Acute Respiratory Viral Infection among Outpatient Healthcare Personnel
Background: Viral respiratory disease is a common source of morbidity among healthcare personnel (HCP). However, the causes of acute respiratory illness (ARI) have not been well studied. We assessed and have updated the viral causes of respiratory illness among HCP enrolled in a cluster randomized clinical trial at 99 outpatient departments and emergency departments in 7 locations across the US.
Methods: During 12 weeks of the 2011-2 (YR1), 2012-3 (YR2), and 2013-4 (YR3) respiratory seasons, HCP were surveyed for signs and symptoms of ARI. Participants with symptoms were cultured and swabs were frozen at -800C. Two random swabs were obtained during the intervention period. Samples were tested for 13 viruses by RT-PCR/ESI-MS, (Abbott Molecular). Paired blood samples were obtained for influenza antibodies (>2-fold antibody increase).
Results: Among 3084 participants (619 YR1; 1077 YR2; 1388 YR3), 7375 swabs were obtained (1377 YR1; 2655 YR2; 3343 YR3). The vaccination rates of participants who completed the study and were vaccinated prior to the start of study are: 84% YR1 and 83% YR2. During year 1 and 2, 56% of participants reported influenza-like-illness (ILI). For years 1 and 2: 954 symptomatic (321 YR1; 633 YR2) and 3073 asymptomatic (1056 YR1; 2017 YR2) were tested. 56% of participants who had asymptomatic swabs and 100% of participants who had at least one symptomatic swab, tested positive for 8 pathogens (Figure 1). Combining the swab and serology results, YR2 samples revealed the following viral causes of respiratory infections: 39% influenza A , 22% influenza B, 1% parainfluenza, 1% adenovirus, 20% coronavirus, 1% metapneumovirus, 11% rhinovirus, and 5% respiratory syncytial virus (RSV) (Figure 2). 13 cases of influenza A were identified by serological and viral testing 10 cases of influenza B were identified by serological and viral testing (Figu 3).
Conclusion: ARIs are common among highly vaccinated HCP with 24% developing symptoms during the respiratory viral season and 30% had identifiable viral causes – most commonly (36%) influenza. A significant number of asymptomatic HCP (27%) with an identifiable virus were found. Identification of viruses in HCPs that cause morbidity to patients is critical to patient safety and prevention efforts.
Figure 3: Serologic and nose/throat sample results.
M. Bessesen, None
D. Cummings, None
C. Gibert, None
G. Gorse, None
J. Holden, None
A. C. Nyquist, None
C. S. Price, None
L. Radonovich, None
M. Rodriguez-Barradas, None
M. S. Simberkoff, None
T. M. Perl, None