982. Summer outbreak of severe RSV-B disease, Minnesota, 2017
Session: Named Lecture: Caroline B. Hall Lectureship
Friday, October 5, 2018: 10:30 AM
Room: S 214-216
Background:

Respiratory syncytial virus (RSV) causes seasonal outbreaks peaking from Oct.-April in the United States. While symptoms are typically mild and limited to the upper respiratory tract in older children and adults, RSV can cause severe lower respiratory disease, hospitalization and death, particularly among younger children, the immunocompromised and the elderly. During summer 2017, the Minnesota Department of Health (MDH) received a report of a cluster of severe respiratory illness in children with RSV-B infection admitted at an urban county hospital.

Methods:

MDH conducts surveillance for RSV in Minneapolis-St. Paul with collection of respiratory specimens and clinical and demographic data. We compared characteristics of cases reported in summer 2017 with the previous 4 summer seasons. To understand the genetic relatedness among viruses, we performed complete genome sequencing from primary specimens using an Illumina MiSeq platform employing both a sequence-independent sequencing method and a RSV-specific, overlapping PCR-based approach.

Results:

From May-Sept. 2017, 58 cases of RSV (48 RSV-B) were reported to MDH compared to 18 (7 RSV-B) during the same period in 2016, 27 in 2015 and 29 in 2014. The median age and frequency of co-morbidities was similar across years; however, 50% required ICU admission in 2017 compared to 12% in preceding 3 years. The RSV-B genome was sequenced from 10 specimens from March-May 2016, 20 specimens from May-Sept. 2017 and 30 specimens from Oct. 2017-Jan. 2018. Phylogenic analysis revealed that 15 cases from May-Sept. 2017 formed a unique clade distinct from the lineage encompassing 2016 cases from Minnesota and 35 representative complete RSV genomes in GenBank isolated from 6 continents over 13 years. From Oct. 2017-Jan. 2018 we detected co-circulation of viruses from both lineages among older adults and children.

Conclusion:

We identified an outbreak of RSV-B associated with severe disease among urban Minnesota children during a time of expected low RSV circulation. Complete genome sequencing data suggested emergence of a new lineage distinct from viruses circulating in Minnesota during the previous season. Genomic characterization can provide useful insights into epidemiologic variations.

Beth Thielen, MD, PhD1, Erica Bye, MPH2, Xiong Wang, DVM, PhD3, Hannah Friedlander, MPH2, Stacene Maroushek, MD, PhD4, Meghan Shilts, MHS5, Anna Strain, PhD2, Kathryn Como-Sabetti, MPH3, Patricia Ferrieri, MD, FIDSA6 and Ruth Lynfield, MD, FIDSA2, (1)Adult and Pediatric Infectious Diseases, University of Minnesota, Minneapolis, MN, (2)Minnesota Department of Health, St. Paul, MN, (3)Minnesota Department of Health, Saint Paul, MN, (4)Hennepin County Medical Center, Minneapolis, MN, (5)Vanderbilt University, Nashville, TN, (6)Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, MHealth, Minneapolis, MN

I am a fellow in adult and pediatric infectious diseases at the University of Minnesota. My research interest is in pathogenesis of respiratory viruses.

Ms. Como-Sabetti is an Epidemiologist at the Minnesota Department of Health and Children’s Hospitals and Clinics of Minnesota. She received her Bachelor’s of Science at North Dakota State University if Nutrition Science and her Master’s of Public Health in Epidemiology at the University of Minnesota, School of Public Health. She has worked as an Epidemiologist for the Minnesota Department of Health since 1997 in the areas of vaccine preventable diseases, emerging infections, antibiotic resistant pathogens, and judicious antibiotic use. She also works in the area of infectious disease epidemiology and infection control for Children’s Hospitals of Minnesota. Her current research interests include risks and prevention of methicillin-resistant Staphylcoccus aureus infections in community and health care settings.

Ruth Lynfield, M.D. received her medical degree from Cornell University Medical College and did postgraduate training in pediatrics and in pediatric infectious diseases at Massachusetts General Hospital (MGH). She attended in pediatric infectious disease at MGH from1992-1997, and was Assistant Director of the New England Regional Newborn Screening Program at the Massachusetts State Laboratory from 1992-1997. Dr. Lynfield then joined the Minnesota Department of Health as a medical epidemiologist, and was appointed State Epidemiologist in 2007 and Medical Director of the department in 2010. She is the Co-Principal investigator of the Minnesota Emerging Infections Program. She has conducted numerous infectious disease investigation and responses to outbreaks; she has also developed surveillance systems, and conducted public health research, evaluation and planning. Her research focuses on emerging infections, antimicrobial resistance and prevention of infectious diseases. Dr. Lynfield has also worked on antimicrobial stewardship tools and guidance across the continuum of care, and across disciplines (a One Health Approach). Dr. Lynfield chairs the CDC Board of Scientific Counselors- Office of Infectious Diseases, and is a past member of the FDA Vaccines and Related Biological Products Advisory Committee, and the National Vaccine Advisory Committee. She is also a member of the American Academy of Pediatrics’ Committee on Infectious Disease. She has co-chaired the CDC Emerging Infections Program Steering Committee since 2008. Dr. Lynfield has chaired the Infectious Disease Society of America (IDSA) Public Health Committee, the IDSA Antibiotic Resistance Working Group, and has served on multiple other public health workgroups and committees. She is an Adjunct Professor of Medicine and Epidemiology at the University of Minnesota.


Disclosures:

B. Thielen, None

E. Bye, None

X. Wang, None

H. Friedlander, None

S. Maroushek, None

M. Shilts, None

A. Strain, None

K. Como-Sabetti, None

P. Ferrieri, None

R. Lynfield, None

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