Background: Acute respiratory illness (ARI) is a common source of morbidity among healthcare personnel (HCP). However, the causes of ARI in this high-risk population are not well studied. Over the last 3 respiratory illness seasons, we assessed the viral causes of respiratory illness among HCP working in the outpatient setting enrolled in a cluster, randomized clinical trial at 116 outpatient departments and emergency departments in 7 geographic locations across the US.
Methods: During 12 weeks of the 2011-2 (YR1), 2012-3 (YR2), 2013-4 (YR3) and 2014-5 (YR4) respiratory seasons, HCP were surveyed for symptoms of ARI. Participants with symptoms were cultured and 2 random swabs were obtained. 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 4,947 participants (619 YR1; 1,077 YR2; 1,388 YR3; 1,863 YR4), 11,467 swabs were obtained (1,377 YR1; 2,655 YR2; 3,343 YR3; 4,092 YR4). The pre-study influenza vaccination rates of participants who completed the study are: 84% YR1; 83% YR2; 75% YR3; 72% YR4. Influenza-like-illness (ILI) rates during the study are: 36% YR1; 48% YR2; 44% YR3; 40% YR4. For years 1-3: 1,839 symptomatic (324 YR1; 711 YR2; 804 YR3) and 3,812 asymptomatic (1,044 YR1; 1,977 YR2; 791 YR3) were tested. 38% of participants who had asymptomatic swabs and 44% of participants who had at least one symptomatic swab tested positive. Combined swab and serology results revealed the following viral causes of ARI: 33% coronavirus, 23% rhinovirus, 21% influenza A , 8% influenza B, 7% respiratory syncytial virus (RSV), 4% metapneumovirus, 1% parainfluenza, and 1% adenovirus (Figure 1). Of the total 45% influenza positives, 61% were identified through serology alone (Figure 2).
Conclusion: ARIs are common among highly vaccinated high risk HCP with 43% developing symptoms during the respiratory viral season and 33% had identifiable viral causes – most commonly (33%) coronavirus. Five percent asymptomatic HCP with an identifiable virus were found. Identification of viruses in HCPs that cause morbidity to patients is critical to patient safety and prevention efforts.
Note: Data analysis is ongoing, more information will be available
D. Cummings, None
C. Gaydos, Abbott/Ibis: Grant Investigator , Research support
C. Gibert, None
G. Gorse, None
J. Holden, None
A. C. Nyquist, None
C. S. Price, None
L. J. Radonovich, None
N. G. Reich, None
M. C. Rodriguez-Barradas, None
M. S. Simberkoff, None
T. M. Perl, None