Objective.Norovirus(NV) is an etiologic agent of outstanding importance that can cause severe epidemic gastroenteritis in day-care centers,schools,nursing homes,and hospitals.Therefore NV requires foremost attention a...Objective.Norovirus(NV) is an etiologic agent of outstanding importance that can cause severe epidemic gastroenteritis in day-care centers,schools,nursing homes,and hospitals.Therefore NV requires foremost attention as a pathogen responsible for epidemics of gastroenteritis in immunocompromised inpatients.In this study,a NV outbreak in a pediatric oncology unit is described and the consequences for this high-risk population are discussed.Material and methods.Stool and vomitus samples from 11 patients were tested for NV and other relevant viruses during the outbreak by reverse transcriptase-polymerase chain reaction(RT-PCR) and/or enzyme-linked immunosorbent assay(ELISA) (whenever an appropriate ELISA was available) .Norwalk virus PCR amplifications were sequenced and phylogenetic analysis was performed.Results.The index patient and the chain of infection were identified.Follow-up investigation surprisingly demonstrated viral shedding for a maximum of 140 days(median 23 days) .Three patients experienced severe or life-threatening symptoms,probably related to NV infection.Conclusions.In the event of an outbreak of gastroenteritis(involving two or more symptomatic patients) in a pediatric oncology unit,the search for NV in stool or vomitus specimens should be initiated in good time.As long as the data are limited regarding whether a detectable viral antigen or RNA in stools represents an infectious virus,patients have to be isolated as long as the diagnostic assays remain positive.During the acute phase of the illness,health-care workers should wear masks in addition to practicing meticulous hand hygiene with a disinfectant of proven activity against NV.Pediatric oncology patients must be closely monitored during follow-up investigations as they may shed the virus for months.There is some evidence from the outbreak described here that those patients face a greater risk of severe NV-related complications.展开更多
文摘Objective.Norovirus(NV) is an etiologic agent of outstanding importance that can cause severe epidemic gastroenteritis in day-care centers,schools,nursing homes,and hospitals.Therefore NV requires foremost attention as a pathogen responsible for epidemics of gastroenteritis in immunocompromised inpatients.In this study,a NV outbreak in a pediatric oncology unit is described and the consequences for this high-risk population are discussed.Material and methods.Stool and vomitus samples from 11 patients were tested for NV and other relevant viruses during the outbreak by reverse transcriptase-polymerase chain reaction(RT-PCR) and/or enzyme-linked immunosorbent assay(ELISA) (whenever an appropriate ELISA was available) .Norwalk virus PCR amplifications were sequenced and phylogenetic analysis was performed.Results.The index patient and the chain of infection were identified.Follow-up investigation surprisingly demonstrated viral shedding for a maximum of 140 days(median 23 days) .Three patients experienced severe or life-threatening symptoms,probably related to NV infection.Conclusions.In the event of an outbreak of gastroenteritis(involving two or more symptomatic patients) in a pediatric oncology unit,the search for NV in stool or vomitus specimens should be initiated in good time.As long as the data are limited regarding whether a detectable viral antigen or RNA in stools represents an infectious virus,patients have to be isolated as long as the diagnostic assays remain positive.During the acute phase of the illness,health-care workers should wear masks in addition to practicing meticulous hand hygiene with a disinfectant of proven activity against NV.Pediatric oncology patients must be closely monitored during follow-up investigations as they may shed the virus for months.There is some evidence from the outbreak described here that those patients face a greater risk of severe NV-related complications.
