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Nosocomial vs community-acquired pandemic influenza A (H1N1) 2009: a nested case-control study

G Khandaker1, H Rashid, Y Zurynski

  • 1National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and The University of Sydney, Sydney, New South Wales, Australia.

The Journal of Hospital Infection
|September 5, 2012
PubMed

Insights

Children with underlying conditions or exposed to smokers are more susceptible to hospital-acquired pandemic influenza A (H1N1). Nosocomial influenza cases had fewer classic symptoms but longer hospital stays.

Area of Science:

  • Pediatric Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • The clinical and epidemiological characteristics of hospital-acquired (nosocomial) influenza in children are not well-defined.
  • Pandemic influenza A (H1N1) 2009 (pH1N1) presented a significant public health challenge, particularly in pediatric populations.

Purpose of the Study:

  • To compare the clinical and epidemiological features of nosocomial versus community-acquired pandemic influenza A (H1N1) in hospitalized Australian children.
  • To identify risk factors associated with nosocomial pH1N1 infection in pediatric patients.

Main Methods:

  • A nested case-control study was conducted comparing hospitalized children under 15 with pH1N1.
  • Data collection occurred between June 1 and September 30, 2009, across six Australian pediatric hospitals.
  • Nosocomial cases were compared with gender- and age-matched community-acquired controls.

Main Results:

  • Of 506 hospitalized children with pH1N1, 47 (9.3%) acquired the infection nosocomially.
  • Nosocomial cases had a higher prevalence of underlying medical conditions (81% vs. 42%) and household smoker exposure (36% vs. 20%).
  • Fewer nosocomial cases presented with classic influenza symptoms, but they received more oseltamivir treatment and had longer hospital stays (mean 8.5 vs. 4.5 days).

Conclusions:

  • Children with pre-existing diseases and exposure to household smokers are at increased risk for nosocomial pH1N1.
  • Nosocomial influenza in children may present with atypical symptoms ('occult presentation').
  • The clinical course of nosocomial influenza in children was not markedly different from community-acquired cases, with no deaths reported in the nosocomial group.
Abstract

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