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Active Surveillance for Influenza Reduces but Does Not Eliminate Hospital Exposure to Patients With Influenza

Published online by Cambridge University Press:  10 January 2017

Brenda L. Coleman
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Wil Ng
Affiliation:
North York General Hospital, Toronto, Ontario, Canada
Vinaya Mahesh
Affiliation:
North York General Hospital, Toronto, Ontario, Canada
Maja McGuire
Affiliation:
North York General Hospital, Toronto, Ontario, Canada
Kazi Hassan
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada
Karen Green
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada
Shelly McNeil
Affiliation:
Canadian Center for Vaccinology, IWK Health Center and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
Allison J. McGeer
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Kevin Katz*
Affiliation:
University of Toronto, Toronto, Ontario, Canada North York General Hospital, Toronto, Ontario, Canada
*
Address correspondence to Dr Kevin Katz, North York General Hospital, 4001 Leslie Street, Toronto, ON M2K 1E1 (kevin.katz@nygh.on.ca).

Abstract

OBJECTIVE

To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital

DESIGN/METHOD

Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons

RESULTS

Of the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively.

CONCLUSIONS

In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination.

Infect Control Hosp Epidemiol 2017;38:387–392

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Authors of equal contribution.

References

REFERENCES

1. Schanzer, DL, Sevenhuysen, C, Winchester, B, Mersereau, T. Estimating influenza deaths in Canada, 1992–2009. PLoS One 2013;8:e80481.CrossRefGoogle ScholarPubMed
2. Vanhems, P, Voirin, N, Roche, S, et al. Risk of influenza-like illness in an acute health care setting during community influenza epidemics in 2004–2005, 2005–2006, and 2006–2007: a prospective study. Arch Intern Med 2011;171:151157.CrossRefGoogle Scholar
3. Macesic, N, Kotsimbos, TC, Kelly, P, Cheng, AC. Hospital-acquired influenza in an Australian sentinel surveillance system. Med J Aust 2013;198:370372.CrossRefGoogle Scholar
4. Jhung, MA, D’Mello, T, Pérez, A, et al. Hospital-onset influenza hospitalizations—United States, 2010–2011. Am J Infect Control. 42:711.CrossRefGoogle Scholar
5. Veenith, T, Sanfilippo, F, Ercole, A, et al. Nosocomial H1N1 infection during 2010–2011 pandemic: a retrospective cohort study from a tertiary referral hospital. J Hosp Infect 2012;81:202205.CrossRefGoogle ScholarPubMed
6. Pagani, L, Thomas, Y, Huttner, B, et al. Transmission and effect of multiple clusters of seasonal influenza in a Swiss geriatric hospital. J Am Geriatr Soc 2015;63:739744.CrossRefGoogle Scholar
7. Ahmed, F, Lindley, MC, Allred, N, Weinbaum, CM, Grohskopf, L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis 2014;58:5057.CrossRefGoogle ScholarPubMed
8. Blanco, N, Eisenberg, MC, Stillwell, T, Foxman, B. What transmission precautions best control influenza spread in a hospital? Am J Epidemiol 2016;183:10451054.CrossRefGoogle ScholarPubMed
9. Public Health Ontario. Best practices for prevention of transmission of acute respiratory infection in all health care settings, Annex B. In: Provincial Infectious Diseases Advisory Committee (PIDAC), 2nd ed. Toronto: Queen’s Printer for Ontario; 2013.Google Scholar
10. Prevention strategies for seasonal influenza in healthcare settings. Centers for Disease Control and Prevention website. http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm. Published 2013. Accessed December 5, 2016.Google Scholar
11. Ontario Agency of Health Protection and Promotion. Routine practices and additional precautions in all health care settings, 3rd ed. In: Provincial Infectious Diseases Advisory Committee (PIDAC), 2nd ed. Toronto: Queen’s Printer for Ontario; 2012.Google Scholar
12. FluWatch. Public Health Agency of Canada website. http://www.phac-aspc.gc.ca/fluwatch/14-15/def14-15-eng.php. Published 2014. Accessed December 5, 2016.Google Scholar
13. Overview of influenza surveillance in the United States. Centers for Disease Control and Prevention website. http://www.cdc.gov/flu/weekly/overview.htm. Published 2015. Accessed December 5, 2016.Google Scholar
14. Aoki, FY, Allen, UD, Stiver, HG, Evans, GA. The use of antiviral drugs for influenza: guidance for practitioners 2012/2013. Can J Infect Dis Med Microbiol 2012;23:e79e92.Google Scholar
15. Priest, P, Kelly, H. Influenza case definitions need to be fit for purpose. Euro Surveill 2015;20:2930.CrossRefGoogle ScholarPubMed
16. Babcock, HM, Merz, LR, Dubberke, ER, Fraser, VJ. Case-control study of clinical features of influenza in hospitalized patients. Infect Control Hosp Epidemiol 2008;29:921926.CrossRefGoogle ScholarPubMed
17. Babcock, HM, Merz, LR, Fraser, VJ. Is influenza an influenza-like illness? Clinical presentation of influenza in hospitalized patients. Infect Control Hosp Epidemiol 2006;27:266270.CrossRefGoogle ScholarPubMed
18. Jiang, L, Lee, VJ, Lim, WY, et al. Performance of case definitions for influenza surveillance. Euro Surveill 2015;20:21145.CrossRefGoogle ScholarPubMed
19. Suess, T, Remschmidt, C, Schink, SB, et al. Comparison of shedding characteristics of seasonal influenza virus (sub)types and influenza A(H1N1)pdm09; Germany, 2007–2011. PLoS One 2012; doi.org/10.1371/journal.pone.0051653.CrossRefGoogle Scholar
20. Cowling, BJ, Chan, KH, Fang, VJ, et al. Comparative epidemiology of pandemic and seasonal influenza A in households. N Engl J Med 2010;362:21752184.CrossRefGoogle ScholarPubMed
21. Lau, LLH. Viral shedding and clinial illness in naturally acquired influenza virus infections. J Infect Dis 2010;201:15091516.CrossRefGoogle Scholar
22. Bin-Reza, F, Lopez Chavarrias, V, Nicoll, A, Chamberland, ME. The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza Other Respir Viruses 2012;6:257267.CrossRefGoogle ScholarPubMed
23. MacIntyre, CR, Wang, Q, Cauchemez, S, et al. A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir Viruses 2011;5:170179.CrossRefGoogle ScholarPubMed
24. Public Health England. The use of facemasks and respirators during an influenza pandemic: scientific evidence base review. In: Health Do, 2nd ed. London: Public Health England; 2014.Google Scholar
25. Yang, P, Seale, H, MacIntyre, CR, et al. Mask-wearing and respiratory infection in healthcare workers in Beijing, China. Braz J Infect Dis 2011;15:102108.CrossRefGoogle ScholarPubMed
26. Aiello, AE, Perez, V, Coulborn, RM, Davis, BM, Uddin, M, Monto, AS. Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial. PLoS One 2012;7:e29744.CrossRefGoogle ScholarPubMed