LETTERS TO THE EDITOR
Outbreak of intra-hospital acquired rotavirus in a pediatric hospital in Mexico
To the Editor: Rotavirus constitutes the principal causal agent of intra-hospital diarrhea in children, with a described incidence of intra-hospital gastroenteritis of 2 to 7% of hospitalized children primarily between 6 and 23 months old.1 The transmission is from person to person and the virus survives on the hands of health workers during four hours; in inanimate objects it could survive for several days. For this reason, health workers are considered to be the probable cause of transmission in the majority of the cases.2-3 People infected by rotavirus generally present acute vomiting followed by profuse, watery diarrhea without blood and with or without fever. The first episode is normally very serious, thus the clinical signs are very severe in children as well as in immunocompromised patients and elderly people.4-5
The objective of this letter is to briefly comment on the presentation of intra-hospital outbreaks of rotavirus at the Instituto Nacional de Pediatria, from February 7 to 28, 2007. Patients with clinical signs of diarrhea three days prior to their admission to the hospital and positive for rotavirus by ELISA were included in the study. Follow-up of the cases was done and preventive measures and control of the outbreak were implemented. Two cases of community rotavirus were considered as the cause of the outbreak with identification of 13 cases of intra-hospital rotavirus, including the two community cases. The result of the outbreak was corroborated by reviewing the virology laboratory reports prior to the outbreak, for the year 2006, during which only six cases of rotavirus were reported. The first case was seen on February 7, 2007 which led the Intra-hospital Infection Committee and the Epidemiology Service to begin to strengthen the standard and take specific control measures, such as hand hygiene and isolation of the cases so as to control the outbreak; the last case was presented on February 28, 2007.
None of the cases had a record of vaccination against rotavirus. The mean age of children was six months with a range of 1 to 24 months. The average hospital stay for the cases, from the beginning of the diarrhea, was 11 days (with a range of 3 to 33 days). Transmission was probably by health workers who did not adequately observe techniques for washing their hands with soap and water, considering that the most effective method of tackling intra-hospital outbreak of rotavirus, besides isolating the patients and strictly following contact measures, is the use of alcohol gel in hand asepsis, as is described by the literature.5
Rapid implementation of measures for isolation from contact in a rotavirus outbreak is recommended, as well as reinforcement of standard precautions by indicating the use of gel with alcohol for hand asepsis in the affected units, in addition to continued education of personnel to modify their conduct and remind them of the importance of following the standard and specific precautions to prevent new outbreaks, as happened in our study.
Guillermo Sólomon Santibáñez
Dirección General, Instituto Nacional de Pediatría (INP), México
Jaime Ramírez Mayans
Dirección Médica, INP
Napoleon González Saldaña
Hilda Hernández Orozco
Jose Luis Castañeda Narvaez
Comité de Infecciones, INP
Ester Lombardo Aburto
Wendy Domínguez Viveros
Servicio de Epidemiología, INP
Natividad Navarrete Delgadillo
Laboratorio de Virología, INP
Hugo Juárez Olguín
Laboratorio de Farmacología, INP
Correspondence and Reprints:
Hugo Juárez Olguín, Instituto Nacional de Pediatría
Avenida Imán #1, 3dr piso, Col Cuicuilco
CP 04530, México City, Mexico.
Tel and Fax 5255 1084 3883
1. Román RE, Wilhelmi De GML, Cileruelo P, Calvop RC, García GML. Gastroenteritis aguda nosocomial e infección asintomática por rotavirus y astrovirus en niños hospitalizados. An Pediatr (Barc) 2003;60:337-343.
2. Chandran A, Henzen HR, Santosaham M, Siberry KG. Nosocomial rotavirus infections: a systemic review. J Pediatr 2006;194:441-447.
3. Ratner JA, Neu N, Jacob K, Grumet S, Adachi N. Nosocomial rotavirus in a pediatric hospital. Infect Control Hosp Epidemiol 2001;22:299-301.
4. Delpiano ML, Riquelme RJ, Casado FM, Álvarez HZ. Comportamiento clínico y costos de la gastroenteritis por rotavirus en lactantes: Adquisición comunitaria versus nosocomial. Rev Chil Infectol 2006;23:45-52.
5. Jarvis RW. Endemic and epidemic hospital infections. In: Bennett & Brachman editor Hospital Infections 5ed. Philadelphia. Wolters Kluwer Lippincott Williams & Wilkins; 2007:566-569.