Long focus of respiratory diseases and pneumonia formed in Birobidzhan asylum for psychoneurological patients in March-April 2018

Aim. Etiological diagnosis and epidemiological evaluation of long lasting and massive cite of respiratory infections and pneumonia developed in Birobidzhan asylum for psychoneurological patients (BAPP) during March-April of 2018.

Materials and methods. Epidemiological analysis of 166 people included 150 out of 523 patients of BAPP (28.7%) and 16 BAPP staff members. Pneumonia was registered in 36 out of 166 surveyed people (21.7%), acute respiratory viral infection and influenza was diagnosed in 130 people (78.3%). All infected people were hospitalized. Lethal cases were registered. PCR analysis was performed for all infected persons in order to identify nucleic acids of viral, atypical respiratory pathogens and several bacterial causative agents. Microbiological studies were performed using the classical method. Bacteriological examination of 26 staff members was performed as well as sanitary-bacteriological inspection of hospital environment (75 samples) and chemical analysis of disinfecting solutions (30 samples).

Results. Laboratory confirmed cases of influenza type B and A were revealed in 69 people (41.6%) out of 166 examined patients. Single cases of rhinovirus infection (0.6%) were identified. High levels of S. pneumoniae (55.6%) and H. influenzae (from 44.4 to 16.1% at different stages of the study) were detected. Bacteriological evaluation of 54 patients of BAPP revealed low levels of S. pneumoniae carriage (5.6%) and presence of H. influenzae (3.6%). S. aureus (37.0±6.6%), K. pneumoniae (9.3%), Candida spp. (24.1%) as well as single cases of Enterobacter spp., S. marcescens, Citrobacter spp., non-fermenting Grammnegative bacteria without markers of drug resistance were detected. Bacteriological and virological examination of two autopsy materials obtained from patients died from pneumoniae showed presence of influenza B RNA, DNA of S. pneumoniae and H. influenzaе in one case and К. pneumoniae that ESBL-produced in other. Strains of such type can be formed in hospital environment or in conditions of private community. Circulation of bacterial pathogens was surveyed in one of the institutions that provided medical aid for supervisees of the asylum. Laboratory examination of hospital personnel revealed clinically relevant pathogens (S. aureus, K. pneumoniae, Acinetobacter spp. without markers of drug resistance) in 11 out of 26 staff members (42.3%). Hospital environment evaluation showed presence of bacterial flora in 11.9% of samples including E. coli, A. baumannii and one strain of P. aeruginosa that produced carbapenemases. Violation of disinfection regimen was detected in 60% of disinfection solution samples that had reduced concentration of active agent. Revealed violations characterize hospital environment as potentially dangerous that can cause formation of healthcare-associated infections.

Conclusion. Foci of viral-bacterial respiratory infections and pneumonia had developed in BAPP. Presence of multiple risk factors among supervised group of people determined large-scale involvement and duration of the outbreak involving supervisees and personnel of the asylum. Repeated hospitalization of patients in hospitals of the city in which several factors that presumably contributed to formation of healthcare-associated infections played an important role in sustaining the epidemiological process.

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