Parainfluenza III Outbreak in a Veterans’ Affairs affiliated Nursing Home

Abstract

BACKGROUND Parainfluenza III is one of the four serotypes of the parainfluenza virus (PIV) that causes upper respiratory tract infections (URI) in adults. Clinical presentation can range from mild URI to pneumonia, to death. We report a cluster of respiratory illness due to PIV III in a Community Living Center, (CLC) Nursing Unit. METHODS An outbreak of PIV III URI occurred at a VAMC CLC - 30 bed unit in June 2018. Cases were confirmed via nasopharyngeal respiratory viral real-time PCR panel. Case definition included a resident with new onset respiratory complaints and positive PCR test. Clinical presentation, laboratory data and outcome were reviewed in each case. RESULTS Ten residents tested positive for PIV III from 6/2 to 6/26, 2018. All residents were men with ages ranging from 59 to 84?years. The index case occurred on 6/2 with temperature of 102.30F. Thereafter, a health care provider presented with symptoms of URI but continued to work. The Infection control team was notified on five cases detected on 6/12; 4 cases were detected 6/18 to 6/26. One patient required hospitalization due to post-viral bacterial pneumonia. No deaths occurred. Five healthcare providers presented with symptoms of URI during this outbreak. Aggressive infection control measures were implemented: temporally halting admissions; high index of suspicion for symptomatic patients with obtaining viral panel; encouraging them to remain in their room; and teaching respiratory etiquette; enforcing hand hygiene and symptomatic patients leaving the nursing unit had to wear a mask; terminal cleaning of virus-contaminated surfaces/objects; discouraging floating of staff, directing ill employees to stay home. CONCLUSIONS PIV III can cause a serious outbreak in nursing homes. Therefore, Infection Control Preventionists can have an instrumental role in rapid recognition of an outbreak and strategically implementing targeted measures to halt the outbreak.