Nosocomial influenza in a general hospital for indigent patients

Surveillance of influenza virus infections was maintained on the medical and pediatric wards of a general hospital serving indigent patients of Harris County, Texas during the winter of 1987-88. Influenza A/Sichuan/2/87(H3N2) was the predominant virus during the community epidemic. Influenza A(H3N2) virus was isolated from six of 17 adult patients (35%) suspected to have nosocomial infections; two of these patients died of fulminating pneumonia. Another patient, admitted with alcoholism and hematemesis, developed pneumonia after a documented influenza infection, and the hospital stay was extended for two weeks. The paucity of virus positive community acquired infections on the medical wards suggested that the health care team was the probable source of the nosocomial infections. Community-acquired infections with influenza viruses were common on the pediatric service; however, most admissions were for acute conditions requiring brief hospital stays. Therefore, while nosocomial infections were unusual on the pediatric ward, they may have become evident after discharge. Recommendations for reducing the impact of nosocomial influenza virus infections include hospital-centred vaccination programs for both high risk patients and hospital personnel. Amantadine can be an important adjunctive therapy for reducing nosocomial spread during influenza A virus epidemics.