Respiratory Viral RNA on Toys in Pediatric Office Waiting Rooms

From The Pediatric Infectious Disease Journal®
Diane E. Pappas, MD, JD; J. Owen Hendley, MD; Richard H. Schwartz, MD

Posted: 02/26/2010; Pediatr Infect Dis J. 2010;29(2):102-104.

Abstract
Background: Toys in pediatric office waiting rooms may be fomites for transmission of viruses.

Methods: Eighteen samples were taken from office objects on 3 occasions. Samples were tested for presence of picornavirus (either rhinovirus or enterovirus) on all 3 sample days; in addition, January samples were tested for respiratory syncytial virus and March samples were tested for influenza A and B. In addition, 15 samples were obtained from the sick waiting room before and after cleaning. Polymerase chain reaction was used to detect picornavirus, respiratory syncytial virus, and influenza A or B virus. Finally, 20 samples were obtained from the fingers of a researcher after handling different toys in the sick waiting room, and samples were then obtained from all the same toys; all samples were tested for picornavirus by polymerase chain reaction.

Results: Viral RNA was detected on 11 of 52 (21%) of toys sampled. Ten of the positives were picornavirus; 1 was influenza B virus. Three (30%) of 10 toys from the new toy bag, 6 of 30 (20%) in the sick child waiting room, and 2 of 12 (17%) in the well child waiting room were positive. Six (40%) of 15 toys in the sick waiting room were positive for picornaviral RNA before cleaning; after cleaning, 4 (27%) of 15 were positive in spite of the fact that RNA was removed from 4 of 6 of the original positives. Three (15%) of 20 toys in the sick waiting room were positive for picornaviral RNA, but RNA was not transferred to the fingers of the investigator who handled these toys.

Comment: About 20% of the objects in a pediatric office may be contaminated with respiratory viral RNA, most commonly picornavirus RNA.
Cleaning with a disinfectant cloth was only modestly effective in removing the viral RNA from the surfaces of toys, but transfer of picornaviral RNA from toys to fingers was inefficient.

Introduction
Many parents are concerned that pediatric office toys are contaminated with germs that may cause well children who play with such toys to become sick after the office visit.
There are few scientific data available to confirm or deny this belief.
Influenza A viral RNA has been detected on objects and surfaces in homes and day care centers during influenza season, with over 50% of surfaces positive for presence of influenza RNA.[1] Bacterial contamination of toys in a pediatric office with coliforms has been demonstrated using eluates of toys placed in broth.

In a study of spread of DNA markers, cauliflower mosaic virus was smeared onto balls in infant and toddler child care settings; the DNA markers spread through the classroom within 1 to 2 hours after introduction and could even be found on environmental surfaces in the childrens' homes the next day.

The presence and transferability of respiratory viral RNA on toys in the pediatric office has not been studied.

In this study we looked for the presence of specific RNA from 3 common respiratory viruses (picornavirus, respiratory syncytial virus, and influenza A and B), on the toys in a pediatric office sick and well waiting rooms during respiratory virus season.