Nosocomial Transmission of Respiratory Syncytial Virus in an Outpatient Cancer Center Helen Y. Chu, Janet A. Englund, Sara Podczervinski, Jane Kuypers,

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Nosocomial Transmission of Respiratory Syncytial Virus in an Outpatient Cancer Center Helen Y. Chu, Janet A. Englund, Sara Podczervinski, Jane Kuypers, Angela P. Campbell, Michael Boeckh, Steven A. Pergam, Corey Casper Biology of Blood and Marrow Transplantation Volume 20, Issue 6, Pages 844-851 (June 2014) DOI: 10.1016/j.bbmt.2014.02.024 Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Histogram of all RSV cases at the SCCA per day in the 2007-2008 outbreak (A) and only cases where the viral strain was sequenced (B). Histogram of all RSV cases at the SCCA per day in the 2012 outbreak (C) and only cases where the viral strain was sequenced (D). The asterisk represents an identical viral strain for that season. The pattern of the box represents the team of providers seen by the patient. Biology of Blood and Marrow Transplantation 2014 20, 844-851DOI: (10.1016/j.bbmt.2014.02.024) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Our Respiratory Virus Management Plan was implemented January 1, 2008 and included designation of 3 tiers of heightened respiratory viral surveillance and infection control strategies. Biology of Blood and Marrow Transplantation 2014 20, 844-851DOI: (10.1016/j.bbmt.2014.02.024) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Chart of RSV cases per day during the outbreak as compared with numbers of patients seen and numbers of community RSV cases in the Pacific Northwest Region for the (A) 2007-2008 season and (B) 2011-2012 season. The bars represent the numbers of RSV-positive cases at the SCCA clinic. The dotted line represents the number of patients (in multiples of 1000) seen at the SCCA clinic. The dashed line represents the numbers of community cases in the Pacific Northwest. Biology of Blood and Marrow Transplantation 2014 20, 844-851DOI: (10.1016/j.bbmt.2014.02.024) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Phylogenetic trees were constructed using sequenced samples from the 2 outbreaks. The outbreak strains are identified by year followed by provider team. The reference and community strains are labeled with year followed by reference strain (RS) or community strain (CS). The numbers at the nodes are the bootstrap values. This phylogenetic tree shows the sequenced samples from the 2007-2008 outbreak. Of the 15 outbreak strains, 14 were subtype A and 1 was subtype B. The tree with the highest log likelihood (–1047.02) is shown. Community samples were collected during RSV season in the Seattle region from November to April from inpatients at Seattle Children's Hospital and the University of Washington, as well as community childcare attendees. Biology of Blood and Marrow Transplantation 2014 20, 844-851DOI: (10.1016/j.bbmt.2014.02.024) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 Phylogenetic trees were constructed using sequenced samples from the 2 outbreaks. The outbreak strains are identified by year followed by provider team. The reference and community strains are labeled with year followed by reference strain (RS) or community strain (CS). The numbers at the nodes are the bootstrap values. This phylogenetic tree shows the sequenced samples from the 2012 outbreak. Of the 10 outbreak strains, 9 were subtype A and 1 was subtype B. The tree with the highest log likelihood (–905.54) outbreak is shown. Community samples were collected during RSV season in the Seattle region from November to April from inpatients at Seattle Children's Hospital and the University of Washington, as well as community childcare attendees. Biology of Blood and Marrow Transplantation 2014 20, 844-851DOI: (10.1016/j.bbmt.2014.02.024) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions