• Acute respiratory illness (ARI) is a common problem among healthcare personnel (HCP) that results in transmission and lost work time.

• The burden of coronavirus, rhinovirus, respiratory syncytial virus (RSV), metapneumovirus, adenovirus, influenza, and parainfluenza in this population is poorly studied.

• Given the paucity of data, the causes of respiratory disease were investigated in the context of a cluster randomized clinical trial among HCPs in outpatient settings.

• In a national cluster-randomized clinical trial, ARI among HCP was assessed.

Overall 5,269 HCP at 7 sites participated in the study over the past four respiratory seasons. More participants were enrolled each year which increased the number of swabs collected. 1,394 were collected in Year 1, 2,702 in Year 2, 3,422 in Year 3, and 4,047 in Year 4.

METHODS

RESULTS: SWAB COLLECTION

Acute Respiratory Viral Infection Among Outpatient Healthcare PersonnelAmanda Krosche, BS1; Mary Bessesen, MD2; Alexandria Brown, PhD3; Derek Cummings, PhD, MPH, MSc4; Charlotte Gaydos, DrPH, MPH, MS1; Cynthia Gibert, MD, MSc5; Geoffrey Gorse, MD6; Ann-Christine Nyquist, MD,

MSPH7; Connie Price, MD8; Lewis Radonovich, MD9; Nicholas Reich, PhD3; Maria Rodriguez-Barradas, MD10; Michael Simberkoff, MD11; and Trish M Perl, MD, MSc, FIDSA1; for the ResPECT Study Team*1Johns Hopkins University School of Medicine, Baltimore, MD; 2VA-Eastern Colorado Healthcare System, Denver, CO; 3University of Massachusetts, Amherst, MA; 4University of Florida, Gainseville, FL, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 5Washington DC VA Medical Center, Washington, DC; 6VA St. Louis Health Care System, St. Louis University School of Medicine, St. Louis, MO; 7Children’s Hospital Colorado, Aurora, CO; 8Denver Health Medical Center, Denver, CO; 9North Florida/South Georgia Veterans Health System, Gainesville, FL; 10Michael E. DeBakey VA Medical Center, Houston, TX; 11New York Harbor Healthcare System, New York, NY;

*The ResPECT Study Team (alphabetically): Jill Adams, BSN, BA; Tamara Blevins, BS; Megan Brocato, BA; Laura Chopko, BA; Madeline Dansky, BA; Aaron Eagan, RN, BSN; Ed Fisher, MS; Benedict J. Frederick, BA;

Erron Fritchman-Palmer, MPH; Armandina Garza, BS; Justin Getka, BA; Kaitlin Gorman, BS; Andre Hackman, BA; Kelly Haines, MSW, MPH; Tina Hoang, MS; Amy Irwin, DNP, RN; Barbara Kertz, MS; Shannon Kingery,

BS; Caitlin Langhorne, MPH; Scott Laverie; Justin Lessler, PhD, MS; Melanie Lipka, BS; Jenna Los, MLA; Mahwish Mushtaq, MD, MPH; GiraPatel, MS; Kathleen Peoples, BA; Virginia Courtney Pike, BA; Kathleen Pulice, BS; Christine Reel-Brander, RN; Ronald Shaffer, PhD; Michael

Sherman; Courtney Southard, MPH; Nicole Spector, BA; Michael Tsang, MSc, PhD; Blanca Vargas, MD; Yinyi Yu, BS; Casey Brown Zarian, BS, RN

• In a cluster, randomized clinical trial (ResPECT), HCP in outpatient clinics and emergency departments at 7 institutions in 4 geographically distinct regions of the US were enrolled after providing informed consent.

• Participants enrolled worked >24 hours per week and had extensive patient contact.

• Each study period lasted twelve weeks. To capture the peak of respiratory season, each study period began when a pre-defined number of flu were confirmed cases in one week.

• Pre and post- winter respiratory virus season sera were collected and tested for influenza virus antibodies by hemagglutination inhibition (HAI) assay. A 4-fold or greater increase in antibody titer comparing post to pre-season sera to influenza A/H1N1, A/H3N2, and B/Massachusetts and/or B/Brisbane-like viruses indicated intercurrentinfluenza infection. Pre-season sera were to be collected at least 2 weeks after influenza vaccination.

• HCP recorded symptoms of ARI in an online survey. Recorded symptoms triggered an alert and nasal/throat samples were obtained from the HCP then stored at -80C.

• Participants were randomly swabbed twice during the study period.

• Samples were tested using a multiplex PCR that tests for 13 viruses. Major viruses included influenza A and B, adenovirus, parainfluenza 1-3, metapneumovirus, RSV, rhinovirus, and coronavirus.

Figure 2. Symptomatic swabs collected per year per week.

UPDATED ABSTRACT

Background: Acute respiratory illness (ARI) causes morbidity among healthcare providers (HCP). However, the causes of ARI in this high-risk population are not well studied. Over the last 4 respiratory illness seasons, we assessed the viral causes of respiratory illness among HCP working in the outpatient setting enrolled in a cluster, randomized clinical trial at 115 outpatient departments and emergency departments in 7 geographic locations across the US.

Methods: Over a 12-week respiratory season, HCP were surveyed for signs and symptoms of ARI. HCP with symptoms had nasal/throat samples obtained and frozen at -80oC. Two randomized asymptomatic swabs were also obtained from each participating HCP during the respiratory season. Samples were tested for 13 viruses by RT-PCR/ESI-MS. Paired blood samples were obtained for influenza antibodies (>4-fold antibody increase).

Results: Among 5,269 participants (682 YR1; 1,201 YR2; 1,556 YR3; 1,830 YR4), 11,565 swabs were obtained (1,394 YR1; 2,702 YR2; 3,422 YR3; 4,047 YR4). Influenza-like-illness (ILI) rates during the study are: 40% YR1; 48% YR2; 44% YR3; 42% YR4. To date, 2,835 symptomatic (288 YR1; 702 YR2; 865 YR3; 980 YR4) and 6,794 asymptomatic (1,043 YR1; 1,987 YR2; 2,483 YR3; 1,281 YR4) have been tested. Nineteen percent of all participants and 38% of participants who had at least one symptomatic swab tested positive. Combined swab and serology results revealed the following viral causes of ARI: 28% coronavirus, 26% rhinovirus, 25% influenza A , 8% influenza B, 8% respiratory syncytial virus (RSV), 3% metapneumovirus, 1% parainfluenza, and 1% adenovirus. Of the total 32% influenza positives, 63% were identified through serology alone.

Conclusion: ARIs are common among high risk HCP with 40% developing symptoms during the respiratory viral season and 28% of those symptomatic swabs having identifiable viral causes – most commonly (37%) coronavirus. Four percent of asymptomatic HCP had an identifiable virus. Identification of viruses in HCP that cause morbidity to patients is critical to patient safety and prevention efforts.

BACKGROUND

All testing for years 1-3 is complete, but testing for year 4 is ongoing. Year 4 serology is 55% complete, symptomatics are 89% complete, and asymptomatics are 43% complete. The results presented are what is currently complete.

Figure 5. Virus prevalence in all positive swabs. Of the 9,629 swabs tested, 1,084 (11%) tested positive for one of eight viruses.

Figure 3. Virus prevalence in symptomatic participants.Of the swabs tested, 2,835 (29%) were symptomatic, and 796 (28%) of these tested positive for one of eight viruses.

Figure 4. Virus prevalence in asymptomatic participants. Of the swabs tested, 6,794 (71%) were asymptomatic, and 288 (4%) of these tested positive for one of eight viruses.

RESULTS: SWAB PATHOGEN BREAKDOWN

Funded by the Centers for Disease Control and PreventionFunded by Veterans Health Administration, National Center for Occupational Health and Infection Control

CONCLUSIONS

• 40% of outpatient HCP developed ARI symptoms during the respiratory viral season: 28% had viral causes identified.

• Viral pathogens were identified in 4% of asymptomatic HCP.

• Number of symptomatic swabs collected was highest mid-study each year, indicating that the height of the respiratory season was successfully captured by each year of the study.

• The most common virus identified in symptomatic swabs was coronavirus, 37% of positive swabs. Rhinovirus was most commonly identified in asymptomatic swabs at 45%.

• An additional 279 cases of influenza were identified through serology alone.

RESULTS: COMBINED SWABS & SEROLOGY

Figure 6. Influenza Testing: Viral and Serologic.287 cases of influenza were identified by serology alone.

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