Abstract
Background: Norovirus outbreaks in hospital settings are a common challenge for infection prevention teams. Given the high burden of norovirus in most communities, it can be difficult to distinguish between ongoing in-hospital transmission of the virus and new introductions from the community, and it is challenging to understand the long-term impacts of outbreak-associated viruses within medical systems using traditional epidemiological approaches alone. Methods: Real-time metagenomic sequencing during an ongoing norovirus outbreak associated with a retrospective cohort study. Results: We describe a hospital-associated norovirus outbreak that affected 13 patients over a 27-day period in a large, tertiary, pediatric hospital. The outbreak was chronologically associated with a spike in self-reported gastrointestinal symptoms among staff. Real-time metagenomic next-generation sequencing (mNGS) of norovirus genomes demonstrated that 10 chronologically overlapping, hospital-acquired norovirus cases were partitioned into 3 discrete transmission clusters. Sequencing data also revealed close genetic relationships between some hospital-acquired and some community-acquired cases. Finally, this data was used to demonstrate chronic viral shedding by an immunocompromised, hospital-acquired case patient. An analysis of serial samples from this patient provided novel insights into the evolution of norovirus within an immunocompromised host. Conclusions: This study documents one of the first applications of real-time mNGS during a hospital-associated viral outbreak. Given its demonstrated ability to detect transmission patterns within outbreaks and elucidate the long-term impacts of outbreak-associated viral strains on patients and medical systems, mNGS constitutes a powerful resource to help infection control teams understand, prevent, and respond to viral outbreaks.
Original language | English (US) |
---|---|
Pages (from-to) | 941-948 |
Number of pages | 8 |
Journal | Clinical Infectious Diseases |
Volume | 69 |
Issue number | 6 |
DOIs | |
State | Published - Aug 30 2019 |
Externally published | Yes |
Keywords
- hospital epidemiology
- infection prevention
- metagenomic next generation sequencing
- norovirus
- outbreak
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases