An outbreak of norovirus infection in a bone marrow transplant unit

• Published in: American journal of infection control Vol. 41; no. 9; pp. 820 - 823
• Main Authors: Doshi, Manish, MD, Woodwell, Simone, BS, MT, CIC, Kelleher, Kimberly, BS, MT, ASCP, Mangan, Kenneth, MD, Axelrod, Peter, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2013; Elsevier; Mosby-Year Book, Inc
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Caliciviridae Infections - epidemiology; Cohort Studies; Diarrhea; Disease Outbreaks; Epidemiology. Vaccinations; Female; Gastroenteritis - epidemiology; Gastroenteritis - virology; General aspects; Hematopoetic stem cell transplantation; Human infectious diseases. Experimental studies and models; Humans; Infection Control; Infectious Disease; Infectious diseases; Male; Medical sciences; Middle Aged; Norovirus - isolation & purification; Nosocomial; Nosocomial infections; Stem cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplants & implants; Viral infections; Nosocomial; Hematopoetic stem cell transplantation; Prevention; Virus; Epidemic; Nosocomial infection; Norovirus; Caliciviridae; Check; Stem cell transplantation; Bone marrow transplantation
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2012.10.025

Background Norovirus is a single-stranded RNA virus belonging to the Caliciviridae family. Methods Our observational cohort study aimed to describe a nosocomial outbreak of norovirus on a bone marrow transplant (BMT) unit. Results Six of 8 BMT patients with increased liquid stools tested positive for norovirus: 4 had new onset diarrhea; 2 had acute exacerbations of chronic diarrhea caused by graft versus host disease. Eight non-BMT inpatients had norovirus infection, but 7 of these were community acquired; cumulative incidence rates in BMT and non-BMT units were 26% and 0.16%, respectively. In BMT patients, diarrhea (increased or new onset) lasted 6 to 33 days—durations shorter than those reported in sporadic BMT cases. All patients had private rooms and bathrooms. Five of 6 patients were on the BMT unit during their presumed incubation periods. Three were in adjacent rooms. Three nurses and 1 physician had symptoms compatible with norovirus infection, and all 4 worked while ill. The outbreak ended coincident with implementation of stricter infection control practices. Conclusion Norovirus appeared to spread in a BMT unit more avidly than it did among general medical patients. Explanations include prolonged diarrhea and viral excretion, long hospital stays of infected patients, rarity of empiric contact isolation for diarrhea, routine handling of liquid stool, and a closed community of health care workers.