Pandemic (H1N1) 2009 Influenza in Hospitalized Children in Manitoba: Nosocomial Transmission and Lessons Learned from the First Wave

Abstract

Objective.To review the experiences at Winnipeg Children's Hospital (WCH) during the 2009 influenza season, with an emphasis on nosocomial transmission and infection prevention and control responses.Design.A case series of patients admitted to WCH who had laboratory-confirmed cases of influenza between January 1 and July 31, 2009, with a comparison of patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza; a review of the impact of infection prevention and control modifications on nosocomial transmission.Patients and Setting.A total of 104 inpatients with influenza, 81 of whom had pandemic (H1N1) 2009 influenza, were reviewed at a large Canadian pediatric tertiary care center.Results.There were no differences in risk factors, presentation, or outcome between patients with seasonal influenza and those with pandemic (H1N1) 2009 influenza. There were 8 nosocomial cases of pandemic (H1N1) 2009 influenza. Excluding patients with nosocomial cases, mean length of hospital stay was significantly shortened to 3.7 days for individuals who had pandemic (H1N1) 2009 influenza and who received empiric oseltamivir on admission to the hospital, compared with 12.0 days for patients for whom treatment was delayed (P = .02). Treatment with oseltamivir of all patients with suspected cases of influenza and prompt modifications to infection control practices, including playroom closures and enhanced education of visitors and staff, terminated nosocomial transmission.Conclusions.Infection with pandemic (H1N1) 2009 influenza virus resulted in a substantial number of hospitalizations of pediatric patients in Manitoba, including those with nosocomial cases, thereby stressing the capacity of WCH. Immediate therapy with oseltamivir on admission to the hospital resulted in a significantly reduced length of hospitalization. This, coupled with intensified infection prevention and control practices, halted nosocomial transmission. These strategies should be considered in future pandemic influenza or other respiratory viral outbreaks.