OUTBREAK OF PARAINFLUENZA VIRUS TYPE-3 IN AN INTERMEDIATE CARE NEONATAL NURSERY

Background. Of the four serotypes of human parainfluenza virus, parain fluenza type 3 causes the majority of infections in young children and infants, Parainfluenza type 3 can occur in newborns, although most ar e born with neutralizing antibodies, There have been only infrequent r eports of parainfluenza type 3 causing nosocomial respiratory infectio n in the newborn nursery setting, We report an outbreak occurring in t he intermediate care nursery (IMCN) at St, Boniface Hospital, Winnipeg , Canada, Method, On August 6, 1996, nursing staff of IMCN notified In fection Control that six infants had developed respiratory tract sympt oms including nasal discharge and cough, Three more cases were recogni zed by August 8, 1996, Infection control precautions including cohorti ng of infant cases and ill staff, gowning and reinforcement of hand wa shing practices and visitor regulations were instituted, When two furt her cases occurred on August 9, 1996, the unit was closed to all admis sions and remained closed until August 30, 1996, The last infant case occurred on August 10, 1996, Results. The attack rate among infants wa s 63% (12 of 19), No mortality was associated with this outbreak and m orbidity was minimal (no ventilator support was required), although on e-half of the infants developed radiologic pulmonary infiltrates and o ne-half required supplemental oxygen therapy, Parainfluenza type 3 was isolated from nasopharyngeal secretions in 6 of 12 infant cases, Ther e was a significant difference (P = 0.02) in age between the ill and n on-ill infants; ill infants were a mean age of 42 days compared with a mean age of 11 days for non-ill infants at the midpoint of the outbre ak, Sixteen of 65 (25%) IMCN nursing/medical staff reported an upper r espiratory tract illness between July 10 and August 18, 1996, None of the staff was cultured, Conclusions, High patient census, limited numb ers of full time staff, inadequate cohorting attempts because of staff ing constraints and crowding in the IMCN were thought to be contributo rs to this outbreak. Institution of basic barrier precautions and temp orary closure of the unit were effective in preventing further spread of the outbreak.