1315

70°C. All samples were tested at a single dilution of 1 in 50. The results were expressed as ELISA units as extrapolated from a standard curve of known positive samples tested in serial dilutions in each plate. A value of more than 40 ELI SA units (above the mean + 3SD of the value in normally nourished, uninfected control -

children) was assigned to determine a positive IgM response. Sera with a positive IgM response were tested for rheumatoid factor by a latex agglutination test. No patients or controls had rotavirus in stool specimens. Rotavirus-specific IgM titres (all positive sera testing negative for rheumatoid factor) were:

Rotavirus specific lgM titre positive

Group Lactose intolerance Cow’s milk protein intolerance Enteric pathogens Aetiology not known ADOUI one-uuro 01

15/23 1/1 0/15 4/16 20/55

patients witn protractea cliarrnoea anct tailure

to thrive had

high titres of rotavirus-specific IgM in serum, which is a sensitive serological indicator of recent rotavirus infection.6,7 No patient had had diarrhoea during the previous 6 weeks so it is reasonable to assume that a substantial proportion of cases of protracted diarrhoea was associated with, or may have been a sequela to, a recent rotavirus infection, especially since peak titres IgM are seen at 2-4 weeks post-infection. Serological evidence of recent rotavirus infection was most commonly observed in patients who had

patient

protracted diarrhoea and lactose intolerance. Since no excreting rotavirus in the stools, the protracted

was

diarrhoea following the initial rotavirus infection could have resulted from secondary lactose intolerance itself. High titres were also seen in 4 patients in whom no aetological factor could be identified. In these 4 patients, other factors (eg, jejunal bacterial overgrowth or impaired epithelial cell turnover) could have perpetuated the diarrhoea or delayed recovery after the initial rotavirus infection. V. KHOSHOO* M. K. BHAN

Department of Paediatrics, Division of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India

S. JAYASHREE R. KUMAR

Viral Gastroenteritis Unit, Centers for Disease Control, Atlanta, Georgia, USA

ROGER I. GLASS

*Present address: Department of Paediatrics, Ontario, Canada M5G 1X8.

Hospital for Sick Children, Toronto,

Specific etiologies of chronic diarrhea in infancy. In: Lebenthal E, ed. Chronic diarrhea m children. New York: Raven Press, 1984: 107-45. Saulsbury FT, Winkelstein JA, Yolken YH. Chronic rotavirus infection in

1. Branski D.

2. 3

immunodeficiency. J Pediatr 1980; 97: 61-65. Bishop RF, Davadson GP, Holmes IH, Ruck BJ. Virus particles m epithelial cells of duodenal mucosa from children with acute nonbacterial gastroenteritis. Lancet 1973; ii: 1281-83.

4. WHO. Manual for laboratory investigations of acute enteric infections (CDD/83.3). Geneva: WHO, 1983. 5. Jayashree S, Bhan MK, Kumar R, Raj P, Glass R, Bhandari N. Serum and salivary antibodies as indicators of rotavirus infection in neonates. J Infect Dis 1988; 158: 1117-20. 6. Brussow H, Werchau H, Lerner L, et al. Seroconversion patterns to four human rotavirus serotypes in hospitalised infants with acute rotavirus gastroenteritis. J Infect Dis 1988; 158: 588-95. 7. Champsaur H, Henry-Amar M, Goldszmidt D, et al. Rotavirus carnage, asymptomatic infection, and disease in the first two years of life II: serological response. J Infect Dis 1984; 149: 675-82.

Airborne transmission of varicella-zoster virus in

hospitals

SIR,-Mrs Meurisse (May 5, p 1100), Dr Morgan-Capner, and Dr Sutherland (June 16, p 1460) and their colleagues have explained the need to know the immune status of hospital employees so that they can avoid contact with patients with varicella-zoster virus (VZV) infection. Unfortunately, employees may not always be aware of their exposure. This is shown by our recent experience, where routine screening identified susceptible employees, but failed to prevent

nosocomial transmission of VZV because

consider the possibility of airborne transmission.

we

did

not

In January, 1990, a patient with varicella pneumonia was transferred to this hospital. Because the patient was pregnant and no other beds were available, she was placed on an obstetric unit, in a private room 9 metres along a connecting corridor from the neonatal intensive care unit (NICU). The NICU is separated from the corridor by two sets of double doors and has its own air handling system. The patient remained in the private room until transferred to a medical unit after 24 h. All of the obstetric nurses were known to be immune to VZV through pre-employment history or screening, and none developed VZV infection. The personnel on the NICU were not considered to be exposed. 18 days after admission of the patient with varicella pneumonia, chickenpox developed in a nurse in the NICU. She was the only susceptible nurse of 95 employed in the NICU. She had worked the night the patient with VZV was admitted. She knew that she was susceptible to VZV, but was unaware of the proximity of the infected patient. Though she had not entered the patient’s room, she had walked past several times on the night of admission to go to her locker. When the nurse got chickenpox, she exposed 45 infants in the NICU. This required treatment of the infants with varicella-zoster immune globulin and separation of the exposed infants from the unexposed for the 28 days isolation period. An extensive interview with the nurse failed to identify any exposure outside the hospital. Thus, the most likely source of infection was airborne transmission as she walked back and forth by the patient’s room. Airborne transmission of VZV in hospitals has been reported on several occasions.l-3In addition to knowing the immune status of employees, those responsible for infection control must be aware that exposed employees include any staff in the vicinity of an infected patient who may thus be at risk from airborne transmission. Infection Control Department, University of Cincinnati Hospital, Cincinnati, Ohio 45267-0788, USA

NANCY A. MENKHAUS BRUCE LANPHEAR CALVIN C. LINNEMANN

J, Zaia J, Levin M, et al. Airborne transmission of chickenpox in a hospital. N Engl J Med 1980; 302: 450-53. 2. Gustaffon T, Laveley G, Brawner E, et al. An outbreak of airborne nosocomial varicella. Pediatrics 1982; 70: 550-56. 3. Josephson A, Gombert M. Airborne transmission of nosocomial varicella from localized zoster. J Infect Dis 1988; 158: 238-41. 1. Ledair

Needlestick

hepatitis C virus seroconversion in

a

surgeon

SIR,-Employment in health care has been associated with non-A, non-B hepatitis, and occupational transmission in health-care settings has been documented. 1,2 Surveillance data from the Centers for Disease Control show that in about 5% of US patients with non-A, non-B hepatitis the only identifiable source of infection is occupational exposure to blood.3 We report the first case, as far as we are aware, of HCV infection after needlestick injury in a health-care worker. During an operation on a patient known to be an HIVseropositive intravenous drug abuser, the surgeon was punctured on the elbow by a needle contaminated with the patient’s blood. 4 h later the surgeon started zidovudine prophylaxis (1200 mg daily). At that time he was seronegative for HBV surface antigen and for antibodies to HIV, but positive for anti-HBs and anti-HBc; serum alanine aminotransferase (ALT) was 25 IU/1. 25 days later he had asthenia, gastric pain, nausea, and vomiting; ALT was 125 IU/1 and treatment was stopped. 5 days later, because his symptoms had not improved, he was tested for antibodies to HCV, with negative results. ALT was 553 IU/1, and rose to 2200 IU/1 on day 78. He was positive for antibodies to HCV at 98 days post injury (HCV encoded antigen, recombinant clOO-3, Ortho ELISA test system) and ALT was 183 IU/1. He remained negative for antibodies to HIV. Although the patient’s HCV serological status is unknown, in view of the high prevalence of anti-HCV carriage in intravenous drug abusers, we should not exclude the patient as a source of HCV infection. In view of the clinical outcome, laboratory data, and seroconversion of the surgeon it seems probable that the case reported here represents occupational transmission of HCV infection.

Airborne transmission of varicella-zoster virus in hospitals.

1315 70°C. All samples were tested at a single dilution of 1 in 50. The results were expressed as ELISA units as extrapolated from a standard cur...
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