An outbreak of the 2009 influenza a (H1N1) virus in a children's hospital.
BACKGROUND
Preventing nosocomial transmission of influenza is essential to reduce the morbidity and mortality associated with this infection. In October 2009, an outbreak of the 2009 influenza A (H1N1) virus occurred in a hematology ward of a children's hospital over a 21-day period and involved two patients and four healthcare workers.


OBJECTIVE
To investigate nosocomial transmission of the 2009 influenza A (H1N1) virus in patients and healthcare workers.


METHODS
An outbreak investigation was initiated in response to suspected nosocomial transmission of the 2009 influenza A (H1N1) virus during the peak of the 2009 pandemic. Cases were confirmed using a polymerase chain reaction (PCR) test specific for the 2009 H1N1 influenza A virus. Viruses isolated from nasopharyngeal swabs were genetically characterized using Sanger sequencing of uncloned "bulk" PCR products.


METHODS
Virus sequencing to investigate nosocomial transmission.


RESULTS
Two immunocompromised patients and four healthcare workers were found to be part of a nosocomial outbreak of the 2009 influenza A (H1N1) virus. One immunocompromised patient had a second episode of clinical influenza infection after isolation precautions had been discontinued, resulting in additional exposures. Strain-specific PCR showed that all cases were caused by infection of the 2009 H1N1 virus. Sequencing of viral genes encoding hemagglutinin and polymerase basic subunit 2 (PB2) revealed that all viruses isolated were genetically identical at these loci, including the two episodes occurring in the same immunocompromised patient.


CONCLUSIONS
Prompt institution of isolation precautions is essential in preventing nosocomial outbreaks of the 2009 novel influenza A (H1N1) virus. Our data suggest that isolation precautions may need to be continued for a prolonged period of time in immunocompromised patients with influenza infection.
Sections of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Allison
A
Bearden
Thomas C
TC
Friedrich
Tony L
TL
Goldberg
Barbara
B
Byrne
Carol
C
Spiegel
Peter
P
Schult
Nasia
N
Safdar
D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D004196:Disease Outbreaks; D006776:Hospitals, Pediatric; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission / Q000821:virology; D008297:Male; D017720:Molecular Epidemiology; D009305:Nasopharynx / Q000821:virology; D010356:Patient Isolation; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA