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Suspected Nosocomial Influenza Cases in an Intensive Care Unit

Georgia. During November 1987, CDC received reports of three patients and one nurse with suspected influenza infections in a 15-bed medical-surgical intensive care unit (MSICU). The index case occurred in a 71-year-old female with diabetes mellitus who was admitted to the MSICU on October 29 and subsequently required mechanical ventilation. Influenza A was identified by fluorescent antibody (FA) staining of tissue culture cells inoculated with an endotracheal aspirate collected on November 11. The patient died on November 14, and influenza virus was identified in lung tissue collected postmortem. The second patient, an intubated 60-year-old woman with chronic obstructive lung disease, had been hospitalized since October 26. Influenza A was identified by FA staining of cell culture inoculation of a lung biopsy specimen obtained on November 23. The same procedure was used to identify influenza A in an endotracheal aspirate specimen collected on November 26 from an intubated 76-year-old man who had been hospitalized since September 28. Further investigation revealed that a nurse who had cared for all three patients was absent from work during the last week of November because of an influenza-like illness. Neither the three patients nor the nurse had received the 1987-88 influenza vaccine. Isolates were not available for confirmation and subtype identification.

Other reports. For the report week ending January 2, four states* reported regional outbreaks of influenza-like illness. Fifteen states** have reported isolates of influenza A(H3N2), which is the predominant subtype so far this season. Influenza A, subtype pending, has been reported from Hawaii, Louisiana, Utah, and Washington. Reported by: P Patterson, D Smith, RK Sikes, DVM, MPH, State Epidemiologist, Georgia Dept of Human Resources. Univ Hygienic Laboratory, Univ of Iowa. Participating State and Territorial Epidemiologists and State Laboratory Directors. WHO Collaborating Center for Influenza, Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: In the past, hospital laboratories have had to send specimens to reference laboratories for virus isolation and identification. Now, many hospital laboratories are able to rapidly identify influenza A or B viruses by using monoclonal antibodies for typing virus antigens produced in cell culture. Results can usually be obtained within 24 to 72 hours after inoculation of the specimen.

Rapid diagnosis may be particularly useful in preventing nosocomial outbreaks of influenza A since patients exposed to the virus can be given amantadine, an antiviral drug effective against influenza type A. Rapid diagnostic capabilities may also help hospitals encourage their staffs to use antiviral prophylaxis or to be vaccinated, as recommended by the Immunization Practices Advisory Committee (ACIP) (1). Rapid diagnosis, coupled with prompt reporting to public health officials, will also help detect possible epidemics. However, confirmation by a second laboratory is important during nonepidemic periods because it will help avoid reports of false-positive results, which could set control measures into motion unnecessarily.

The cases reported here were identified by laboratory testing. Ideally, suspect isolates should be saved, and a sample should be forwarded to the appropriate state health department for confirmation. Isolates confirmed by state health departments are then forwarded to the WHO Collaborating Center for Influenza at CDC for detailed antigenic analysis, including strain identification. Early in the influenza season, these antigenic analyses need to be performed on as many isolates as possible because the findings are used to identify vaccine strains for the coming year.

Reference

  1. Immunization Practices Advisory Committee. Prevention and control of influenza. MMWR 1987;36:373-80,385-7. *Alabama, South Dakota, Utah, and Wisconsin. **California, Colorado, Florida, Iowa, Kansas, Minnesota, Missouri, Montana, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.



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