Notes from the Field: Respiratory Syncytial Virus Infections in a Neonatal Intensive Care Unit — Louisiana, December 2017

Abstract

In December 2017, the Louisiana Department of Health was notified of seven cases of respiratory syncytial virus (RSV) infection in a five-unit (units A-E), 84-bed neonatal intensive care unit (NICU) that included 66 individual infant rooms. The first case occurred in an infant who had been discharged postpartum from the NICU 30 days earlier and was readmitted for respiratory distress (day 0), approximately 2 weeks after the peak in reported RSV cases in Louisiana (mid-November) (1). The other six infants had at least one respiratory symptom while in the NICU postpartum. Upon identification of the first case, the facility implemented contact precautions for symptomatic infants, and NICU staff members were asked to report any respiratory symptoms. Nasopharyngeal specimens were obtained from infants who had rhinorrhea, cough, or nasal congestion. Nasopharyngeal swabs were also obtained from asymptomatic infants in two of the three units where the seven identified patients resided. A case was defined as laboratory-confirmed RSV infection in an NICU patient during December 2017. After consultation with CDC, a team of Louisiana Department of Health epidemiologists visited the facility 3 days after notification to review medical charts, observe infection control procedures, interview NICU staff members, and determine measures to prevent further transmission. All seven patients were born at the facility. The first identified RSV case occurred in the only patient who had been discharged. Symptom onsets occurred over an 11-day period (Figure). Six of the seven patients were born at 25-36 weeks' gestational age. One patient was housed in unit A, one in unit B, and five in unit C. The median age of patients from birth to symptom onset was 15 days (range = 7-147 days). The most commonly observed signs and symptoms among patients with RSV included cough (four patients), nasal congestion (seven), tachypnea (four), tachycardia (four), and poor feeding (four). One patient required bilevel positive airway pressure, another required continuous positive airway pressure, and a third required endotracheal intubation and mechanical ventilation. Hospital staff members reported that two of the patients were visited by ill family members despite a policy prohibiting ill visitors. No staff members reported symptoms. Respiratory specimens from the seven patients were tested at the hospital laboratory by real-time reverse transcription-polymerase chain reaction; all were positive for RSV and negative for influenza, coronavirus, parainfluenza, and human metapneumovirus. Nasal swabs were sent to CDC for subtype-specific testing by real-time reverse transcription-polymerase chain reaction. All seven specimens were identified as RSV type B. Enterovirus or rhinovirus was also detected in one patient's specimen. No additional patients had RSV detected in any specimens. During the facility visit, epidemiologists reviewed infection control policies, availability and use of personal protective equipment, infection control signage, visitor education, and environmental cleaning. Louisiana Department of Health recommended that the facility, in addition to the standard and contact precautions already in place, implement droplet precautions; restrict visitation from sick persons and children aged <12 years; that visitors, including family members, wear facemasks when entering patient rooms; and that the facility increase hand hygiene stations, enhance environmental cleaning, and designate certain staff members to care for RSV patients. No additional cases were identified during the 14 days following the last observed symptom onset, and all seven patients recovered.