BACKGROUND: Chronic care facility residents are at risk of severe influenza infection and death. Adamantanes have been used by chronic care facilities for influenza A prophylaxis; however, genotypic resistance has altered prophylaxis recommendations. An outbreak of influenza A (H3N2) in a chronic care facility housing neurologically impaired children and young adults and subsequent control measures are described. PATIENTS AND METHODS: Resident charts were retrospectively reviewed. Isolates were characterized by strain identification and pyrosequencing. RESULTS: Although 95 (97%) of 98 residents had been immunized against influenza at the start of the influenza season, 16 (84%) of 19 case patients were identified on the first floor. However, following implementation of enhanced infection control practices and adamantane prophylaxis, only 10 (13%) of 79 case patients were identified on the second floor. Subsequent pyrosequencing studies revealed a serine to asparagine mutation at position 31 of the M2 protein. CONCLUSIONS: Enhanced infection control precautions and adamantane prophylaxis were used to control spread of influenza in a chronic care facility. This outbreak demonstrates the importance of timely and consistent implementation of infection control measures in controlling influenza outbreaks in long term care facilities and raises questions about a possible role for adamantanes in preventing transmission of adamantane-resistant influenza A viruses.
BACKGROUND: Chronic care facility residents are at risk of severe influenza infection and death. Adamantanes have been used by chronic care facilities for influenza A prophylaxis; however, genotypic resistance has altered prophylaxis recommendations. An outbreak of influenza A (H3N2) in a chronic care facility housing neurologically impaired children and young adults and subsequent control measures are described. PATIENTS AND METHODS: Resident charts were retrospectively reviewed. Isolates were characterized by strain identification and pyrosequencing. RESULTS: Although 95 (97%) of 98 residents had been immunized against influenza at the start of the influenza season, 16 (84%) of 19 case patients were identified on the first floor. However, following implementation of enhanced infection control practices and adamantane prophylaxis, only 10 (13%) of 79 case patients were identified on the second floor. Subsequent pyrosequencing studies revealed a serine to asparagine mutation at position 31 of the M2 protein. CONCLUSIONS: Enhanced infection control precautions and adamantane prophylaxis were used to control spread of influenza in a chronic care facility. This outbreak demonstrates the importance of timely and consistent implementation of infection control measures in controlling influenza outbreaks in long term care facilities and raises questions about a possible role for adamantanes in preventing transmission of adamantane-resistant influenza A viruses.
Authors: Scott A Harper; John S Bradley; Janet A Englund; Thomas M File; Stefan Gravenstein; Frederick G Hayden; Allison J McGeer; Kathleen M Neuzil; Andrew T Pavia; Michael L Tapper; Timothy M Uyeki; Richard K Zimmerman Journal: Clin Infect Dis Date: 2009-04-15 Impact factor: 9.079
Authors: Muthannan A Ramakrishnan; Zheng Jin Tu; Sushmita Singh; Ashok K Chockalingam; Marie R Gramer; Ping Wang; Sagar M Goyal; My Yang; David A Halvorson; Srinand Sreevatsan Journal: PLoS One Date: 2009-09-22 Impact factor: 3.240
Authors: Nila J Dharan; Monica Patton; Alicia M Siston; Julie Morita; Enrique Ramirez; Teresa R Wallis; Varough Deyde; Larisa V Gubareva; Alexande I Klimov; Joseph S Bresee; Alicia M Fry Journal: Emerg Infect Dis Date: 2009-12 Impact factor: 6.883