Yue Mimi C, Collins Joel T, Subramoniapillai Elango, Kennedy Glen A
Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Asia Pac J Clin Oncol. 2017 Feb;13(1):37-43. doi: 10.1111/ajco.12565. Epub 2016 Oct 12.
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.
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.
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.
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.
描述一家血液科及异基因造血干细胞移植病房内甲型H1N1流感的医院感染暴发情况以及全员使用奥司他韦预防的效果。
回顾该病房所有入院患者的病历，以确定医院感染暴发情况，从首例病例出现前1周开始，直至奥司他韦预防措施实施后4周。构建临床症状、病毒传播、管理、患者结局及后续检测的时间线。所有流感病例均通过采集鼻咽拭子和/或支气管肺泡灌洗样本进行聚合酶链反应检测来确诊。
除首例病例外，暴发期间另有11例患者被诊断为甲型流感。6例患者（50%）出现流感样疾病，5例（42%）仅有呼吸道症状，1例（8%）无症状。共有5例患者死亡，其中4例（33%）入住重症监护病房。7例病例聚集导致暴发被识别，随后该病房所有住院患者开始每日服用75毫克奥司他韦进行全员预防。同时加强了严格的感染控制措施。全员使用奥司他韦预防措施实施后，未再出现与此次暴发相关的甲型流感病例。后来有3例病例与最初暴发期间的H1N1暴露有关。
H1N1流感感染在血液病患者中与显著的死亡率相关。医院感染暴发期间使用奥司他韦进行全员预防似乎对控制病毒传播有效。我们建议在任何医院流感暴发时尽早实施感染控制和全员预防。
