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Transmission of 2009 Pandemic Influenza A (H1N1) Virus among Healthcare Personnel—Southern California, 2009

Published online by Cambridge University Press:  02 January 2015

Jenifer L. Jaeger
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Minal Patel
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
Nila Dharan
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Kathy Hancock
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Elissa Meites
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
Christine Mattson
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
Matt Gladden
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
David Sugerman
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Saumil Doshi
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Dianna Blau
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
Kathleen Harriman
Affiliation:
California Department of Public Health, Sacramento, California
Melissa Whaley
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Hong Sun
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Michele Ginsberg
Affiliation:
San Diego County Health and Human Services Agency, San Diego, California
Annie S. Kao
Affiliation:
San Diego County Health and Human Services Agency, San Diego, California
Paula Kriner
Affiliation:
Imperial County Public Health Department, El Centro, California
Stephen Lindstrom
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Seema Jain
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Jacqueline Katz
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Lyn Finelli
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Sonja J. Olsen
Affiliation:
National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
Alexander J. Kallen*
Affiliation:
National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
*
Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, 1600 Clifton Road NE, MS A-35, Atlanta, GA 30333 (akallen@cdc.gov)

Abstract

Objective.

In April 2009, 2009 pandemic influenza A (H1N1) (hereafter, pH1N1) virus was identified in California, which caused widespread illness throughout the United States. We evaluated pH1N1 transmission among exposed healthcare personnel (HCP) and assessed the use and effectiveness of personal protective equipment (PPE) early in the outbreak.

Design.

Cohort study.

Setting.

Two hospitals and 1 outpatient clinic in Southern California during March 28-April 24, 2009.

Participants.

Sixty-three HCP exposed to 6 of the first 8 cases of laboratory-confirmed pH1N1 in the United States.

Methods.

Baseline and follow-up questionnaires were used to collect demographic, epidemiologic, and clinical data. Paired serum samples were obtained to test for pH1N1-specific antibodies by microneutralization and hemagglutination-inhibition assays. Serology results were compared with HCP work setting, role, and self-reported PPE use.

Results.

Possible healthcare-associated pH1N1 transmission was identified in 9 (14%) of 63 exposed HCP; 6 (67%) of 9 seropositive HCP had asymptomatic infection. The highest attack rates occurred among outpatient HCP (6/19 [32%]) and among allied health staff (eg, technicians; 8/33 [24%]). Use of mask or N95 respirator was associated with remaining seronegative (P = .047). Adherence to PPE recommendations for preventing transmission of influenza virus and other respiratory pathogens was inadequate, particularly in outpatient settings.

Conclusions.

pH1N1 transmission likely occurred in healthcare settings early in the pandemic associated with inadequate PPE use. Organizational support for a comprehensive approach to infectious hazards, including infection prevention training for inpatient- and outpatient-based HCP, is essential to improve HCP and patient safety.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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