今日の臨床サポート

院内感染予防(隔離の必要な疾患とその緊急対応)(小児科)

著者: 新庄正宜 慶應義塾大学病院 小児科

監修: 渡辺博 帝京大学老人保健センター

著者校正/監修レビュー済:2021/03/17
参考ガイドライン:
患者向け説明資料

概要・推奨   

  1. いずれの患者に対しても、標準予防策を実施する。加えて、感染経路に適した感染対策を実施する必要がある(推奨度1)
  1. 医療従事者は、事前に麻疹・水痘・ムンプス・風疹の免疫を獲得しておくことが勧められる(推奨度1)
  1. 医療従事者には、シーズン前にインフルエンザワクチンを接種しておくことが勧められる(推奨度1)
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
新庄正宜 : 特に申告事項無し[2021年]
監修:渡辺博 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行い、ガイドライン更新と関連する内容について加筆修正を行った。
  1. 新型コロナウイルス感染症(COVID-19)についてはここでは触れない。

まとめ

まとめ  
  1. 小児科診療において、隔離の必要な感染性疾患として、麻疹、水痘、風疹などの発疹性疾患、流行性耳下腺炎(ムンプス)、百日咳、インフルエンザ、RSウイルスによる呼吸器系疾患、ノロウイルス、ロタウイルスによる消化器系疾患などが挙げられる(小児で隔離の必要な主な疾患 >詳細情報 、各疾患の臨床的特性 >詳細情報 、各疾患の感染様式・潜伏期・感染性のある期間 >詳細情報 )。
  1. 麻疹、水痘は空気感染するため、個室(可能な限り陰圧)に収容、その他は可能な限り個室で対応する(各疾患の感染様式・潜伏期・感染性のある期間 >詳細情報 )。
  1. 突然の院内発症が起きた場合には、発端者を隔離・治療し、接触者リストを作成したうえ疾患によっては接触後予防を施し、二次発症者がいないかをサーベイランス(監視)する(病棟で突発的な感染症の発生~具体的な対応 >詳細情報 )。
  1. 麻疹、水痘、百日咳、インフルエンザの患者と接触した場合には、予防投与(ワクチンあるいは抗微生物薬)が有効である。
  1. 医療従事者は、事前に予防できる疾患の免疫を獲得しておくことが必要である。
 
  1. ロタウイルスワクチンで、ロタウイルスの流行全体を抑制することにより、結果的に院内感染の発症を減らすことが望まれる(推奨度1O(参考文献:[1]
  1. 米国では、ロタウイルスワクチンの導入により、2003~07年と比較して2007~08年には1年あたりのロタウイルス市中感染入院が82%(入院100件あたり1.62から0.28へ)、病院感染入院が62%(0.53 /1000 patient-daysから0.20へ)減少した。
  1. しかし、この間手指衛生の順守率が改善しても、病院感染/市中感染の比率は下がることがなかった。
  1. 以上から、流行そのものを減らさなければ、病院感染を防ぐことは難しいことがわかる。
 
  1. 医療従事者は、事前に麻疹・水痘・ムンプス・風疹の免疫を獲得しておくことが勧められる(推奨度1JG
  1. 医療従事者が発症すると、重症化の可能性のみならず周りの患者や医療従事者への感染源となることから、免疫を獲得したうえで勤務する。
  1. 当該疾患に未罹患でワクチンにより免疫を獲得する場合の接種回数は、それぞれ2回を原則とする[2][3]
  1. 接種記録と罹患記録は、本人と医療機関の双方で保管する。
  1. これらの疾患の感染力は非常に強く、基本再生産数(R0)すなわち「感受性人口集団に侵入した感染者1人が、その全感染期間の間に生産する二次感染者の総数」は、麻疹においては12~21、水痘においては8~10、風疹においては6~9、ムンプスにおいては4~14と推測されている[4]
 
  1. 医療従事者には、シーズン前にインフルエンザワクチンを接種しておくことが勧められる(推奨度1JG
  1. 接種不適当者に該当しない全医療関係者(の接種希望者)(妊婦や高齢者含む)を対象として、インフルエンザHAワクチンを毎年1回接種する[2][3]
  1. 追記:インフルエンザワクチンの効果は、ワクチン株と流行株の差異、接種年齢など、型によって大きく異なる。ワクチンを接種しても罹患することはあるため、特に流行期の標準予防策や飛沫予防策を徹底する。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: Evan J Anderson, Angela Rupp, Stanford T Shulman, Deli Wang, Xiaotian Zheng, Gary A Noskin
雑誌名: Pediatrics. 2011 Feb;127(2):e264-70. doi: 10.1542/peds.2010-1830. Epub 2011 Jan 24.
Abstract/Text OBJECTIVE: Data show that after the implementation of routine rotavirus vaccination for infants in the United States, community-acquired (CA) rotavirus cases declined substantially in the 2007-2008 season. The impact of community-based rotavirus vaccination on the substantial burden of hospital-acquired (HA) rotavirus has not been documented.
PATIENTS AND METHODS: We assessed CA and HA rotavirus, respiratory syncytial virus, and influenza infections at Children's Memorial Hospital for 5 winter seasons (defined as occurring from September through May) from 2003 to 2008. We also report rotavirus data from the 2008-2009 season.
RESULTS: A similar dramatic decline (>60% compared with the median of previous seasons) occurred in the rates of cases of both CA (P < .0001) rotavirus hospitalizations and HA (P < .01) rotavirus infections in the 2007-2008 season compared with previous seasons, whereas the rates of CA and HA influenza and respiratory syncytial virus, respectively, remained stable. Improvements in hand-hygiene compliance did not correlate with a reduction in the transmission rate of rotavirus in the hospital. Both CA and HA rotavirus rates remained much lower in the 2008-2009 than in the 2003-2007 seasons.
CONCLUSIONS: Community-based rotavirus vaccination is associated with a substantial reduction in the number of children who are admitted with rotavirus. These data also indicate that routine community-based rotavirus infant vaccination protects hospitalized children from acquiring rotavirus. Vaccination efforts should be encouraged as a strategy to affect the substantial burden of HA rotavirus.

PMID 21262887  Pediatrics. 2011 Feb;127(2):e264-70. doi: 10.1542/peds.・・・
著者: Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC)
雑誌名: MMWR Recomm Rep. 2011 Nov 25;60(RR-7):1-45.
Abstract/Text This report updates the previously published summary of recommendations for vaccinating health-care personnel (HCP) in the United States (CDC. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices [ACIP] and the Hospital Infection Control Practices Advisory Committee [HICPAC]. MMWR 1997;46[No. RR-18]). This report was reviewed by and includes input from the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee. These updated recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs. The recommendations for vaccinating HCP are presented by disease in two categories: 1) those diseases for which vaccination or documentation of immunity is recommended because of risks to HCP in their work settings for acquiring disease or transmitting to patients and 2) those for which vaccination might be indicated in certain circumstances. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. Certain infection-control measures that relate to vaccination also are included in this report. In addition, ACIP recommendations for the remaining vaccines that are recommended for certain or all adults are summarized, as are considerations for catch-up and travel vaccinations and for work restrictions. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies. The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term-care facilities (e.g., nursing homes and skilled nursing facilities); physician's offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services.

PMID 22108587  MMWR Recomm Rep. 2011 Nov 25;60(RR-7):1-45.
著者: Irene Barrabeig, Ariadna Rovira, Cristina Rius, Pilar Muñoz, Nuria Soldevila, Joan Batalla, Angela Domínguez
雑誌名: Pediatr Infect Dis J. 2011 Jan;30(1):78-80. doi: 10.1097/INF.0b013e3181f7001c.
Abstract/Text The effectiveness of measles vaccine for postexposure prophylaxis at educational centers was investigated. A total of 166 children who shared the classroom with 10 confirmed cases during the infectious period of cases were studied. Of total susceptible exposed children, 72% (54/75) were vaccinated and 25 contracted measles. Vaccine effectiveness in children vaccinated within 72 hours of exposure was 90.5% (95% confidence interval, 34%-99%).

PMID 20844460  Pediatr Infect Dis J. 2011 Jan;30(1):78-80. doi: 10.109・・・
著者: A Endo, H Izumi, M Miyashita, K Taniguchi, O Okubo, K Harada
雑誌名: J Pediatr. 2001 Jun;138(6):926-8. doi: 10.1067/mpd.2001.113710.
Abstract/Text We assessed results after postexposure prophylaxis against measles with immunoglobulin administered intramuscularly. Children were given 0.33 mL/kg of immunoglobulin from commercially available lots containing various titers of measles antibody within 5 days after exposure. In children receiving immunoglobulin with a titer of < or =16 IU/mL, 57% had clinically evident measles. Immunoglobulin preparations with higher measles antibody titers are required.

PMID 11391343  J Pediatr. 2001 Jun;138(6):926-8. doi: 10.1067/mpd.2001・・・
著者: Y Asano, H Nakayama, T Yazaki, R Kato, S Hirose
雑誌名: Pediatrics. 1977 Jan;59(1):3-7.
Abstract/Text A live varicella vaccine (Oka strain) was given to susceptible household contacts of varicella to test the protective efficacy of the vaccination. Twenty-six contacts of 21 families were vaccinated, usually within three days after onset of the index cases. None of the vaccinated children developed clinical symptoms of varicella. Eighteen of 24 sera obtained before vaccination were found to be seronegative by complement fixation and neutralization tests. Seroconversion was observed in all of the 18. On the other hand, all of 19 unvaccinated contacts in the 15 families, who served as controls, showed typical manifestations of varicella from 10 to 33 days after onset of the index varicella cases. In three families, where only one sibling contact received vaccine and the other was an unvaccinated control, none of the vaccinated children showed any clinical symptoms while unvaccinated controls exhibited typical varicella symptoms 10 to 14 days after the onset of the index cases. These results indicate that varicella is prevented in household contacts by vaccination within three days following exposure.

PMID 190583  Pediatrics. 1977 Jan;59(1):3-7.
著者: Meirav Mor, Liora Harel, Ernesto Kahan, Jacob Amir
雑誌名: Vaccine. 2004 Dec 2;23(3):325-8. doi: 10.1016/j.vaccine.2004.06.004.
Abstract/Text The aim of the present study was to examine the efficacy of postexposure vaccination with Varilrix in the household setting. A randomized, double-blind, placebo-controlled design was used. Twenty-two children received the varicella vaccine and 20, a placebo. The relative risk of developing varicella with a placebo compared with the vaccine was 1.1 (95% confidence interval 0.55-2.21). The risk of developing moderate to severe disease was eight times greater in the placebo group (RR=8), indicating an 80% protective effect against moderate/severe disease. The varicella vaccine Varilrix may not be effective in preventing varicella when administered after household exposure, although it is highly effective in ameliorating the disease in those who acquire it under these circumstances.

PMID 15530676  Vaccine. 2004 Dec 2;23(3):325-8. doi: 10.1016/j.vaccine・・・
著者: Y Asano, T Yoshikawa, S Suga, I Kobayashi, T Nakashima, T Yazaki, T Ozaki, A Yamada, J Imanishi
雑誌名: Pediatrics. 1993 Aug;92(2):219-22.
Abstract/Text OBJECTIVE: To determine whether varicella can be prevented by administration of oral acyclovir (ACV) during the incubation period of the disease.
SUBJECTS AND METHODS: ACV (40 or 80 mg/kg daily in four divided doses) was given orally to 25 exposed infants and children for 7 days, starting 7 to 9 days after exposure from the index case in their families. Their clinical features were compared with those of 25 age-matched control subjects who had been exposed in their families but did not receive ACV. A fluorescent antibody to membrane antigen assay was used for determination of the antibody to varicella-zoster virus, and a nested polymerase chain reaction method was used for detection of viremia.
RESULTS: Among the 25 who received ACV, 4 (16%) developed the disease and 1 (4%) had a fever. On the other hand, all of 25 control subjects developed the disease and 17 (68%) had a fever. The incidence of fever and the severity of skin rashes were significantly lower (P < .01) in the subjects who received oral ACV than in the control group. Seroconversion was observed in 84% of subjects who received ACV. In some cases, varicella-zoster virus DNA was detected by polymerase chain reaction amplification in peripheral blood mononuclear cells from blood drawn approximately 14 days after exposure.
CONCLUSIONS: Varicella can be prevented or modified by administration of oral ACV late in the incubation period.

PMID 8393173  Pediatrics. 1993 Aug;92(2):219-22.
著者: M Shinjoh, T Takahashi
雑誌名: J Hosp Infect. 2009 Jun;72(2):163-8. doi: 10.1016/j.jhin.2009.01.020. Epub 2009 Mar 17.
Abstract/Text Varicella zoster virus is highly contagious and can cause serious complications in immunocompromised patients. To prevent people exposed to the virus from developing secondary varicella we have used oral aciclovir as post-exposure prophylaxis (PEP) since 2000. Between 2000 and 2007, there were 11 unexpected occurrences of varicella and 11 unexpected occurrences of zoster in our paediatric wards. There were 174 contacts, 131 exposed to varicella and 43 exposed to zoster. A total of 163 (94%) received PEP and 11 (6%) did not. The rates of secondary infection among contacts given prophylaxis with aciclovir only were 2.1% (3/141) for all contacts and 1.3% (1/76) for immunocompetent contacts. The rate of secondary infection among contacts not given PEP was significantly higher (18%, 2/11) (P<0.05). No adverse events due to PEP were reported. We conclude that oral aciclovir PEP following exposure to VZV on paediatric wards is both safe and effective.

PMID 19282055  J Hosp Infect. 2009 Jun;72(2):163-8. doi: 10.1016/j.jhi・・・
著者: G De Serres, N Boulianne, B Duval
雑誌名: Pediatr Infect Dis J. 1995 Nov;14(11):969-75. doi: 10.1097/00006454-199511000-00009.
Abstract/Text To evaluate the field effectiveness of erythromycin prophylaxis for pertussis within families, a retrospective cohort study was conducted among 246 families. Overall 41% of the subjects (387 of 940) had been sick. The secondary attack rate was 65% for infants younger than 2 years, 54% for those 2 to 4 years old and 39% for children 5 to 9 years old, and it declined thereafter. The secondary attack rate decreased from 25% in families without prophylaxis to 17% in families with prophylaxis. The protection induced by prophylaxis did not vary with age or vaccination status. When prophylaxis was used before the onset of a secondary case, the secondary attack rate was 4% compared with 35% when given after a secondary case (P < 0.001). Erythromycin prophylaxis seems to be efficient in preventing secondary cases but is most useful when administered before the occurrence of the first secondary case.

PMID 8584364  Pediatr Infect Dis J. 1995 Nov;14(11):969-75. doi: 10.1・・・
著者: Masayoshi Shinjoh, Seiji Sato, Norio Sugaya, Keiko Mitamura, Yoshinao Takeuchi, Kenjiro Kosaki, Takao Takahashi
雑誌名: Kansenshogaku Zasshi. 2004 Mar;78(3):262-9.
Abstract/Text During the influenza season, outbreaks of influenza may occur in the pediatric wards due to spread from the patients hospitalized with influenza, or from those hospitalized during the latency period and develop influenza afterwards. Post-exposure prophylaxis with neuraminidase inhibitors has been reported to be effective in preventing outbreaks among household members and nursing home residents. However, for nosocomial spread, its effectiveness and possible adverse effects are to be determined. During the 2002/2003 influenza season, we experienced a total of 3 nosocomial outbreaks of influenza in the pediatric wards in two hospitals in the Kanto district, Japan. Since the number of contacts who developed influenza had been increasing despite the isolation precaution implemented, post-exposure prophylaxis with oseltamivir (2 mg/kg/dose, maximum 75 mg/dose, once a day for 7-10 days) was implemented with a permission from the parents to terminate the outbreaks. In the outbreaks (one with influenza A, two with influenza B), a total of 29 inpatients had contact with influenza patients: among those 29, 13 were given post-exposure prophylaxis, 16 were not. Out of 16 patients who did not receive post-exposure prophylaxis, 11 (69%) developed influenza: out of 13 with post-exposure prophylaxis, none developed influenza. Those patients who developed influenza were given oseltamivir (2 mg/kg/dose, maximum 75 mg/dose, twice a day for 5 days) and accommodated in a private room or a room with other patients with influenza of the same type. No significant adverse effects due to oseltamivir were observed among those who were enrolled in this study.

PMID 15103909  Kansenshogaku Zasshi. 2004 Mar;78(3):262-9.
著者: Masayoshi Shinjoh, Yaoko Takano, Takao Takahashi, Naoki Hasegawa, Satoshi Iwata, Norio Sugaya
雑誌名: Pediatr Infect Dis J. 2012 Nov;31(11):1119-23. doi: 10.1097/INF.0b013e318260265a.
Abstract/Text BACKGROUND: Postexposure prophylaxis (PEP) using neuraminidase inhibitors against exposure to influenza virus has been well studied in household settings but not in nosocomial settings in pediatric wards.
METHODS: We used oseltamivir or zanamivir as PEP in our pediatric wards. All influenza cases were diagnosed by the influenza rapid diagnostic test.
RESULTS: Between 2003 and 2011, there were 20 nosocomial introductions of influenza (10 were A, 9 were B and 1 was undetermined). The index cases consisted of 17 inpatients, 2 parents and 1 medical staff member. The 17 inpatients had been admitted to the hospital for reasons other than infectious disease and they developed influenza after hospitalization. Among the 81 contacts, 28 (35%) were exposed to influenza A, and 52 (64%) were exposed to influenza B. The rate of secondary infection among contacts not given PEP was 29% (5/17), and the rate among contacts given PEP was significantly lower, 3% (2/63; P = 0.004). The 2 infected contacts who had been given PEP were both influenza B cases, and both had received oseltamivir. The contacts who received PEP within 24 hours (59), for influenza A (23) and those who received zanamivir (15) did not develop influenza. No adverse events were reported.
CONCLUSIONS: PEP using oseltamivir or zanamivir for unexpected occurrences of nosocomial influenza in pediatric wards is safe and effective. The influenza rapid diagnostic test that we used was helpful for detecting nosocomial influenza in children.

PMID 22634596  Pediatr Infect Dis J. 2012 Nov;31(11):1119-23. doi: 10.・・・
著者: N Ishiguro, R Oyamada, Y Nasuhara, T Yamada, T Miyamoto, S Imai, K Akizawa, T Fukumoto, S Iwasaki, H Iijima, K Ono
雑誌名: J Hosp Infect. 2016 Oct;94(2):150-3. doi: 10.1016/j.jhin.2016.05.012. Epub 2016 May 25.
Abstract/Text Inpatients who had been in close contact with patients with influenza were given oseltamivir [75mg capsules once daily for adults or 2mg/kg (maximum of 75mg) once daily for children] for three days as postexposure prophylaxis (PEP). The index patients with influenza were prescribed a neuraminidase inhibitor and were discharged immediately or transferred to isolation rooms. The protective efficacy of oseltamivir for three days was 93% overall [95% confidence interval (CI) 53-99%; P=0.023] and 94% for influenza A (95% CI 61-99%; P=0.017), which is comparable to that of seven- to 10-day regimens of oseltamivir as PEP.

Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
PMID 27346624  J Hosp Infect. 2016 Oct;94(2):150-3. doi: 10.1016/j.jhi・・・
著者: Rachel J Jackson, Katy L Cooper, Paul Tappenden, Angie Rees, Emma L Simpson, Robert C Read, Karl G Nicholson
雑誌名: J Infect. 2011 Jan;62(1):14-25. doi: 10.1016/j.jinf.2010.10.003. Epub 2010 Oct 13.
Abstract/Text OBJECTIVE: To systematically review evidence relating to the clinical efficacy of oseltamivir, zanamivir and amantadine in the prevention of influenza.
METHODS: RCTs evaluating these interventions in seasonal prophylaxis and post-exposure prophylaxis were identified using electronic bibliographic databases and handsearching of retrieved articles.
RESULTS: Oseltamivir was effective in preventing symptomatic laboratory-confirmed influenza (SLCI) in seasonal prophylaxis in healthy adults and at-risk elderly subjects and in post-exposure prophylaxis within households of mixed composition. Post-exposure prophylaxis using oseltamivir for paediatric contacts was observed to prevent SLCI. Zanamivir prevented SLCI in seasonal prophylaxis in healthy adults, at-risk adults and adolescents and in post-exposure prophylaxis within mixed households, with a trend for seasonal and post-exposure preventative effects in elderly subjects. Evidence for amantadine prophylaxis across subgroups was very limited. However, amantadine prevented SLCI in seasonal prophylaxis in healthy adults and in outbreak control amongst adolescent subjects. Interventions were reported to be well tolerated by subjects, with a relatively low proportion of subjects experiencing drug-related adverse events and drug-related withdrawals.
CONCLUSIONS: Evidence was identified for the efficacy of oseltamivir and zanamivir in preventing influenza in a range of population subgroups. The evidence base for amantadine was considerably more limited.

Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.
PMID 20950645  J Infect. 2011 Jan;62(1):14-25. doi: 10.1016/j.jinf.201・・・
著者: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
雑誌名: MMWR Recomm Rep. 2011 Mar 4;60(RR-3):1-18.
Abstract/Text Noroviruses are the most common cause of epidemic gastroenteritis, responsible for at least 50% of all gastroenteritis outbreaks worldwide, and a major cause of foodborne illness. In the United States, approximately 21 million illnesses attributable to norovirus are estimated to occur annually. Since 2001, when the most recent norovirus recommendations were published (CDC. "Norwalk-like viruses." Public health consequences and outbreak management. MMWR 2001;50[No. RR-9]), substantial advances have been made in norovirus epidemiology, immunology, diagnostic methods, and infection control. As molecular diagnostic techniques have improved in performance and become more widely available, detection and reporting of norovirus outbreaks have increased. Although the inability to culture human noroviruses in vitro has hampered progress, assessment of the performance of disinfectants has been facilitated by the discovery of new, cultivable surrogates for human noroviruses. In addition, the periodic emergence of epidemic strains (from genogroup II type 4, GII.4) and outbreaks in specific populations (e.g., the elderly in nursing homes) have been characterized. This report reviews these recent advances and provides guidelines for outbreak management and disease prevention. These recommendations are intended for use by public health professionals investigating outbreaks of acute gastroenteritis, including state and local health authorities, as well as academic and research institutions.

PMID 21368741  MMWR Recomm Rep. 2011 Mar 4;60(RR-3):1-18.
著者: Pengbo Liu, Yvonne Yuen, Hui-Mien Hsiao, Lee-Ann Jaykus, Christine Moe
雑誌名: Appl Environ Microbiol. 2010 Jan;76(2):394-9. doi: 10.1128/AEM.01729-09. Epub 2009 Nov 20.
Abstract/Text Disinfection is an essential measure for interrupting human norovirus (HuNoV) transmission, but it is difficult to evaluate the efficacy of disinfectants due to the absence of a practicable cell culture system for these viruses. The purpose of this study was to screen sodium hypochlorite and ethanol for efficacy against Norwalk virus (NV) and expand the studies to evaluate the efficacy of antibacterial liquid soap and alcohol-based hand sanitizer for the inactivation of NV on human finger pads. Samples were tested by real-time reverse transcription-quantitative PCR (RT-qPCR) both with and without a prior RNase treatment. In suspension assay, sodium hypochlorite concentrations of >or=160 ppm effectively eliminated RT-qPCR detection signal, while ethanol, regardless of concentration, was relatively ineffective, giving at most a 0.5 log(10) reduction in genomic copies of NV cDNA. Using the American Society for Testing and Materials (ASTM) standard finger pad method and a modification thereof (with rubbing), we observed the greatest reduction in genomic copies of NV cDNA with the antibacterial liquid soap treatment (0.67 to 1.20 log(10) reduction) and water rinse only (0.58 to 1.58 log(10) reduction). The alcohol-based hand sanitizer was relatively ineffective, reducing the genomic copies of NV cDNA by only 0.14 to 0.34 log(10) compared to baseline. Although the concentrations of genomic copies of NV cDNA were consistently lower on finger pad eluates pretreated with RNase compared to those without prior RNase treatment, these differences were not statistically significant. Despite the promise of alcohol-based sanitizers for the control of pathogen transmission, they may be relatively ineffective against the HuNoV, reinforcing the need to develop and evaluate new products against this important group of viruses.

PMID 19933337  Appl Environ Microbiol. 2010 Jan;76(2):394-9. doi: 10.1・・・
著者: Jane D Siegel, Emily Rhinehart, Marguerite Jackson, Linda Chiarello, Health Care Infection Control Practices Advisory Committee
雑誌名: Am J Infect Control. 2007 Dec;35(10 Suppl 2):S65-164. doi: 10.1016/j.ajic.2007.10.007.
Abstract/Text
PMID 18068815  Am J Infect Control. 2007 Dec;35(10 Suppl 2):S65-164. d・・・

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