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Schwarz H, Böni J, Kouyos RD, Turk T, Battegay E, Kohler M, Müller R, Petry H, Sax H, Weber R, McGeer A, Trkola A, Kuster SP. The TransFLUas influenza transmission study in acute healthcare - recruitment rates and protocol adherence in healthcare workers and inpatients. BMC Infect Dis 2019; 19:446. [PMID: 31113375 PMCID: PMC6528321 DOI: 10.1186/s12879-019-4057-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Detailed knowledge about viral respiratory disease transmission dynamics within healthcare institutions is essential for effective infection control policy and practice. In the quest to study viral transmission pathways, we aimed to investigate recruitment rates and adherence of healthcare workers (HCWs) and hospital inpatients with a study protocol that involves prospective surveillance based on daily mid-turbinate nasal swabs and illness diaries. Methods Single center prospective surveillance of patients and HCWs in three different hospital departments of a tertiary care center during an entire influenza season in Switzerland. Inpatients and acute care HCWs were asked to provide mid-turbinate nasal swabs and illness diaries on a daily basis. Study protocol adherence and recruitment rates were the primary outcomes of interest. Results A total 251 participants (59 (23.5%) health care workers and 192 (76.5%) inpatients) were recruited from three different hospital wards. Recruitment rates differed between HCWs (62.1% of eligible HCWs) and inpatients (32.5%; P < 0.001), but not within HCWs (P = 0.185) or inpatients (P = 0.301) of the three departments. The total number of study-days was 7874; 2321 (29.5%) for inpatients and 5553 (70.5%) for HCWs. HCWs were followed for a median of 96 days (range, 71–96 days) and inpatients for 8 days (range, 3–77 days). HCWs provided swabs on 73% (range, 0–100%) of study days, and diaries on 77% (range 0–100%). Inpatients provided swabs and diaries for 83% (range, 0–100%) of days in hospital. In HCWs, increasing age, working in internal medicine and longer duration of total study participation were positively associated with the proportion of swabs and diaries collected. Adherence to the study protocol was significantly lower in physicians as compared to nurses for both swabs (P = 0.042) and diaries (P = 0.033). In inpatients, no association between demographic factors and adherence was detected. Conclusions Prospective surveillance of respiratory viral disease was feasible in a cohort of inpatients and HCWs over an entire influenza season, both in terms of recruitment rates and adherence to a study protocol that included daily specimen collection and illness diaries. Trial registration clinicaltrials.govNCT02478905. Date of registration June 23, 2015.
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Affiliation(s)
- Hila Schwarz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100 / HAL14 D6, 8091, Zürich, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100 / HAL14 D6, 8091, Zürich, Switzerland
| | - Teja Turk
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100 / HAL14 D6, 8091, Zürich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Pulmonary Division, University Hospital and University of Zurich, Zurich, Switzerland
| | - Rouven Müller
- Hematology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Heidi Petry
- University Hospital Zurich, Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100 / HAL14 D6, 8091, Zürich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100 / HAL14 D6, 8091, Zürich, Switzerland
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100 / HAL14 D6, 8091, Zürich, Switzerland.
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Huh K, Kim I, Jung J, Lee JE, Jhun BW, Gu SH, Song DH, Lee EY, Jeong HJ, Yoo H. Prolonged shedding of type 55 human adenovirus in immunocompetent adults with adenoviral respiratory infections. Eur J Clin Microbiol Infect Dis 2019; 38:793-800. [PMID: 30693422 DOI: 10.1007/s10096-019-03471-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022]
Abstract
Human adenovirus (HAdV) is a common pathogen causing respiratory infections with outbreaks reported in the military and community. However, little information is available on the shedding kinetics. We performed a prospective study of immunocompetent adults confirmed with HAdV respiratory infection by multiplex real-time PCR during an outbreak of HAdV-55. Consecutive respiratory specimens of sputum or nasopharyngeal swab were collected from each patient every 2 days. Viral load was measured by real-time quantitative PCR. Of 32 enrolled patients, 27 (84.4%) had pneumonia. Five patients (15.6%) received cidofovir. Viral load was highest in the earliest samples at 8.69 log10 copies/mL. In a linear regression model, viral load declined consistently in a log-linear fashion at the rate of - 0.15 log10 copies/mL per day (95% confidence interval (CI): - 0.18, - 0.12; R2 = 0.32). However, the regression model estimated the viral shedding duration to be 55 days. The rate of decline in viral load did not differ between patients who received cidofovir and who did not. Patients with prominent respiratory symptoms or extensive involvement on chest radiograph had higher volume of viral excretion. Prolonged viral shedding was observed in otherwise healthy adults with HAdV-55 respiratory infection. This finding should be considered in the establishment of infection control and prevention strategies.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Inseon Kim
- Biosewoom, Inc., Seoul, Republic of Korea
| | - Jaehun Jung
- Armed Forces Medical Command, Seongnam, Republic of Korea
| | - Ji Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-ro 81, Gangnam-gu, Seoul, Republic of Korea
| | - Se Hun Gu
- Agency for Defense Development, Daejeon, Republic of Korea
| | - Dong Hyun Song
- Agency for Defense Development, Daejeon, Republic of Korea
| | - Eun Young Lee
- Department of Laboratory and Diagnostic Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Ho Jung Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-ro 81, Gangnam-gu, Seoul, Republic of Korea.
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Wang B, Russell ML, Fonseca K, Earn DJD, Horsman G, Van Caeseele P, Chokani K, Vooght M, Babiuk L, Walter SD, Loeb M. Predictors of influenza a molecular viral shedding in Hutterite communities. Influenza Other Respir Viruses 2017; 11:254-262. [PMID: 28207989 PMCID: PMC5410723 DOI: 10.1111/irv.12448] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patterns of influenza molecular viral shedding following influenza infection have been well established; predictors of viral shedding however remain uncertain. OBJECTIVES We sought to determine factors associated with peak molecular viral load, duration of shedding, and viral area under the curve (AUC) in children and adult Hutterite colony members with laboratory-confirmed influenza. METHODS A cohort study was conducted in Hutterite colonies in Alberta, Canada. Flocked nasal swabs were collected during three influenza seasons (2007-2008 to 2009-2010) from both symptomatic and asymptomatic individuals infected with influenza. Samples were tested by real-time reverse-transcription polymerase chain reaction for influenza A and influenza B, and the viral load was determined for influenza A-positive samples. RESULTS For seasonal H1N1, younger age was associated with a larger AUC, female sex was associated with decreased peak viral load and reduced viral shedding duration, while the presence of comorbidity was associated with increased peak viral load. For H3N2, younger age was associated with increased peak viral load and increased AUC. For pandemic H1N1, younger age was associated with increased peak viral load and increased viral AUC, female sex was associated with reduced peak viral load, while inapparent infection was associated with reduced peak viral load, reduced viral shedding duration, and reduced viral AUC. CONCLUSIONS Patterns of molecular viral shedding vary by age, sex, comorbidity, and the presence of symptoms. Predictor variables vary by influenza A subtype.
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Affiliation(s)
- Biao Wang
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
| | - Margaret L. Russell
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Kevin Fonseca
- Department of Microbiology and Infectious Diseases and Provincial Laboratory for Public HealthUniversity of CalgaryCalgaryABCanada
| | - David J. D. Earn
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
- Michael G. De‐ Groote Institute for Infectious Disease ResearchMcMaster UniversityHamiltonONCanada
- Department of Mathematics and StatisticsMcMaster UniversityHamiltonONCanada
| | | | | | - Khami Chokani
- Saskatchewan HealthPrince Albert Parkland Health RegionPrince AlbertSKCanada
| | - Mark Vooght
- Saskatchewan HealthFive Hills Health RegionMoose JawSKCanada
| | | | - Stephen D. Walter
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
| | - Mark Loeb
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
- Michael G. De‐ Groote Institute for Infectious Disease ResearchMcMaster UniversityHamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
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