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Prolonged outbreak of adenovirus A31 in allogeneic stem cell transplant recipients
Author(s) -
Swartling L.,
Allard A.,
Törlen J.,
Ljungman P.,
Mattsson J.,
Sparrelid E.
Publication year - 2015
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12443
Subject(s) - outbreak , medicine , transmission (telecommunications) , viremia , transplantation , cidofovir , disease , adenovirus infection , hematopoietic stem cell transplantation , virology , pediatrics , immunology , virus , electrical engineering , engineering
Background An outbreak of human adenovirus ( HA dV) A31 occurred from December 2011 to March 2012 at the Center for Allogeneic Stem Cell Transplantation ( CAST ), Karolinska University Hospital in Sweden. We analyzed the outbreak, the routes of transmission, and report the medical consequences. Methods The medical records of all patients admitted to CAST during the outbreak period were studied. Phylogenetic analysis of the patient HA dV strains was performed by sequencing the hexon gene and the more variable E3 gene. Results We identified 9 cases of HA dV A31. Hygiene measures were implemented, but transmission continued for 2 months. All 9 patients had been admitted to the ward, but 2 had no connection in time to other known HA dV A31 cases. DNA sequencing of the patient strains strongly suggested nosocomial transmission. Transplantation was postponed and then cancelled in 1 patient, and 5 patients were treated with cidofovir because of high levels of viremia. In 7 patients, concomitant graft‐versus‐host disease ( GVHD ) grade II – V complicated the clinical picture, as it was difficult to distinguish symptoms of GVHD from those of HA dV infection. Conclusion An outbreak of HA dV in HSCT recipients can be difficult to control. Although none of the patients had severe disease, the medical consequences were significant. It is possible that unidentified cases with mild symptoms may have caused continuous transmission at the unit. Regular testing of all patients several weeks beyond the last case identified may be an important measure to control transmission.