81. An Outbreak of Respiratory Syncytial Virus Infections in an Outpatient Cancer Unit: Clinical Characteristics and Molecular Investigations
Session: Oral Abstract Session: Infections in Transplantation
Thursday, October 27, 2016: 9:15 AM
Room: 388-390

Background: Respiratory syncytial virus (RSV) infections are common in immunocompromised patients during winter months. Myeloma Institute at Little Rock, Arkansas, conducts more than 400 autologous stem cell transplants every year. During winter in 2015 - 2016, we observed a more severe course of RSV infections in these patients. This study is designed to study the epidemiology of RSV infections in this group of patients, and identify risk factors for severe disease.

Methods: We conducted a retrospective chart review of patients diagnosed with myeloma and other malignancies and undergoing chemotherapy and/or stem cell transplant who developed respiratory symptoms and had a respiratory viral panel (RVP) test positive for RSV between Dec15 2015 to March 31st 2016. Isolates were also sequenced to determine strain relatedness using the Illumina MiSeq platform.

Results: We detected 73 discrete cases of RSV infections, 55 of RSV A and 18 of RSV B. 91.8% of cases were nosocomially acquired. Of the nosocomial transmissions, 83.6% were acquired in the outpatient cancer infusion center setting. 53 patients were undergoing either an autologous stem cell transplant or induction chemotherapy as part of their cancer treatment. Infection progressed to lower respiratory tract infection in 47.9% of cases. 35 patients were hospitalized (mean 17.2±15.2 days, median 12), 6 required intensive care unit level of care. There were 4 deaths in the cohort. Ribavirin was used in 42.5% of cases (mean 9.2±2.9 days, median 10), while pooled immunoglobulins was used in 27.4% of cases. Adjusted incidence of LRTI (OR 3.6, 95% CI 1.1 to 13.6, p=0.035) and hospital admission (OR 4.7, 95% CI 1.14 to 26.1, p=0.03) was significantly higher among the RSV A group compared to the RSV B group. Whole genome sequencing (WGS) of 28 isolates revealed there were 3-6 circulating strains of RSV A and 2 distinct strains of RSV B associated with cases. Hospital acquired strains were genomically unique.

Conclusion: RSV infections are a significant cause of morbidity in outpatient cancer center settings. Infection with RSV A was associated with a significantly increased risk of LRTI and hospitalization as compared to RSV B. WGS reveals that multiple strains may contribute in an outbreak. Strict hand hygiene and droplet precautions for all patients may be required to break transmission chain in multiple strain outbreaks.



Atul Kothari, MD1, Joshua L Kennedy, MD2, Olga Hardin, MD3, Mary J Burgess, MD1, Juan Carlos Rico Crescencio, MD1, Mallikarjuna Rao Rettiganti, PhD4, Sandra Susanibar-Adaniya, MD5, Faith Davies, MBBCh, MRCP, MD, FRCPath6, Gareth Morgan, Ph.D7, Frits Vanrhee, MD, PhD3, Maurizio Zangari, MD8, Carolina Schinke, MD9, Sharmilan Thanendrarajan, MD, PhD10 and Darrell Dinwiddie, PhD11, (1)Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, (2)Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, (3)University of Arkansas for Medical Sciences, Little Rock, AR, (4)Arkansas Childrens Hospital, Little Rock, AR, (5)Myeloma Institute, Little rock, AR, (6)Myeloma Institute, Little Rock, AR, (7)Myeloma Insitute, UAMS, little rock, AR, (8)Myeloma Institute, University of Arkansas for medical Sciences, Little rock, AR, (9)Myeloma Institute, UAMS, Little rock, AR, (10)Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, (11)Department of Pediatrics, Clinical Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, NM


A. Kothari, None

J. L. Kennedy, None

O. Hardin, None

M. J. Burgess, None

J. C. R. Crescencio, None

M. R. Rettiganti, None

S. Susanibar-Adaniya, None

F. Davies, None

G. Morgan, None

F. Vanrhee, None

M. Zangari, None

C. Schinke, None

S. Thanendrarajan, None

D. Dinwiddie, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.