title: Successful use of oseltamivir prophylaxis in managing a nosocomial outbreak of influenza A in a hematology and allogeneic stem cell transplant unit.
abstract: OBJECTIVE
  To describe a nosocomial outbreak of H1N1 influenza A in an inpatient hematology and allogeneic stem cell transplant unit and outcomes of universal oseltamivir prophylaxis.
  
  
  METHODS
  Medical records of all patients admitted to the unit were reviewed to define the nosocomial outbreak, commencing 1 week prior to the index case until 4 weeks following institution of oseltamivir prophylaxis. Timelines for clinical symptoms, viral spread, management, patient outcomes and follow up testing were constructed. All cases of influenza were confirmed on nasopharyngeal swabs and/or bronchoalveolar lavages collected for polymerase chain reaction testing.
  
  
  RESULTS
  In addition to the index case, further 11 patients were diagnosed with influenza A during the outbreak. Six patients (50%) had influenza-like-illness, five (42%) had respiratory symptoms only and one (8%) was asymptomatic. In total, five patients died, including four (33%) patients who were admitted to intensive care. A clustering of seven cases led to recognition of the outbreak and subsequent commencement of universal prophylaxis with oseltamivir 75 mg/day in all inpatients within the unit. Strict infection control processes were reinforced concurrently. There were no further cases of influenza A linked to the outbreak after the implementation of universal oseltamivir prophylaxis. Three later cases were linked to H1N1 exposure during the original outbreak.
  
  
  CONCLUSIONS
  H1N1 influenza infection is associated with significant mortality in hematology patients. Universal prophylaxis with oseltamivir during a nosocomial outbreak appeared to be effective in controlling spread of the virus. We recommend early institution of infection control and universal prophylaxis in any nosocomial outbreak of influenza.
authors.affiliation: Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Mimi C
authors.initials: MC
authors.lastname: Yue
authors.affiliation: Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Collins
authors.affiliation: Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: Elango
authors.initials: E
authors.lastname: Subramoniapillai
authors.affiliation: Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.|School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects / Q000276:immunology; D017053:Infection Control / Q000379:methods*; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir
keywords: H1N1; hematology; hematopoietic stem cell transplant; influenza A; oseltamivir