Department of Pediatrics, School of Medicine, Keio University, Japan.
Pediatr Infect Dis J. 2012 Nov;31(11):1119-23. doi: 10.1097/INF.0b013e318260265a.
Postexposure prophylaxis (PEP) using neuraminidase inhibitors against exposure to influenza virus has been well studied in household settings but not in nosocomial settings in pediatric wards.
We used oseltamivir or zanamivir as PEP in our pediatric wards. All influenza cases were diagnosed by the influenza rapid diagnostic test.
Between 2003 and 2011, there were 20 nosocomial introductions of influenza (10 were A, 9 were B and 1 was undetermined). The index cases consisted of 17 inpatients, 2 parents and 1 medical staff member. The 17 inpatients had been admitted to the hospital for reasons other than infectious disease and they developed influenza after hospitalization. Among the 81 contacts, 28 (35%) were exposed to influenza A, and 52 (64%) were exposed to influenza B. The rate of secondary infection among contacts not given PEP was 29% (5/17), and the rate among contacts given PEP was significantly lower, 3% (2/63; P = 0.004). The 2 infected contacts who had been given PEP were both influenza B cases, and both had received oseltamivir. The contacts who received PEP within 24 hours (59), for influenza A (23) and those who received zanamivir (15) did not develop influenza. No adverse events were reported.
PEP using oseltamivir or zanamivir for unexpected occurrences of nosocomial influenza in pediatric wards is safe and effective. The influenza rapid diagnostic test that we used was helpful for detecting nosocomial influenza in children.
针对流感病毒暴露，在家庭环境中使用神经氨酸酶抑制剂的暴露后预防（PEP）已得到充分研究，但在儿科病房的医院环境中尚未进行研究。
我们在儿科病房使用奥司他韦或扎那米韦进行 PEP。所有流感病例均通过流感快速诊断测试进行诊断。
2003 年至 2011 年期间，共发生 20 例医院内流感传播（10 例为 A 型，9 例为 B 型，1 例为未确定型）。首发病例包括 17 名住院患者、2 名家长和 1 名医务人员。17 名住院患者因非传染病原因住院，住院后发生流感。在 81 名接触者中，28 名（35%）接触 A 型流感，52 名（64%）接触 B 型流感。未接受 PEP 的接触者的继发感染率为 29%（5/17），而接受 PEP 的接触者的感染率明显较低，为 3%（2/63；P=0.004）。接受 PEP 的 2 例感染接触者均为 B 型流感，且均接受了奥司他韦治疗。在 24 小时内接受 PEP 的接触者（59 例），A 型流感（23 例）和接受扎那米韦（15 例）的接触者未发生流感。未报告不良事件。
在儿科病房中针对医院内流感意外发生使用奥司他韦或扎那米韦进行 PEP 是安全有效的。我们使用的流感快速诊断测试有助于检测儿童医院内流感。
