Virus attacked Chicago children in outbreak kept under wraps

Virus attacked Chicago children in outbreak kept under wraps http://www.chicagotribune.com/news/chi-0207210273jul21.story By Michael J. Berens Chicago Tribune staff reporter July 21, 2002 The germ raced through the Misericordia Home for handicapped children in Chicago, masquerading as a cold-weather flu as it moved from bed to bed. Each child already was ill; most had been born with severe physical and mental impairments. The rare strain of adenovirus pounced on their weakened immune systems, enveloping victims with blistering fevers while attacking the brain, lungs or heart. Over several weeks starting in October 1998, 31 children contracted flulike infections and eight died as the microscopic invader snaked through the 93-bed long-term care center, which is operated by the Sisters of Mercy with the support of the Catholic Church. The outbreak on the Southwest Side was one of several nationally linked to the rare virus. But these incidents went largely unreported in the media, and in Chicago the Department of Public Health still is not releasing public records on the outbreak--an example of how health-care facilities and public agencies are able to keep damaging information about infections under wraps. Though the virus' origins remain a mystery, federal and city health-care investigators believe they know how it was spread: The germ hitched rides on health-care workers. Doctors and nurses at Misericordia and Rush-Presbyterian-St. Luke's Medical Center--one of the hospitals that later treated the children--also were infected by the germ, but they continued to work among the children. The lapse meant that every cough, sniffle and touch could result in death to another child, health-care investigators concluded. The Chicago deaths highlight what many epidemiologists warn are escalating rates of infections inside the nation's secondary tier of health care--specialized long-term care centers like Misericordia, nursing homes and outpatient clinics. Though the federal surveillance of germ outbreaks is centered almost exclusively on hospitals, unsanitary conditions inside the nation's growing network of specialized facilities remain largely undocumented. "There are a lot of infections that occur outside hospitals that we know nothing about," said Dr. Donald Graham, a former infection-control investigator for the federal Centers for Disease Control and Prevention and professor at Southern Illinois University School of Medicine. "If we don't count our infections, we won't know about them and we won't be able to intervene." The Chicago outbreak also reveals how the Chicago Department of Public Health undermined its trust as public guardian to protect the private interests of health-care facilities. City officials decided not to alert the public about the lethal outbreak. Even though health department officials acknowledge investigating it, they say they can't locate a single record. "I know how embarrassing this looks for us," health department spokesman Tim Hadac said. Sources connected to the investigation, however, provided the Tribune with city files on the Misericordia outbreak. City health commissioner John Wilhelm defended the secrecy. The city has a fragile, voluntary relationship with health-care facilities, and if the city warned the public about every outbreak, health-care facilities might stop sharing information, he said. During a recent tour of Misericordia, officials said that visitors are now asked to wash their hands or stay home if they have symptoms of any illness, such as the flu. Though it is a medical facility, the home is run differently in many ways from a hospital. Children are bused to special-education classes, for instance, and visitors are welcomed at all hours, presenting opportunities for children to be exposed to germs. "We give these children a quality of life. This is not a lockdown facility. The parents know that infection is an everyday risk, but an acceptable one," said Betty Flynn, a registered nurse and home administrator at Misericordia. The deadliest strain At the time of the outbreak, Misericordia and hospital officials were unaware that they were dealing with the most deadly strain of adenovirus. Drawing upon a biological archive of germ samples collected worldwide, CDC scientists determined that the Chicago outbreak involved a strain known as Ad7d2. As a result, the CDC launched a national hunt for the Ad7d2 germ, first documented by medical investigators in Beijing in 1981. As word spread in the medical community about the deadly germ, a New Orleans doctor filed a report detailing a previously undisclosed June 1996 outbreak in a Houma, La., pediatric facility for long-term care that killed seven children and infected six others, according to CDC records. In October 1999, seven patients were killed and 26 others infected by adenovirus that swept through a New York City chronic-care facility for the mentally ill, those records show. A year later, four children died and 16 other patients were infected after the germ invaded a pediatric long-term care facility in Des Moines. Iowa public health epidemiologist Dr. Patricia Quinlisk said investigators could not determine how the adenovirus entered the pediatric center but said that germs were cultured from the hands of a health-care worker and that several staff members also became ill from the virus. The germ, investigators theorize, may have gained a foothold in the pediatric center after infecting a child who left the facility for special-education classes. In all three cases, the CDC records do not name the facilities, only the cities where they are located. CDC investigators now believe the Ad7d2 germ is more rooted in the United States than previously known. The first Chicago children stricken four years ago at Misericordia had not been bused to outside classes, leading investigators to believe that a visitor, a health-care worker or another child carried the germ into the facility. >From Misericordia, many of the fever-ridden children were sent for treatment to Rush-Presbyterian-St. Luke's Medical Center. A registered nurse assigned to track germs in the intensive care unit was the first to suspect a pattern. Based on the nurse's report and laboratory findings, Dr. John Segreti, chief of the infectious disease department at Rush, said he immediately recognized that the hospital, and potentially the city, was dealing with a deadly germ. Three days after the children were admitted to the hospital, laboratory tests confirmed the presence of adenovirus. During this time, the germ spread inside Rush, infecting a 5-month-old boy who later recovered, Segreti said. Infected children were isolated and health-care workers were ordered to adhere to strict infection-control procedures. "We think it was spread on the hands of a health-care worker," Segreti said. No vaccine available There are more than 50 strains of adenovirus, but there was no way to eradicate the germ. The nation's sole vaccine was discontinued in 1996 by pharmaceutical giant Wyeth-Ayerst. At the time, company officials said demand was too low for the $1-a-pill medicine. Healthy people typically fend off the virus, which might cause fever or other flulike symptoms. But critically ill patients, particularly children whose immune systems are paper thin, can face life-or-death struggles. Segreti said he immediately notified the city health department, which later requested CDC investigators. Segreti and other health-care officials believe the hospital's quick discovery of the germ may have prevented a wider, more devastating outbreak. But Rush administrators say they also learned an important lesson about problems inside their own hospital. Through staff surveys and laboratory tests, Segreti discovered that 36 Rush-Presbyterian health-care workers were confirmed or suspected carriers of the infection, probably picking up germs from the Misericordia children. At least 30 doctors, nurses and technicians had fevers and other symptoms but continued to work among young patients throughout the hospital, Segreti said. At least 26 employees failed to follow strict infection-control procedures, such as wearing gloves or washing hands. "It's not uncommon for people in health care to think they are not part of the problem," Segreti said. Infected workers were sent home for up to two weeks. The staff was retrained on the importance of infection control. At Misericordia, once the outbreak was apparent, ill children were moved together in the same rooms to limit exposure to healthy children, and family visits were temporarily restricted. "We were certainly battening down the hatches," said Deb Ryan, director of nursing at Misericordia. Although nobody located the source of the germ, Misericordia employees received training on hand-washing procedures and wearing gloves and masks. Like the nurses at Rush, at least one Misericordia employee contracted adenovirus, and some employees may have continued to work while ill, Ryan said. Since the outbreak, the staff of 180 has been told to stay home if suffering any symptom of illness, but the message is tough to enforce. "As nurses, we've always been taught to drag yourself to work," Ryan said. "It's been the culture for 30 years. If we don't show up to work, who will take care of the children?" Copyright © 2002, Chicago Tribune

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