patients. METHODS: In order to confirm the source of infection, we sequenced the HCV E1E2 region in 7 CT patients, in PS, and in 2 control samples from unrelated patients also infected with HCV genotype 1b. A transmission probabilistic model was developed to predict the contamination volume of blood that would have been sufficient to transmit infectious virus to all patients. RESULTS: Viral sequencing showed close clustering of the cases with the PS. The transmission probabilistic model predicted that contamination of the multi-dose saline vial with 0.6-8.7 microliters of blood would have been sufficient to transmit infectious virus to all patients. CONCLUSION: Analysis of this unique cohort provides a new understanding of HCV transmission with respect to contaminating volumes and viral titers.


Assuntos
Infecção Hospitalar/transmissão , Surtos de Doenças , Contaminação de Medicamentos , Hepatite C/transmissão , Administração Intravenosa , Adolescente , Adulto , Idoso , Meios de Contraste/administração & dosagem , Infecção Hospitalar/sangue , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Feminino , Genótipo , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/sangue , Hepatite C/epidemiologia , Hepatite C/virologia , Humanos , Masculino , Modelos Estatísticos , Agulhas , RNA Viral/isolamento & purificação , Solução Salina/administração & dosagem , Tomografia Computadorizada por Raios X , Proteínas do Envelope Viral/genética , Carga Viral
16.
Infect Control Hosp Epidemiol ; 40(1): 79-88, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30595141

RESUMO

OBJECTIVE: To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications. DESIGN: Outbreak investigation. SETTING: Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit. METHODS: Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases. RESULTS: In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive. CONCLUSIONS: We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/transmissão , Coronavírus da Síndrome Respiratória do Oriente Médio/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Sequência de Bases , Busca de Comunicante , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Surtos de Doenças , Feminino , Pessoal de Saúde , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Coronavírus da Síndrome Respiratória do Oriente Médio/genética , RNA Viral/genética , Arábia Saudita/epidemiologia
17.
J Infect Dis ; 219(7): 1044-1048, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30358855

RESUMO

Hepatitis B virus (HBV) infection is considered a major public health problem worldwide, and a significant number of reports on nosocomial and occupational outbreaks have been reported. This systematic investigation of HBV stability and susceptibility to different antiseptics revealed that HBV infectivity was very stable, with a half-life of >22 days at 37°C. At 4°C, infectivity was barely reduced for up to 9 months. Different alcohols and commercially available hand antiseptics had a virucidal effect against HBV. We propose that very strict compliance with established hygienic guidelines should be mandatory to avoid and prevent HBV infections.


Assuntos
Anti-Infecciosos Locais/farmacologia , Infecção Hospitalar/prevenção & controle , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/prevenção & controle , Doenças Profissionais/prevenção & controle , 1-Propanol/farmacologia , 2-Propanol/farmacologia , Linhagem Celular , Infecção Hospitalar/virologia , Meio Ambiente , Etanol/farmacologia , Higiene das Mãos/normas , Higienizadores de Mão/farmacologia , Humanos , Concentração de Íons de Hidrogênio , Doenças Profissionais/virologia , Soro , Temperatura , Fatores de Tempo
18.
J Infect Dis ; 219(9): 1364-1372, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30445538

RESUMO

BACKGROUND: Noroviruses are the leading cause of acute gastroenteritis outbreaks worldwide. Clarifying the viral, host, and environmental factors (epidemiologic triad) associated with severe outcomes can help target public health interventions. METHODS: Acute norovirus outbreaks reported to the National Outbreak Reporting System (NORS) in 2009-2016 were linked to laboratory-confirmed norovirus outbreaks reported to CaliciNet. Outbreaks were analyzed for differences in genotype (GII.4 vs non-GII.4), hospitalization, and mortality rates by timing, setting, transmission mode, demographics, clinical symptoms, and health outcomes. RESULTS: A total of 3747 norovirus outbreaks were matched from NORS and CaliciNet. Multivariable models showed that GII.4 outbreaks (n = 2353) were associated with healthcare settings (odds ratio [OR], 3.94 [95% confidence interval {CI}, 2.99-5.23]), winter months (November-April; 1.55 [95% CI, 1.24-1.93]), and older age of cases (≥50% aged ≥75 years; 1.37 [95% CI, 1.04-1.79]). Severe outcomes were more likely among GII.4 outbreaks (hospitalization rate ratio [RR], 1.54 [95% CI, 1.23-1.96]; mortality RR, 2.77 [95% CI, 1.04-5.78]). Outbreaks in healthcare settings were also associated with higher hospitalization (RR, 3.22 [95% CI, 2.34-4.44]) and mortality rates (RR, 5.65 [95% CI, 1.92-18.70]). CONCLUSIONS: Severe outcomes more frequently occurred in norovirus outbreaks caused by GII.4 and those in healthcare settings. These results should help guide preventive interventions for targeted populations, including vaccine development.


Assuntos
Infecções por Caliciviridae/complicações , Infecções por Caliciviridae/epidemiologia , Surtos de Doenças , Norovirus/genética , Fatores Etários , Idoso , Infecções por Caliciviridae/mortalidade , Infecções por Caliciviridae/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/virologia , Feminino , Genótipo , Instalações de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estações do Ano , Índice de Gravidade de Doença , Estados Unidos
19.
Ophthalmology ; 126(1): 137-143, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30180976

RESUMO

PURPOSE: Outbreaks of adenovirus in neonatal intensive care units (NICUs) can lead to widespread transmission and serious adverse outcomes. We describe the investigation, response, and successful containment of an adenovirus outbreak in a NICU associated with contaminated handheld ophthalmologic equipment used during retinopathy of prematurity (ROP) screening. DESIGN: Epidemiologic outbreak investigation. PARTICIPANTS: A total of 23 hospitalized neonates, as well as NICU staff and parents of affected infants. MAIN OUTCOME MEASURES: Routine surveillance identified an adenovirus outbreak in a level IV NICU in August 2016. Epidemiologic investigation followed, including chart review, staff interviews, and observations. Cases were defined as hospital-acquired adenovirus identified from any clinical specimen (NICU patient or employee) or compatible illness in a family member. Real-time polymerase chain reaction (PCR) and partial- and whole-genome sequencing assays were used for testing of clinical and environmental specimens. RESULTS: We identified 23 primary neonatal cases and 9 secondary cases (6 employees and 3 parents). All neonatal case-patients had respiratory symptoms. Of these, 5 developed pneumonia and 12 required increased respiratory support. Less than half (48%) had ocular symptoms. All neonatal case-patients (100%) had undergone a recent ophthalmologic examination, and 54% of neonates undergoing examinations developed adenovirus infection. All affected employees and parents had direct contact with infected neonates. Observations revealed inconsistent disinfection of bedside ophthalmologic equipment and limited glove use. Sampling of 2 handheld lenses and 2 indirect ophthalmoscopes revealed adenovirus serotype 3 DNA on each device. Sequence analysis of 16 neonatal cases, 2 employees, and 2 lenses showed that cases and equipment shared 100% identity across the entire adenovirus genome. Infection control interventions included strict hand hygiene, including glove use; isolation precautions; enhanced cleaning of lenses and ophthalmoscopes between all examinations; and staff furlough. We identified no cases of secondary transmission among neonates. CONCLUSIONS: Adenovirus outbreaks can result from use of contaminated ophthalmologic equipment. Even equipment that does not directly contact patients can facilitate indirect transmission. Patient-to-patient transmission can be prevented with strict infection control measures and equipment cleaning. Ophthalmologists performing inpatient examinations should take measures to avoid adenoviral spread from contaminated handheld equipment.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Surtos de Doenças , Contaminação de Equipamentos , Infecções Oculares Virais/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Oftalmologia/instrumentação , Infecções Respiratórias/epidemiologia , Infecções por Adenovirus Humanos/tratamento farmacológico , Infecções por Adenovirus Humanos/transmissão , Infecções por Adenovirus Humanos/virologia , Adenovírus Humanos/genética , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , DNA Viral/genética , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/transmissão , Infecções Oculares Virais/virologia , Feminino , Idade Gestacional , Humanos , Lactente , Controle de Infecções , Pacientes Internados , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/transmissão , Infecções Respiratórias/virologia , Retinopatia da Prematuridade/diagnóstico , Sequenciamento Completo do Genoma
20.
Clin Infect Dis ; 68(2): 222-228, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-29800111

RESUMO

Background: Norovirus is a leading cause of worldwide and nosocomial gastroenteritis. The study aim was to assess the utility of molecular epidemiology using full genome sequences compared to routine infection prevention and control (IPC) investigations. Methods: Norovirus genomes were generated from new episodes of norovirus at a pediatric tertiary referral hospital over a 19-month period (n = 182). Phylogeny identified clusters of related sequences that were verified using epidemiological and clinical data. Results: Twenty-four clusters of related norovirus sequences ("sequence clusters") were observed, including 8 previously identified by IPC investigations ("IPC outbreaks"). Seventeen sequence clusters (involving 77/182 patients) were corroborated by epidemiological data ("epidemiologically supported clusters"), suggesting transmission between patients. Linked infections were identified among 44 patients who were missed by IPC investigations. Thirty-three percent of norovirus sequences were linked, suggesting nosocomial transmission; 24% of patients had nosocomial infections from an unknown source; and 43% were norovirus positive on admission. Conclusions: We show there are frequent introductions of multiple norovirus strains with extensive onward nosocomial transmission of norovirus in a pediatric hospital with a high proportion of immunosuppressed patients nursed in isolation. Phylogenetic analysis using full genome sequences is more sensitive than classic IPC investigations for identifying linked cases and should be considered when investigating norovirus nosocomial transmission. Sampling of staff, visitors, and the environment may be required for complete understanding of infection sources and transmission routes in patients with nosocomial infections not linked to other patients and among patients with phylogenetically linked cases but no evidence of direct contact.


Assuntos
Infecções por Caliciviridae/transmissão , Infecções por Caliciviridae/virologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Genoma Viral , Norovirus/genética , Criança , Surtos de Doenças , Gastroenterite/virologia , Genótipo , Hospitais Pediátricos , Humanos , Filogenia
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