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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