Clinical and epidemiological characteristics of rotavirus nosocomial infection outbreaks in a neonatal unit during a 2 year period
D. Koukou1, P. Chatzichristou1, T. Siahanidou1, A.V. Skiathitou1, K. Chrysakis2, G.Trimis3, A. Lourida1, GL. Daikos4, V. Syriopoulou1
1First Department of Pediatric, Athens University, “Aghia Sophia” Children’s Hospital, Athens, 2Department of Microbiology, “Aghia Sophia” Children’s Hospital, Athens, 3Vaccine Unit, VIANEX/Sanofi Pasteur MSD, Athens, 41 First Department of Propaedeutic Medicine, Laiko General Hospital, Athens University, Athens, Greece
Rotavirus (RV) gastroenteritis is a common nosocomial infection and cause of outbreaks in neonatal units (NU).
1.To determine the incidence of RV infection among neonates hospitalized in a NU.
2.Evaluate the RV associated clinical manifestation in neonates.
3.Identify risk factors for RV nosocomial transmission.
A case-control study was conducted in the NU of the “Aghia Sophia” Children’s Hospital, the largest tertiary pediatric hospital in Athens, between January 2009 and December 2010. Neonates RV-positive were designated as cases and equal number of neonates RV-negative hospitalized during the same period were considered as controls. RV infection was confirmed by testing fecal samples with rapid immunochromatographic test. Positive samples were further G and P typed through RT-PCR .
•79 RV-cases were identified; 95% of cases were hospital-acquired.
•Annual incidence of RV infection was 7,6/100 and 5/100 admissions in 2009 and 2010 respectively.
•Three seasonal outbreaks were reported (06/2009, 10/2009, 06/2010). The RV outbreaks in the NU were similar to the peaks of the seasonal distribution of the community acquired RV infection observed in hospitalized children in the general pediatric wards of the hospital.
• Age of infected neonates varied from 3-71 days old (mean age: 21,7±11,7) and hospitalization stay varied from 6-106 days (mean hospitalization stay 17,7±17,2 days).
•Diarrhea or watery stools were present in the 48% of cases and loose stools in the 78%. Other clinical symptoms less frequent in older ages like blood (20%) or mucus in fecal (30%), abdominal distention (8,6%), weight loss (59%), consciousness disturbance (11,1%) and septic appearance (7%) were also present.
•RV genotypes were: G4P 89,6%, G1P 4,2% and G12P 6,3%.
•Cases were older than controls (p<0,05) and no other significant differences were identified regarding gender, weight at birth, gestational age, type of birth, hospitalization stay, co infections or antibiotic treatment.
1.Clinical manifestation of RV gastroenteritis in neonatal age is not usually typical.
2.No specific risk factors are associated with the hospital acquired RV infection in neonates.
3.The low infective viral dose, the prolonged stay of the virus in the environment (surfaces, objectives) and the role of medical personnel as a viral reservoir are possible factors for RV outbreaks in nosocomial units like NU.
4.Surveillance and infection control measures are essential to reduce rate of RV nosocomial transmission.