Evolution of an adenovirus outbreak in a multidisciplinary children's hospital

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Abstract
Objective:  To describe the course of an evolving adenovirus outbreak in a multidisciplinary children's hospital with a high‐risk patient population.Methods:  Observational study in a 280‐bed university hospital during June 2002. Active case finding identified children with adenovirus infection. Data are median (interquartile range) or n (%). Adenovirus infection was diagnosed in 49 children, median age 12 months (4−33).Results:  New cases were diagnosed over 26 days and peaked on day 17 (n = 15). Total infected inpatients peaked on days 17−21 (n = 36). Twenty‐three infections (47%) were community‐acquired and 26 (53%) hospital‐acquired. Thirty‐three children (67%) had a coexistent high‐risk condition. Median hospital stay before and after diagnosis was 9 days (3−18) and 9 days (4−29), respectively. Twenty‐two children (45%) were admitted to PICU. Overall hospital mortality was 22% (n = 11) and mortality attributed to adenoviral disease 12% (n = 6). Hospital mortality was similar between community‐ and hospital‐acquired infections (22% compared to 23%) (P = 1.0). Twenty children (41%) received intravenous immunoglobulin (IVIG). Children treated with IVIG had a longer hospital stay (median 40 days vs 14 days) than those who did not receive IVIG (P = 0.01). Neither PICU mortality (29%vs 12%), nor hospital mortality (35%vs 14%), differed significantly between IVIG treated and untreated children (P = 0.76 and P = 0.16, respectively).Conclusion:  The rapid spread of hospital‐acquired adenovirus underlines the importance of effective infection control measures. Despite nosocomial infection amongst high‐risk patients, mortality was similar to that of community‐acquired infection. Administration of immunoglobulin was not associated with demonstrable benefit. A prospective randomized trial would be required to resolve this issue.