Objective. To describe the characteristics and interventions to control a large epidemiological Influenza A Outbreak. Methods. During the months of February to April 2006, a large outbreak of Influenza A was detected, which affected Health Care Workers and hospitalized patients in a large teaching Hospital in Guatemala City. Interventions to interrupt transmission were implemented and included barrier methods (N95 masks, respiratory isolation measures, etc.) and enhanced hand hygiene, vaccination of healthy Health Care Workers (HCW), restrictions for patient visits. Results. From February to April 2006, 59 hospitalized patients diagnosed with Influenza A. 19 AIDS patients (mortality: 71%) and 5/40 (12.5%) in other diseases: cancer (3), severe cardiac failure (1) and severe malnutrition (1). The attack rate at day 20 in doctors and medical students was 21% while in other HCW it was 10.5%. Within 3 weeks of the beginning of the plan, deaths were stopped and no more cases in HCW were detected after 3 additional weeks. Conclusion. A rapid, comprehensive plan for the control of nosocomial epidemic Influenza A outbreaks is essential to limit severe morbidity and mortality in hospitals who attend large immunocompromised populations, including AIDS patients. HCW regular vaccinations programs are mandatory. 1. Introduction Influenza A and B cause highly contagious, acute respiratory illness, associated with high morbidity and mortality among persons with underlying diseases. Influenza can cause extensive nosocomial outbreaks with high mortality rates. The causes of death in the more severe forms of influenza are (a) severe pneumonia with respiratory distress, (b) neurological complications, and (c) secondary bacterial pneumonia. Outbreaks in children units, senior facilities, cancer centers, neonatal units, pulmonary rehabilitation centers, emergency departments, and others have been described. Large nosocomial outbreaks in large tertiary referral hospitals that provide care to large numbers of patients with advanced AIDS have not been frequently described. Roosevelt Hospital is a large teaching, university tertiary referral hospital in Guatemala City, with 850 beds capacity. More than 3,500 AIDS patients were in followups, and 1561 treated with antiretroviral drugs at the time when the outbreak was detected in March 2006; all of whom were at potential risk to develop severe forms of Influenza. 35% of the patients have less than 50 CD4 cells/mm3 and 68% less than 200 CD4 cells/mm3, at the time the HIV infection diagnosis is made at Roosevelt Hospital. The main
References
[1]
H. C. Maltezou and M. Drancourt, “Nosocomial influenza in children,” Journal of Hospital Infection, vol. 55, no. 2, pp. 83–91, 2003.
[2]
C. D. Salgado, B. M. Farr, K. K. Hall, and F. G. Hayden, “Influenza in the acute hospital setting,” Lancet Infectious Diseases, vol. 2, no. 3, pp. 145–155, 2002.
[3]
N. J. Cox and K. Subbarao, “Influenza,” The Lancet, vol. 354, no. 9186, pp. 1277–1282, 1999.
[4]
K. Staynor, G. Foster, M. McArthur, A. McGeer, M. Petric, and A. E. Simor, “Influenza A outbreak in a nursing home: the value of early diagnosis and the use of amantadine hydrochloride,” The Canadian Journal of Infection Control, vol. 9, no. 4, pp. 109–111, 1994.
[5]
C. Sartor, C. Zandotti, F. Romain et al., “Disruption of services in an internal medicine unit due to a nosocomial influenza outbreak,” Infection Control and Hospital Epidemiology, vol. 23, no. 10, pp. 615–619, 2002.
[6]
S. Malavaud, B. Malavaud, K. Sandres et al., “Nosocomial outbreak of influenza virus A (H3N2) infection in a solid organ transplant department,” Transplantation, vol. 72, no. 3, pp. 535–537, 2001.
[7]
D. M. Weinstock, J. Eagan, S. A. Malak et al., “Control of influenza A on a bone marrow transplant unit,” Infection Control and Hospital Epidemiology, vol. 21, no. 11, pp. 730–732, 2000.
[8]
M. E. Evans, K. L. Hall, and S. E. Berry, “Influenza control in acute care hospitals,” American Journal of Infection Control, vol. 25, no. 4, pp. 357–362, 1997.
[9]
A. M. Apalsch, M. Green, J. Ledesma-Medina, B. Nour, and E. R. Wald, “Parainfluenza and influenza virus infections in pediatric organ transplant recipients,” Clinical Infectious Diseases, vol. 20, no. 2, pp. 394–399, 1995.
[10]
F. G. Hayden, “Prevention and treatment of influenza in immunocompromised patients,” American Journal of Medicine, vol. 102, no. 3A, pp. 55–60, 1997.
[11]
G. Boivin, I. Hardy, G. Tellier, and J. Maziade, “Predicting influenza infections during epidemics with use of a clinical case definition,” Clinical Infectious Diseases, vol. 31, no. 5, pp. 1166–1169, 2000.
[12]
I. Raad, J. Abbas, and E. Whimbey, “Infection control of nosocomial respiratory viral disease in the immunocompromised host,” American Journal of Medicine, vol. 102, no. 3A, pp. 48–52, 1997.
[13]
M. L. Pearson, C. B. Bridges, and S. A. Harper, “Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP),” Morbidity and Mortality Weekly Report, vol. 55, no. 2, pp. 1–16, 2006.
[14]
C. Aitken and D. J. Jeffries, “Nosocomial spread of viral disease,” Clinical Microbiology Reviews, vol. 14, no. 3, pp. 528–546, 2001.
[15]
C. B. Bridges, K. Fukuda, T. M. Uyeki, N. J. Cox, and J. A. Singleton, “Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP),” Morbidity and Mortality Weekly Report, vol. 51, no. 3, pp. 1–31, 2002.
[16]
R. Welliver, A. S. Monto, O. Carewicz et al., “Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial,” Journal of the American Medical Association, vol. 285, no. 6, pp. 748–754, 2001.
