• Daniella Gregoria Bomfim Prado da Silva, Flávia Jacqueline Almeida, Mariana Volpe Arnoni, Marco Aurélio Palazzi Sáfadi, Marcelo Jenne Mimica, Daniel Jarovsky, Gabriela Pereira de Almeida Rossetti, Mauricio Magalhães, Danielle Bruna Leal de Oliveira, Luciano Matsumiya Thomazelli, Thais Cristina Colmanetti, Edison Luiz Durigon, and Eitan Naaman Berezin.
• Santa Casa de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil.
• J Pediatr (Rio J). 2020 Mar 1; 96 (2): 233-239.

ObjectiveRespiratory syncytial virus is a pathogen frequently involved in nosocomial outbreaks. Although several studies have reported nosocomial outbreaks in neonatal intensive care units, molecular epidemiology data are scarce. Here, the authors describe two consecutive respiratory syncytial virus outbreaks caused by genotypes ON-1 and NA-2 in a neonatal intensive care unit in São Paulo, Brazil.MethodsA prospective search for respiratory syncytial virus was performed after diagnosing the index case and four other symptomatic newborns in the neonatal intensive care unit. Nasopharyngeal aspirate samples of all patients in the neonatal intensive care unit were tested for 17 respiratory viruses using real-time reverse transcriptase polymerase chain reaction. Genotyping was performed using nucleotide sequencing.ResultsFrom May to August 2013, two different outbreaks were detected in the neonatal intensive care unit. A total of 20 infants were infected with respiratory syncytial virus-A (ten and 14 with ON-1 and NA-2 genotypes, respectively). The mean age of the infants was 10 days, mean birth weight was 1,961g, and the mean gestational age was 33 weeks. Risk factors (heart disease, lung disease, and prematurity) were present in 80% and 85.7% of infants in the ON-1 and NA-2 groups, respectively. In total, 45.8% of infants were asymptomatic and 20.8% required mechanical ventilation. Coinfections were not detected during the outbreaks.ConclusionsInfants in a neonatal intensive care unit who develop abrupt respiratory symptoms should be tested for respiratory viruses, especially respiratory syncytial virus. Even in the absence of severe symptoms, respiratory syncytial virus detection can prevent nosocomial transmission through infection control measures. A better understanding of respiratory syncytial virus molecular epidemiology is essential for developing new vaccines and antiviral drugs against respiratory syncytial virus.Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

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