Enigmatic wave of infection at the cancer ward

Numerous RSV infections at the University of Heidelberg

23/01/2012

At Heidelberg University Hospital, a mysterious accumulation of infections with the so-called RS virus has occurred. The usually rather harmless pathogens can have life-threatening consequences in children and patients with weakened immune systems. According to the clinic, three patients may have already died from an infection with the virus.

The RS virus (respiratory syncytial virus, RSV) causes in humans with intact immune system usually only a harmless cold. But for the already weakened patients in the hospital threaten far worse health problems. Accordingly, the spread of the pathogens at the University Hospital Heidelberg should be assessed critically. Since the beginning of the year 19 patients had been diagnosed with two cancer centers and the intensive care unit with the RS virus. Although a spokeswoman for the clinic stressed that the situation was under control and no patients were threatened, she also had to admit that „in three patients who died during this period, the pathogen was found“ has been. According to the clinic spokeswoman „a causal connection“ between the deaths and the RS virus therefore „not be excluded“.

RS virus is especially dangerous for children and weakened immune systems
The accumulation of infections with the RS virus at the University Hospital of Heidelberg is extremely unusual, according to the clinic spokeswoman and only „Individual cases would be normal“. For the causes of the wave of infection, however, there are no further findings. The RSV infections have been reported to the Public Health Office in accordance with the provisions of the Infection Protection Act. At the same time, the hospital has initiated extensive investigations into possible transmission routes in order to prevent further infections. The RS viruses belong to the family Paramyxoviridae, which also includes measles and mumps virus. They are more likely to cause common colds, but are also considered to be one of the most common causes of lower respiratory tract infections and pneumonia in infants and toddlers. In addition, the viruses often cause severe respiratory infections, especially in older, weakened patients. Most commonly, children under the age of two and babies under six months are usually affected. Complications and severe illnesses occur especially in young children but also in patients with weakened immune systems and previous diseases of the lungs or heart.

Accumulation of RSV infections at the university hospital extremely critical
Therefore, a spread of RS viruses at the University of Heidelberg is particularly critical. Here, the RSV infections were detected at the three wards of the Department of Hematology, Oncology and Rheumatology, where mostly seriously ill patients are treated with various forms of blood cancer. The medical director of the hospital, Professor Anthony Ho, explained that here „Some patients have stem cell transplantation or chemotherapy“ get and „her immune system is no longer intact“ be. Accordingly, that is „Risk of developing severe pneumonia“, significantly increased, so the statement of the physician. In particularly severe disease can also „Ventilation may be required“, why the three deceased patients were last treated in the Intensive Care Unit of the Department of Gastroenterology, Ho explained.

Possible link between RSV infections and three deaths
The extent to which there is a connection between the deaths and the spread of RS viruses at the University Hospital Heidelberg has not yet been clarified. As the medical director Professor Anthony Ho emphasized: „It is unclear whether the RSV infection was the cause of the dying of critically ill patients, because the patients have many problems, but it can not be ruled out.“ Also, the infection route remains unclear. The RS viruses are transmitted by droplet infection, whereby the pathogens, for example, when coughing or sneezing as aerosol (tiny droplets in the air) can be passed from human to human. Even with close skin contact with infected persons, there is a significantly increased risk of transmission. Most of the pathogens then enter the body via the nasal mucosa or the conjunctiva of the eye, where they nest and multiply on the mucous membranes of the respiratory tract. According to the experts, the incubation period is about two to eight days after contact with the RS virus.

Search for the causes of RSV infections
In order to find out more about the spread of the RS virus, the clinic management of the Heidelberg University Hospital ordered a test for the virus from 200 hospital employees and around 70 patients. However, according to the statement of the clinic spokeswoman was just discovered another case, which is a „weakly infected“ Employees who are not currently on duty. The result of a second test is expected in the coming days. In addition, additional hygiene measures were set in order to avoid further spread of the pathogens. „We have done everything we can to break the chain of infection and protect other patients and employees“, emphasized the Medical Director of the University Hospital Heidelberg, Peter Nawroth.

Additional hygiene measures to interrupt the infection chain
For example, the infected patients were isolated, the staff received special masks, and people with respiratory infections were refused a visit. Furthermore, the clinic administration ordered a recording stop for patients who do not necessarily need surgery. An interruption of the infection chain „seems to have succeeded“, because since 17 January 2012, no further infections have occurred, said Peter Nawroth. However, to date „somewhere a dissemination have taken place“, explained the clinic spokeswoman. The cause of the spread of RS viruses at the cancer ward of the University Hospital remains completely open despite the apparently successful containment. Therefore, the University Hospital has requested the experts of the Robert Koch Institute (RKI). These are supposed to help to get to the root of the infection wave. (Fp)

Picture: Electron micrograph of a respiratory syncytial virus (RSV)