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Occupational Exposure to Influenza-Introduction of an Index Case to a Hospital

Published online by Cambridge University Press:  21 June 2016

Craig D. Berlinberg
Affiliation:
Departments of Medicine and Nursing Research and Development, Cedars-Sinai Medical Center: Los Angeles County Department of Health Services, Los Angeles, California
Scott R. Weingarten
Affiliation:
Departments of Medicine and Nursing Research and Development, Cedars-Sinai Medical Center: Los Angeles County Department of Health Services, Los Angeles, California
Linda B. Bolton
Affiliation:
Departments of Medicine and Nursing Research and Development, Cedars-Sinai Medical Center: Los Angeles County Department of Health Services, Los Angeles, California
Steven H. Waterman
Affiliation:
Departments of Medicine and Nursing Research and Development, Cedars-Sinai Medical Center: Los Angeles County Department of Health Services, Los Angeles, California

Abstract

The epidemiology of influenza in the hospital is frequently confounded by failure to separate community-acquired from nosocomial transmission. An 83-year-old woman was hospitalized one day after returning from Asia with complications resulting from acute influenza A (H3N2) infection; she was the first culture-confirmed case in the region during the 1987-1988 influenza season, and her illness antedated other influenza cases in the area by at least four weeks. The patient shed virus at least four days after admission and transmitted influenza to her primary physician; both had received trivalent influenza vaccine four weeks earlier. Surveillance data from the 28 health care providers (HCPs) in contact with the index case (mean age: 34.5 years; median time of contact: four hours, none receiving vaccine) revealed no evidence of transmission as detected by paired type-specific complement-fixation antibodies and throat culture (20 subjects) or acute serologies and culture (7 subjects). No febrile respiratory illnesses were detected among other patients on the same ward, although three were reported among HCPs. Thus, neither secondary spread of influenza from infected patient to hospital HCPs nor nosocomial transmission apparently took place, although transmission did occur to the primary physician.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

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References

1. Valenti, WM, Menengus, MA, Hall, CB, et al: Nosocomial viral infections: I. Epidemiology and significance. Infect Control 1980: 1:3337.CrossRefGoogle ScholarPubMed
2. Blumenfeld, HL, Kilbourne, ED, Louria, DB, et al: Studies on influenza in the pandemic of 1957-58: I. An epidemiologic. clinical and serologic investigation of an intrahospital epidemic, with a note on vaccination efficacy. J Clin Invest 1959: 38: 199212.CrossRefGoogle Scholar
3. Muchmore, HG, Felton, FG, Scott, lV: A confirmed hospital epidemic of Asian influenza. J Okla State Med Assoc 1960: 53: 142145.Google ScholarPubMed
4. Boger, WP, Frankel, JW: Asian influenza: Isolated outbreak within a large closed population. Am J Public Health 1962: 52:834–810.CrossRefGoogle ScholarPubMed
5. McDougal, BA, Hodges, GR, Lewis, HD, et al: Nosocomial influenza A infection. South Med J 1977: 70:10231024.CrossRefGoogle ScholarPubMed
6. Van Voris, LP, Belshe, RB, Shaffer, JI.: Nosocomial influenza B virus infection in the elderly. Ann Intern Med 1982; 96:153l58.CrossRefGoogle ScholarPubMed
7. Kapila R., Lintz DI, Tecson, FT, et al; A nosocomial outbreak of influenza A. Chest 1977; 71:576579.CrossRefGoogle ScholarPubMed
8. Balkovic, ES, Goodman, RA, Rose, KB, et al: Nosocomial influenza A (MINI) infection. Am J Med Technol 1980: 46:318320.Google Scholar
9. O'Donoghue, JM, Ray, CG, Terry, DW Jr, et al: Prevention of nosocomial influenza infection with amantadine. Am J Epidemiol 1973; 97:276282.CrossRefGoogle ScholarPubMed
10. Immunization Practices Advisory Committee: Prevention and control of influenza. MMWR 1987; 30:373-380, 385387.Google Scholar
11. Hoffman, PC, Dixon, RE: Control of influenza in the hospital. Ann Intern Med 1977; 87:725728.CrossRefGoogle ScholarPubMed
12. Valenti, WM, Betts, RF Hall, CB: Nosocomial viral infections: II. Guidelines for prevention and control of respiratory viruses, herpesviruses, and hepatitis viruses, Infect Control 1980; 1:105178.CrossRefGoogle ScholarPubMed
13. Dowdle, WA, Kendal, AP, Noble, GR: Influenza viruses, in Lennette, EH. Schmidt, NJ (eds): Diagnosta Procedures for Viral, Rickettsial, and Chlamydial Infections. ed 5. American Public Health Association, Washington. DC. 1979. pp 585609.Google Scholar
14. Centers for Disease Control: Acute respiratory illness among cruise-ship passengers—Asia. MMWR 1988; 37:6366.Google Scholar
15. Centers for Disease Control: Influenza A isolates—United Stales, 1987. MMWH 1987; 30:751.Google Scholar
16. Pachucki, CT, Lentino, JR, Jackson, GG: Attitudes and behavior of health care personnel regarding use use and efficacy of influenza vaccine. J Infect Dis 1970; 134:100107.Google Scholar
17. Ksiazek, TG, Olson, JG, Irving, GS, et al: An influenza outbreak due to A/USSR/77-like (HIND virus aboard a US Navy ship. Am J Epidemiol 1980; 112: 187494.CrossRefGoogle Scholar
18. Moser, MR, Bender, TR, Margolis, HS: An outbreak of influenza aboard a commercial airliner. Am J Epidemiol 1979; 110:16.CrossRefGoogle ScholarPubMed
19. Patriarca, PA, Weber, JA, Parker, RA, et al: Efficacy of influenza vaccine in nursing homes; reduction in illness and complications during an influenza A (H3N2) epidemic. JAMA 1985; 253:11361139.CrossRefGoogle ScholarPubMed
20. Silverstone, FA, Libow, LS, Duthie, F. et al: Outbreak of influenza B. 1980. in a geriatric long term care facility. Gerontologist 1980; 20:200.Google Scholar
21. Weingarten, S, Friedlander, M, Rascon, D. et al: Influenza surveillance in an acute-care hospital. Arch Intern Med 1988; 148:113116.CrossRefGoogle Scholar
22. Hall, CB, Douglas, RG Jr: Nosocomial influenza infection as a cause of intercurrent feyers in infants. Pediatrics 1975; 55:673677.CrossRefGoogle Scholar
23. Hammond, GW Cheang, M: Absenteeism among hospital staff during an influenza epidemic: Implications for immunoprophylaxis. Can Med Assoc J 1984; 131:449452.Google ScholarPubMed
24. Fralick, RA: Absenteeism among hospital staff during influenza epidemic. Can Med Assoc J 1985: 133:641642.Google ScholarPubMed