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Respiratory Virus Shedding in a Cohort of On-Duty Healthcare Workers Undergoing Prospective Surveillance

  • Jennifer C. Esbenshade (a1), Kathryn M. Edwards (a1), Adam J. Esbenshade (a1), Vanessa E. Rodriguez (a2), H. Keipp Talbot (a3), Marlon F. Joseph (a2), Samuel K. Nwosu (a4), James D. Chappell (a5), James E. Gern (a6), John V. Williams (a1) (a5) and Thomas R. Talbot (a3) (a7)...



Healthcare-associated transmission of respiratory viruses is a concerning patient safety issue.


Surveillance for influenza virus among a cohort of healthcare workers (HCWs) was conducted in a tertiary care children's hospital from November 2009 through April 2010 using biweekly nasal swab specimen collection. If a subject reported respiratory symptoms, an additional specimen was collected. Specimens from ill HCWs and a randomly selected sample from asymptomatic subjects were tested for additional respiratory viruses by multiplex polymerase chain reaction (PCR).


A total of 1,404 nasal swab specimens were collected from 170 enrolled subjects. Influenza circulated at very low levels during the surveillance period, and 74.2% of subjects received influenza vaccination. Influenza virus was not detected in any specimen. Multiplex respiratory virus PCR analysis of all 119 specimens from symptomatic subjects and 200 specimens from asymptomatic subjects yielded a total of 42 positive specimens, including 7 (16.7%) in asymptomatic subjects. Viral shedding was associated with report of any symptom (odds ratio [OR], 13.06 [95% confidence interval, 5.45–31.28]; P< .0001) and younger age (OR, 0.96 [95% confidence interval, 0.92–0.99]; P = .023) when controlled for sex and occupation of physician or nurse. After the surveillance period, 46% of subjects reported working while ill with an influenza-like illness during the previous influenza season.


In this cohort, HCWs working while ill was common, as was viral shedding among those with symptoms. Asymptomatic viral shedding was infrequent but did occur. HCWs should refrain from patient care duties while ill, and staffing contingencies should accommodate them.


Corresponding author

A-2200 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232 (


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1.Englund, JA. Diagnosis and epidemiology of community-acquired respiratory virus infections in the immunocompromised host. Biol Blood Marrow Transplant 2001;7(suppl):2S4S.
2.Mlinaric-Galinovic, G, Varda-Brkic, D. Nosocomial respiratory syncytial virus infections in children's wards. Diagn Microbiol Infect Dis 2000;37(4):237246.
3.Thorburn, K, Kerr, S, Taylor, N, van Saene, HK. RSV outbreak in a paediatric intensive care unit. J Hosp Infect 2004;57(3):194201.
4.Campbell, AP, Chien, JW, Kuypers, J, et al.Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT. J Infect Dis 2010;201(9):14041413.
5.Whimbey, E, Englund, JA, Couch, RB. Community respiratory virus infections in immunocompromised patients with cancer. Am J Med 1997;102(3A):1018; discussion, 25–16.
6.Peck, AJ, Englund, JA, Kuypers, J, et al.Respiratory virus infection among hematopoietic cell transplant recipients: evidence for asymptomatic parainfluenza virus infection. Blood 2007;110(5): 16811688.
7.Elder, AG, O'Donnell, B, McCruden, EA, Symington, IS, Carman, WF. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993–4 epidemic: results of serum testing and questionnaire. BMJ 1996;313(7067):12411242.
8.Lau, LL, Cowling, BJ, Fang, VJ, et al.Viral shedding and clinical illness in naturally acquired influenza virus infections. J Infect Dis 2010;201(10):15091516.
9.Patrozou, E, Mermel, LA. Does influenza transmission occur from asymptomatic infection or prior to symptom onset? Public Health Rep 2009;124(2):193196.
10.Carrat, F, Vergu, E, Ferguson, NM, et al.Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol 2008;167(7):775785.
11.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guide-lines for preventing health-care–associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Morb Mortal Wkly Rep 2004;53(RR-3):136.
12.Widera, E, Chang, A, Chen, HL. Presenteeism: a public health hazard. J Gen Intern Med 2010;25(11):12441247.
13.Rosvold, EO, Bjertness, E. Physicians who do not take sick leave: hazardous heroes? Scand J Public Health 2001;29(1):7175.
14.Letvak, SA, Ruhm, CJ, Gupta, SN. Original research: nurses' presenteeism and its effects on self-reported quality of care and costs. Am J Nurs 2012;112(2):3038.
15.Jena, AB, Baldwin, DC JrDaugherty, SR, Meltzer, DO, Arora, VM. Presenteeism among resident physicians. JAMA 2010;304(11): 11661168.
16.Perkin, MR, Higton, A, Witcomb, M. Do junior doctors take sick leave? Occup Environ Med 2003;60(9):699700.
17.Bellei, N, Carraro, E, Perosa, AH, Benfica, D, Granato, CF. Influenza and rhinovirus infections among health-care workers. Respirology 2007;12(1):100103.
18.Self, WH, Grijalva, CG, Zhu, Y, et al.Emergency department visits for influenza A(H1N1)pdm09, Davidson County, Tennessee, USA. Emerg Infect Dis 2012;18(5):863865.
19.Wilde, JA, McMillan, JA, Serwint, J, Butta, J, O'Riordan, MA, Steinhoff, MC. Effectiveness of influenza vaccine in health care professionals: a randomized trial. JAMA 1999;281(10):908913.
20.Lee, WM, Grindle, K, Pappas, T, et al.High-throughput, sensitive, and accurate multiplex PCR-microsphere flow cytometry system for large-scale comprehensive detection of respiratory viruses. J Clin Microbiol 2007;45(8):26262634.
21.Olenec, JP, Kim, WK, Lee, WM, et al.Weekly monitoring of children with asthma for infections and illness during common cold seasons. J Allergy Clin Immunol 2010;125(5):10011006.
22.Foy, HM, Cooney, MK, Allan, ID, Albrecht, JK. Influenza B in households: virus shedding without symptoms or antibody response. Am J Epidemiol 1987;126(3):506515.
23.Frank, AL, Taber, LH, Wells, CR, Wells, JM, Glezen, WP, Paredes, A. Patterns of shedding of myxoviruses and paramyxoviruses in children. J Infect Dis 1981;144(5):433441.
24.Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42(2):377381.
25.Interim results: influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination coverage among health-care personnel—United States, August 2009–January 2010. MMWR Morb Mortal Wkly Rep 2010;59(12):357362.
26.Ison, MG, Hayden, FG, Kaiser, L, Corey, L, Boeckh, M. Rhinovirus infections in hematopoietic stem cell transplant recipients with pneumonia. Clin Infect Dis 2003;36(9):11391143.
27.Ghosh, S, Champlin, R, Couch, R, et al.Rhinovirus infections in myelosuppressed adult blood and marrow transplant recipients. Clin Infect Dis 1999;29(3):528532.
28.Wang, Z, Malanoski, AP, Lin, B, et al.Broad spectrum respiratory pathogen analysis of throat swabs from military recruits reveals interference between rhinoviruses and adenoviruses. Microbiol Ecol 2010;59(4):623634.
29.Miller, EK, Williams, JV, Gebretsadik, T, et al.Host and viral factors associated with severity of human rhinovirus-associated infant respiratory tract illness. J Allerg Clin Immunol 2011;127(4):883891.
30.Kreijtz, JH, Fouchier, RA, Rimmelzwaan, GF. Immune responses to influenza virus infection. Virus Res 2011;162(1–2):1930.
31.Moss, P. Cellular immune responses to influenza. Dev Biol 2003;115:3137.
32.Gerth, HJ, Gruner, C, Muller, R, Dietz, K. Seroepidemiological studies on the occurrence of common respiratory infections in paediatric student nurses and medical technology students. Epidemiol Infect 1987;98(1):4763.

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Respiratory Virus Shedding in a Cohort of On-Duty Healthcare Workers Undergoing Prospective Surveillance

  • Jennifer C. Esbenshade (a1), Kathryn M. Edwards (a1), Adam J. Esbenshade (a1), Vanessa E. Rodriguez (a2), H. Keipp Talbot (a3), Marlon F. Joseph (a2), Samuel K. Nwosu (a4), James D. Chappell (a5), James E. Gern (a6), John V. Williams (a1) (a5) and Thomas R. Talbot (a3) (a7)...


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