ARTICLE IN PRESS American Journal of Infection Control ■■ (2015) ■■–■■
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
j o u r n a l h o m e p a g e : w w w. a j i c j o u r n a l . o r g
Clinical Case Study
Outbreak of parvovirus B19 infection among anesthesiology and surgical fellows Reynaldo Lara-Medrano MD a, Michel Fernando Martínez-Reséndez MD a, Elvira Garza-González PhD b, Ana Gabriela Medina-Torres MD c, Adrián Camacho-Ortiz MD d,* a
Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico Servicio de Anestesiología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico d Coordinación de Epidemiología Hospitalaria, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico b c
Key Words: Health care worker Hospital Hospital acquired infections Work related risk
A human parvovirus B19 outbreak was detected in personnel assigned to a surgical area (anesthesiology fellows and an otorhinolaryngology fellow) in a university hospital. The attack rate between susceptible members was higher than previous reports. Diagnosis was determined by polymerase chain reaction for human parvovirus B19 in serum of 1 subject and immunoglobulin M/immunoglobulin G antibody titer in the remaining subjects. Medical personnel were put on leave of absence until resolution of symptoms and laboratory confirmation of health. No cases of infection were detected in hospitalized patients or other health care workers on follow-up. © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Infection by human parvovirus B19 (HPV B19) or infectious erythema occurs primarily through respiratory secretions. The prevalence of anti-HPV B19 antibodies in adults varies between 40% and 70% depending on the studied population.1 Susceptible adults are occasionally infected through contact with children during acute infection. We describe an outbreak of HPV B19 in surgical fellows by horizontal transmission.
REPORT At the end of February 2013, an anesthesiology fellow reported to the infection control unit the appearance of a facial rash that extended to neck and upper extremities, as well as generalized arthralgia, myalgia, and fever of recent onset. Infectious erythema was considered the probable cause along with mononucleosis and dengue fever. Three members of the same on-call team of anesthesiologists were found to have similar symptomatology; furthermore, an otorhinolaryngology (ORL) fellow not assigned to
* Address correspondence to Adrián Camacho-Ortiz, MD, Hospital Universitario Dr José Eleuterio González, Gonzalitos y Madero SN, Mitras Centro, Monterrey, NL, Mexico 64460. E-mail address: [email protected] (A. Camacho-Ortiz). Conflicts of interest: None to report.
the team had the same symptomatology (she was in a personal relationship with 1 of the affected anesthesiology fellows). All anesthesiology fellows on the team shared the same work schedule; that is, averaging 10 hours of daily close contact during which they shared the same work area. Four out of 5 affected staff members were women, with a median age of 24 years (range, 24-31 years) The predominant symptoms in all affected health care workers (HCWs) were rash and fever (80%) followed by anemia, myalgia, headache (60%), and flu-like symptoms in (40%). All personnel who presented with fever were put on leave of absence until symptoms resolution. We determined serum anti-HPV B19 immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in those patients with resolution of symptoms. We used reverse transcription polymerase chain reaction (RT-PCR) (Quest diagnostics Nichols institute, San Juan Capistrano, CA) to detect viral load in the blood in 1 of the fellows with active symptoms. All tests, including antibody titers for HPV B19 and RT-PCR, were positive. Serum levels of antibodies were measured by enzyme-linked immunosorbent assay with the following reference values: negative, 1.1. Reference values for a negative RTPCR result were
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
j o u r n a l h o m e p a g e : w w w. a j i c j o u r n a l . o r g
Clinical Case Study
Outbreak of parvovirus B19 infection among anesthesiology and surgical fellows Reynaldo Lara-Medrano MD a, Michel Fernando Martínez-Reséndez MD a, Elvira Garza-González PhD b, Ana Gabriela Medina-Torres MD c, Adrián Camacho-Ortiz MD d,* a
Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico Servicio de Anestesiología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico d Coordinación de Epidemiología Hospitalaria, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico b c
Key Words: Health care worker Hospital Hospital acquired infections Work related risk
A human parvovirus B19 outbreak was detected in personnel assigned to a surgical area (anesthesiology fellows and an otorhinolaryngology fellow) in a university hospital. The attack rate between susceptible members was higher than previous reports. Diagnosis was determined by polymerase chain reaction for human parvovirus B19 in serum of 1 subject and immunoglobulin M/immunoglobulin G antibody titer in the remaining subjects. Medical personnel were put on leave of absence until resolution of symptoms and laboratory confirmation of health. No cases of infection were detected in hospitalized patients or other health care workers on follow-up. © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Infection by human parvovirus B19 (HPV B19) or infectious erythema occurs primarily through respiratory secretions. The prevalence of anti-HPV B19 antibodies in adults varies between 40% and 70% depending on the studied population.1 Susceptible adults are occasionally infected through contact with children during acute infection. We describe an outbreak of HPV B19 in surgical fellows by horizontal transmission.
REPORT At the end of February 2013, an anesthesiology fellow reported to the infection control unit the appearance of a facial rash that extended to neck and upper extremities, as well as generalized arthralgia, myalgia, and fever of recent onset. Infectious erythema was considered the probable cause along with mononucleosis and dengue fever. Three members of the same on-call team of anesthesiologists were found to have similar symptomatology; furthermore, an otorhinolaryngology (ORL) fellow not assigned to
* Address correspondence to Adrián Camacho-Ortiz, MD, Hospital Universitario Dr José Eleuterio González, Gonzalitos y Madero SN, Mitras Centro, Monterrey, NL, Mexico 64460. E-mail address: [email protected] (A. Camacho-Ortiz). Conflicts of interest: None to report.
the team had the same symptomatology (she was in a personal relationship with 1 of the affected anesthesiology fellows). All anesthesiology fellows on the team shared the same work schedule; that is, averaging 10 hours of daily close contact during which they shared the same work area. Four out of 5 affected staff members were women, with a median age of 24 years (range, 24-31 years) The predominant symptoms in all affected health care workers (HCWs) were rash and fever (80%) followed by anemia, myalgia, headache (60%), and flu-like symptoms in (40%). All personnel who presented with fever were put on leave of absence until symptoms resolution. We determined serum anti-HPV B19 immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in those patients with resolution of symptoms. We used reverse transcription polymerase chain reaction (RT-PCR) (Quest diagnostics Nichols institute, San Juan Capistrano, CA) to detect viral load in the blood in 1 of the fellows with active symptoms. All tests, including antibody titers for HPV B19 and RT-PCR, were positive. Serum levels of antibodies were measured by enzyme-linked immunosorbent assay with the following reference values: negative, 1.1. Reference values for a negative RTPCR result were
