36Background: Nosocomial respiratory virus outbreaks represent serious public health challenges. 37Rapid and precise identification of cases and tracing of transmission chains is critical to end outbreaks 38 and to inform prevention measures. 39 Methods: We combined conventional surveillance with Influenza A virus (IAV) genome sequencing to 40 identify and contain a large IAV outbreak in a metropolitan healthcare system. A total of 381 41 individuals, including 91 inpatients and 290 health care workers (HCWs), were included in the 42 investigation.43 Results: During a 12-day period in early 2019, infection preventionists identified 89 HCWs and 18 44 inpatients as cases of influenza-like illness (ILI), using an amended definition, without the requirement 45 for fever. Sequencing of IAV genomes from available nasopharyngeal (NP) specimens identified 66 46 individuals infected with a nearly identical strain of influenza A H1N1 (43 HCWs, 17 inpatients, and 6 47 with unspecified affiliation). All HCWs infected with the outbreak strain had received the seasonal 48 influenza virus vaccination. Characterization of five representative outbreak viral isolates did not show 49 antigenic drift. In conjunction with IAV genome sequencing, mining of electronic records pinpointed 50 the origin of the outbreak as a single patient and a few interactions in the emergency department that 51 occurred one day prior to the index ILI cluster.52 Conclusions: We used precision surveillance to identify and control a large nosocomial IAV outbreak, 53 mapping the source of the outbreak to a single patient rather than HCWs as initially assumed based 54 on conventional epidemiology. These findings have important ramifications for more effective 55 prevention strategies to curb nosocomial respiratory virus outbreaks.56 57
Background Nosocomial respiratory virus outbreaks represent serious public health challenges. Rapid and precise identification of cases and tracing of transmission chains is critical to end outbreaks and to inform prevention measures. Methods We combined conventional surveillance with influenza A virus (IAV) genome sequencing to identify and contain a large IAV outbreak in a metropolitan healthcare system. A total of 381 individuals, including 91 inpatients and 290 health care workers (HCWs), were included in the investigation. Results During a 12-day period in early 2019, infection preventionists identified 89 HCWs and 18 inpatients as cases of influenza-like illness (ILI), using an amended definition without the requirement for fever. Sequencing of IAV genomes from available nasopharyngeal (NP) specimens identified 66 individuals infected with a nearly identical strain of influenza A H1N1pdm09 (43 HCWs, 17 inpatients, and 6 with unspecified affiliation). All HCWs infected with the outbreak strain had received the seasonal influenza virus vaccination. Characterization of five representative outbreak viral isolates did not show antigenic drift. In conjunction with IAV genome sequencing, mining of electronic records pinpointed the origin of the outbreak as a single patient and a few interactions in the emergency department that occurred one day prior to the index ILI cluster. Conclusions We used precision surveillance to delineate a large nosocomial IAV outbreak, mapping the source of the outbreak to a single patient rather than HCWs as initially assumed based on conventional epidemiology. These findings have important ramifications for more effective prevention strategies to curb nosocomial respiratory virus outbreaks.
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