Does universal screening of all incoming pediatric patients – even those without classic symptoms – prevent significantly the spread of respiratory viruses in the hospital? Hopkins Children’s infectious disease specialist Aaron Milstone and Johns Hopkins virologist Alexandra Valsamakis are looking for answers, using data and nose-swab samples collected during a recent flu season.
For the cold and flu season of 2007-2008, every child admitted to Hopkins Children’s infant and toddler inpatient unit received a nasal swab. The samples were tested for respiratory viruses. Nearly 10 percent of the children subsequently identified as having a virus appeared a-symptomatic. They were kept separate at admission from those children who were virus-free, as are all children whose hallmark respiratory symptoms –a cough, sneezing and runny nose – identify them as having a virus such as influenza and respiratory syncytial virus (RSV). With implementation of the universal screening, the hospital reported the lowest incidence number of hospital-acquired RSV in ten years.
With a recent grant from the R Baby Foundation, Milstone and Valsamakis are evaluating the 2007-2008 data, and looking at the cost of the gathering and testing viral samples against the risk of transmission. They expect their follow-up of the original study, “Detection of Respiratory Viruses in Nasal Aspirates of Infants Hospitalized for Reasons Other than Influenza-Like Illness: Implications for Prevention of Nosocomial Viral Transmission,” to identifying the benefits and risks of universal screening.
“Hopkins Children’s implemented the initial universal screening, which continues today, because there were concerns that kids with atypical symptoms were being missed,” says Milstone, a member of Johns Hopkins Hospital Epidemiology and Infection Control (HEIC) Committee. “These very young children are just, as an age group, a cesspool for respiratory viruses. So they were our focus.”
New diagnostic tests can identify viruses by identifying their specific genes, such as those for the RHINO virus (the common cause of the common cold), enteroviruses and coronaviruses (SARS, for example). “Buy further studying these children, we can characterize what viruses are coming into the hospital,” says Milstone. “We are very focused on preventing the transmission of RSV and influenza, for example. Now, with these very sensitive new tests, we can equally identify many other viruses, even if the symptoms are not obvious”
The researchers will also study the clinical spectrum of multiple viruses, to identify their earliest presenting symptoms. “A goal is to develop a new model of respiratory syndrome surveillance for doctors and other health care providers,” Milstone adds.
"The ultimate goal," says Phyllis Rabinowitz of the R Baby Foundation, is to "lower the risk and actuality of viral infections spreading throughout hospitals."