Respiratory Syncytial Virus Outbreak Activity -- United States, 1992

The National Respiratory and Enteric Virus Surveillance System (NREVSS) was established in 1989 to monitor trends in respiratory syncytial virus (RSV), parainfluenza viruses, adenoviruses, and rotaviruses in the United States and to provide information to public health officials and health-care providers about the presence of these viruses in their communities. Based on reports of RSV detections to the NREVSS, during the 1992-93 season, outbreaks of RSV had occurred in all regions of the United States by December 1992. This report summarizes surveillance results for RSV-antigen detections from June 27, 1992, through December 12, 1992, and assesses trends in RSV from July 1, 1990, through December 12, 1992.

Participating laboratories (e.g., hospital-based, public-health, and free-standing) report to CDC weekly the number of specimens tested for RSV by antigen-detection and virus-isolation methods and the number of positive results. Data are analyzed as the percentage of specimens tested positive. Since July 1992, 61 laboratories in 36 states tested 7195 specimens by antigen-detection methods; of these, 451 (6%) were positive. The overall rate of detection from July-August 1992 for all reporting laboratories was less than 5%. From September through November, the rate increased steadily to 10% and reached 25% in December. During 1992, onset of outbreak activity (defined by NREVSS as weeks with more than 10% of specimens positive) was noted first in laboratories in the Northeast during September and in all other regions by December.

During the 1990-91 season, the onset of outbreak activity nationally occurred in early October and peaked in late January 1991. During the 1991-92 season, the onset was in late September 1991 and peaked in mid-February 1992. Although the timing of the peak in the percentage of specimens positive for individual laboratories varied, these peaks usually occurred within 1 month of the national peak. In both previous seasons, RSV outbreak activity was reported by individual laboratories for up to 6 months.

Reported by: Emory Univ School of Public Health, Atlanta. National Respiratory and Enteric Virus Surveillance System laboratories. Respiratory and Enterovirus Br, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that RSV outbreak activity has begun for the 1992-93 winter respiratory season in the United States. RSV outbreak activity is important for patient management because antiviral chemotherapy may be indicated for some patients, and nosocomial transmission can be prevented by infection-control procedures (1,2).

RSV causes communitywide outbreaks of acute respiratory disease each year throughout the United States and has been associated with increases in hospitalizations and deaths from lower respiratory tract disease in infants and young children (3). Outbreaks usually begin in late fall or early winter and persist until spring. Children aged 2-6 months are at greatest risk for serious manifestations (e.g., pneumonia and bronchiolitis) of infection with RSV; however, children of any age with underlying cardiac or pulmonary disease or who are immunocompromised are at risk for serious complications of this infection (4-7). RSV causes repeated symptomatic infections throughout life. In adults, RSV usually causes upper respiratory tract manifestations but can cause serious lower respiratory tract disease, especially in the elderly and in persons with compromised immune systems (8,9).

The presence of RSV in a community should alert health-care workers to the risk for nosocomial transmission. RSV is a common but preventable nosocomial infection. The source of nosocomially acquired infection can be infected patients, staff, visitors, or fomites; the risk for transmission is present throughout the period of community outbreaks. Nosocomial RSV can be controlled with strict attention to contact-isolation procedures (2,10).

References

1. Committee on Infectious Diseases, American Academy of

Pediatrics. Ribavirin therapy of respiratory syncytial virus. Pediatrics 1987;79:475-8.

2. Madge P, Paton JY, McColl JH, Mackie PLK. Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus. Lancet 1992;340:1079-83.

3. Anderson LJ, Parker RA, Strikas RL. Association between respiratory syncytial virus outbreaks and lower respiratory tract deaths of infants and young children. J Infect Dis 1990;161:640-6.

4. Hall CB, Powell KR, MacDonald NE, et al. Respiratory syncytial viral infection in children with compromised immune function. N Engl J Med 1986;315:77-81.

5. Hall CB, Kopelman AE, Douglas RG Jr, Geiman JM, Meagher MP. Neonatal respiratory syncytial virus infection. N Engl J Med 1979;300:393-6.

6. Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics 1988;82:199-203.

7. MacDonald NE, Hall CB, Suffin SC, Alexson C, Harris PJ, Manning JA. Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med 1982;307:397-400.

8. Sorvillo FJ, Huie SF, Strassburg MA, Butsumyo A, Shandera WX, Fannin SL. An outbreak of respiratory syncytial virus pneumonia in a nursing home for the elderly. J Infect Dis 1984;9:252-6.

9. Harrington RD, Hooton TM, Hackman RC, et al. An outbreak of respiratory syncytial virus in a bone marrow transplant center. J Infect Dis 1992;165:987-93. 10. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals. Infect Control 1983;4(suppl):245-325.

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