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Respiratory Syncytial Virus Outbreak in a Long-Term Care Facility Detected Using Reverse Transcriptase Polymerase Chain Reaction: An Argument for Real-Time Detection Methods

Authors

  • L. Brett Caram MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Jodi Chen MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • E. William Taggart BS,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • David R. Hillyard MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Rosemary She MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Christopher R. Polage MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Jack Twersky MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Kenneth Schmader MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Cathy A. Petti MD,

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Christopher W. Woods MD, MPH

    1. From the *Division of Infectious Diseases, Duke University Medical Center, and Infectious Diseases Section, Durham Veterans Affairs Medical Center, Durham, NCDepartment of Medicine, Duke University Medical Center, Durham, North CarolinaHealth Sciences Center§ARUP Laboratories, University of Utah, Salt Lake City, Utah; and Division of Geriatrics, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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Address correspondence to L. Brett Caram, Service 111-H, Durham VA Medical Center, Durham, NC 27705. E-mail: caram001@mc.duke.edu

Abstract

OBJECTIVES: To report an outbreak of respiratory synctyial virus (RSV) in a long-term care facility (LTCF) during ongoing routine respiratory illness surveillance.

DESIGN: Rapid antigen testing, viral culture, direct fluorescent antibody (DFA) testing, and reverse transcriptase polymerase chain reaction (RT-PCR) testing for up to 15 viruses in symptomatic residents and chart review.

SETTING: A 120-bed LTCF.

MEASUREMENTS: Comparison of rapid antigen testing, respiratory viral cultures, and DFA testing and RT-PCR in residents with symptoms of a respiratory tract infection.

RESULTS: Twenty-two of 52 residents developed symptoms of a respiratory tract infection between January 29, 2008, and February 26, 2008. RSV was detected using RT-PCR in seven (32%) of the 22 cases. None of the seven cases had positive RSV rapid antigen testing, and only two had positive culture or DFA results. This outbreak occurred during a time when state wide RSV rates were rapidly declining. One patient was admitted to the hospital during the infection and subsequently died.

CONCLUSION: RSV may cause outbreaks in LTCFs that traditional diagnostic methods do not detect. RT-PCR can provide a more timely and accurate diagnosis of outbreaks, which allows for early symptomatic treatment, rational use of antibiotics, and improved infection control.

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