Parainfluenza Virus Type-3 Outbreak in Level II Neonatal Care Unit: Role of Nursing Infants inside Closed Incubators in the Control of the Viral Outbreak

Parainfluenza type 3 virus (PIV-3) outbreaks in neonatal care units are rare. We aimed to report our experience of PIV-3 outbreak in level II neonatal care unit (NCU-II). A retrospective review of medical records of all infants managed in NCU-11 during the PIV-3 outbreak period. During the viral outbreak, 49 infants were cared for in NCU-II, and only 7 infants proved to be infected with PIV-3. The attack rate was 14%. The first 4 infected infants were transferred to standby isolation room outside NCU-II, and the unit was closed. All exposed and infected infants were cohorted, nursed inside closed incubators and other infection control measures were reinforced. Due to bed crises and 5 days after the closure of the unit and before the end of the viral outbreak; the standby isolation room was closed and NCU-II was reopened for new admissions and was divided into 3 zones for: infected, exposed, and newly admitted infants. Three more infants that were initially exposed to index case turned positive. There was no further transmission of the PIV-3 after opening the neonatal unit. Infants nursed in open crib at onset of PIV-3 outbreak were at high risk for infection (P value <0.0001). All infected infants survived and were discharged in good condition. Re-enforcing standard infection control measures, cohorting and placing all the exposed and infected infants inside closed incubators could contain respiratory outbreaks in neonatal nurseries without significant morbidity or mortality and most probably without the need to close the unit.