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SFTS virus may be transmitted via aerosols
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The virus that causes severe fever with thrombocytopenia syndrome, or SFTS, may have been transmitted person-to-person via aerosols at a hospital in South Korea, indicating that airborne precautions should be added to standard precautions to prevent nosocomial spread of the virus, researchers said.
SFTS was first isolated in 2009 in China and reported in The New England Journal of Medicine in 2011, but the virus has been circulating longer than that, having been retrospectively identified as the cause of previously unexplained illnesses in multiple studies.
According to Jaeyoung Moon, MD, and colleagues from Korea University Ansan Hospital and the Korean CDC, the virus is mainly spread through the bite of infected ticks, although human-to-human transmission also has been reported and mostly occurs through direct blood exposure.
“A recent outbreak of SFTS in a Korean hospital suggests possible droplet transmission. In China, probable aerosol transmission in a family cluster has also been reported,” Moon and colleagues wrote in Infection Control & Hospital Epidemiology. “Considering the increasing incidence and high overall case fatality ratio (approximately 32.6%) of SFTS in Korea, better understanding the mode of SFTS transmission is essential for infection control.”
According to Moon and colleagues, in September 2017, the hospital in Ansan confirmed a case of SFTS in a 57-year-old man with evidence of a tick bite on his back who reported collecting mushrooms on a mountain 10 days before illness onset. Laboratory tests revealed leukopenia, thrombocytopenia and elevated levels of aspartate transaminase, alanine transaminase and creatine phosphokinase, Moon and colleagues said.
According to their report, the patient experienced hypersomnia and disorientation and was transferred to the ICU, where standard and contact precautions were implemented. He was intubated for mechanical ventilation but died due to multiorgan failure.
Of the 14 health care workers who had contact with the patient, two developed confirmed or suspected SFTS infection, according to Moon and colleagues. The first was a 31-year-old male physician who attempted to perform an endotracheal intubation with frequent orotracheal suctions for the index patient, they explained. His contact with the index patient lasted less than 10 minutes, and he wore a fluid-shield mask and gloves during the procedure, although this does not protect the conjunctiva or upper respiratory tract, Moon and colleagues noted. The second case was in a 26-year-old male mortuary beautician who did not wear gloves or a mask during exposure to the index patient. Neither of the patients reported recent outdoor activity.
Moon and colleagues suggested that the physician was infected via aerosols “generated from suctions of oral bleeding during endotracheal intubation,” whereas the mortuary beautician may have been infected via direct contact with the index patient’s blood.
“This case supports the hypothesis that a fatally ill patient with high viral loads of SFTS may be highly contagious by releasing viable pathogen through small-particle aerosols,” they wrote. “Therefore, additional airborne precautions such as particulate respirator (N95 mask or equivalent), a face shield, and negative pressure ventilation may be needed during aerosol-generating procedures for SFTS patients, especially fatally ill patients with high viral loads.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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