Abstract
Traditional epidemiological investigation of nosocomial transmission of influenza involves the identification of patients who have the same influenza virus type and who have overlapped in time and place. This method may misidentify transmission where it has not occurred or miss transmission when it has. We used influenza virus whole-genome sequencing (WGS) to investigate an outbreak of influenza A virus infection in a hematology/oncology ward and identified 2 separate introductions, one of which resulted in 5 additional infections and 79 bed-days lost. Results from WGS are becoming rapidly available and may supplement traditional infection control procedures in the investigation and management of nosocomial outbreaks.
Highlights
Nosocomial transmission of influenza A virus is of significant concern since infection in individuals who are immunocompromised, immunosuppressed, at extremes of age, or pregnant have an increased risk of severe illness, morbidity and death [1, 2]
Nosocomial transmission of influenza virus within the healthcare setting has been identified through traditional molecular diagnostic methods for the detection of viral species, combined with data collected on patient and staff movement within the hospital
We describe an outbreak of influenza A virus infection, during early 2016, on a hematology/oncology ward in a National Health Service (NHS) hospital in London, in which timely use of whole-genome sequencing (WGS) would have identified the presence or absence of nosocomial transmission and allowed a more targeted infection control response
Summary
Nosocomial transmission of influenza A virus is of significant concern since infection in individuals who are immunocompromised, immunosuppressed, at extremes of age, or pregnant have an increased risk of severe illness, morbidity and death [1, 2]. On day 1, a further patient (patient C; Figure 1) on the south side of the ward, developed symptoms and tested positive for influenza A virus. Since this south-side patient had no clear link to patients A and B on the north side, it was assumed that an outbreak was not occurring, and the ward was not closed. A visiting relative of patient B later revealed that they had coryzal symptoms that preceded and continued throughout the outbreak This relative tested positive for influenza A virus 1 week after the first patients were tested
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