Pandemic (H1N1) 2009 Influenza in Hospitalized Children in Manitoba: Nosocomial Transmission and Lessons Learned from the First Wave

Objective. To review the experiences at Winnipeg Children’s Hospital (WCH) during the 2009 influenza season, with an emphasis on nosocomial transmission and infection prevention and control responses. Design. A case series of patients admitted to WCH who had laboratory-confirmed cases of influenza b...

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Published in:	Infection control and hospital epidemiology Vol. 32; no. 5; pp. 435 - 443
Main Authors:	Fanella, Sergio T., Pinto, Michelle A., Bridger, Natalie A., Bullard, Jared M. P., Coombs, Jennifer M. L., Crockett, Maryanne E., Olekson, Karen L., Poliquin, Philippe G., Van Caeseele, Paul G., Embree, Joanne E.
Format:	Journal Article
Language:	English
Published:	Chicago, IL University of Chicago Press 01-05-2011
Subjects:	Adolescent Antiviral Agents - therapeutic use Biological and medical sciences Child Child health services Child, Preschool Community-Acquired Infections - drug therapy Community-Acquired Infections - epidemiology Cross Infection - drug therapy Cross Infection - epidemiology Cross Infection - prevention & control Cross Infection - transmission Disease transmission Diseases Female General aspects H1N1 subtype influenza A virus Hospital admissions Human infectious diseases. Experimental studies and models Human viral diseases Humans Infant Infant, Newborn Infection Control Infections Infectious diseases Influenza A virus Influenza A Virus, H1N1 Subtype Influenza B virus Influenza virus Influenza, Human - drug therapy Influenza, Human - epidemiology Influenza, Human - prevention & control Influenza, Human - transmission Intensive care units Length of Stay - statistics & numerical data Male Manitoba - epidemiology Medical sciences Miscellaneous Nursing Original Article Oseltamivir - therapeutic use Pandemics Pediatrics Public health. Hygiene Public health. Hygiene-occupational medicine Retrospective Studies Risk Factors Seasons Viral diseases Viral diseases of the respiratory system and ent viral diseases Viruses Canada Manitoba North America America Canada, Manitoba Canada, Manitoba, Winnipeg Human Infection Nosocomial infection Respiratory disease H1N1 influenza Viral disease Transmission Hospitalization Child Public health
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Summary:	Objective. To review the experiences at Winnipeg Children’s Hospital (WCH) during the 2009 influenza season, with an emphasis on nosocomial transmission and infection prevention and control responses. Design. A case series of patients admitted to WCH who had laboratory-confirmed cases of influenza between January 1 and July 31, 2009, with a comparison of patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza; a review of the impact of infection prevention and control modifications on nosocomial transmission. Patients and Setting. A total of 104 inpatients with influenza, 81 of whom had pandemic (H1N1) 2009 influenza, were reviewed at a large Canadian pediatric tertiary care center. Results. There were no differences in risk factors, presentation, or outcome between patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza. There were 8 nosocomial cases of pandemic (H1N1) 2009 influenza. Excluding patients with nosocomial cases, mean length of hospital stay was significantly shortened to 3.7 days for individuals who had pandemic (H1N1) 2009 influenza and who received empiric oseltamivir on admission to the hospital, compared with 12.0 days for patients for whom treatment was delayed ( ). Treatment with oseltamivir of all patients with suspected cases of influenza and prompt modifications to infection control practices, including playroom closures and enhanced education of visitors and staff, terminated nosocomial transmission. Conclusions. Infection with pandemic (H1N1) 2009 influenza virus resulted in a substantial number of hospitalizations of pediatric patients in Manitoba, including those with nosocomial cases, thereby stressing the capacity of WCH. Immediate therapy with oseltamivir on admission to the hospital resulted in a significantly reduced length of hospitalization. This, coupled with intensified infection prevention and control practices, halted nosocomial transmission. These strategies should be considered in future pandemic influenza or other respiratory viral outbreaks.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0899-823X 1559-6834
DOI:	10.1086/659401