RSV Spreads Through a Louisiana Newborn Intensive Care Unit, December 2017

In December 2017 the Louisiana Department of Health learned of seven cases of respiratory syncytial virus (RSV) in a neonatal intensive care unit (NICU) — 84 beds in five units (A–E), with 66 single infant rooms.

The outbreak

• The first case (day 0) was a baby who had left the NICU 30 days earlier and was readmitted with breathing trouble — about 2 weeks after Louisiana's RSV season peaked in mid-November.
• The other six had at least one respiratory symptom while still in the NICU after birth.
• All seven were born at the facility; symptoms began over 11 days.

Day of symptom onset among the seven babies: day 0 in unit A, days 3–8 in unit C, day 10 in unit B. CDC / MMWR

Once the first case was found, the hospital put symptomatic babies on contact precautions and asked staff to report any respiratory symptoms. Nose-and-throat swabs were taken from babies with runny nose, cough or congestion, and from babies without symptoms in two of the three units where the cases were. Three days after being notified, and after consulting CDC, state epidemiologists visited to review charts, watch infection control, interview staff and plan prevention.

The tests

At the hospital lab, all seven samples were positive for RSV and negative for influenza, coronavirus, parainfluenza and human metapneumovirus. CDC typed all seven as RSV type B; one also had enterovirus or rhinovirus. No other baby tested positive.

What stopped it

On top of the standard and contact precautions already in place, the health department recommended:

• droplet precautions
• no visits from sick people or children under 12
• face masks for all visitors, family included, entering babies' rooms
• more hand-hygiene stations and extra environmental cleaning
• dedicated staff for the babies with RSV

No new cases appeared in the 14 days after the last symptom onset, and all seven babies recovered.

Why it matters

RSV is a leading cause of lower respiratory tract infections in young children worldwide. In the United States, babies 2 months and younger are hospitalized for it at an estimated 17.9 per 1,000 a year. During RSV season — usually fall through spring — health facilities face a higher risk of spread inside the hospital, though it is rarely identified and reported. NICUs are a particular worry, with premature babies and babies with underlying conditions.

To prevent spread, the recommendations are standard and contact precautions, grouping sick patients and the staff who care for them, keeping out visitors with symptoms and young siblings, and stressing hand hygiene.

Sources

Based on Washington EJ, Rose EB, Langley GE, et al., "Notes from the Field: Respiratory Syncytial Virus Infections in a Neonatal Intensive Care Unit — Louisiana, December 2017," MMWR Morbidity and Mortality Weekly Report, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain.