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Nosocomial Pandemic (H1N1) 2009, United Kingdom | CDC EID

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Volume 17, Number 4–April 2011
Nosocomial Pandemic (H1N1) 2009, United Kingdom, 2009–2010
Joanne E. Enstone, Puja R. Myles, Peter J.M. Openshaw, Elaine M. Gadd, Wei Shen Lim, Malcolm G. Semple, Robert C. Read, Bruce L. Taylor, James McMenamin, Colin Armstrong, Barbara Bannister, Karl G. Nicholson, and Jonathan S. Nguyen-Van-Tam

Author affiliations: University of Nottingham, Nottingham, UK (J.E. Enstone, P.R. Myles, J.S. Nguyen-Van-Tam); Imperial College, London, UK (P.J.M. Openshaw); Department of Health, London (E.M. Gadd, C. Armstrong, B. Bannister); Nottingham University Hospitals National Health Service Trust, Nottingham (W.S. Lim); University of Liverpool, Liverpool, UK (M.G. Semple); University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK (R.C. Read); Portsmouth Hospitals National Health Service Trust, Portsmouth, UK (B.L. Taylor); Health Protection Scotland, Glasgow, Scotland (J. McMenamin); and University Hospitals of Leicester National Health Service Trust, Leicester, UK (K.G. Nicholson)

Suggested citation for this article

To determine clinical characteristics of patients hospitalized in the United Kingdom with pandemic (H1N1) 2009, we studied 1,520 patients in 75 National Health Service hospitals. We characterized patients who acquired influenza nosocomially during the pandemic (H1N1) 2009 outbreak. Of 30 patients, 12 (80%) of 15 adults and 14 (93%) of 15 children had serious underlying illnesses. Only 12 (57%) of 21 patients who received antiviral therapy did so within 48 hours after symptom onset, but 53% needed escalated care or mechanical ventilation; 8 (27%) of 30 died. Despite national guidelines and standardized infection control procedures, nosocomial transmission remains a problem when influenza is prevalent. Health care workers should be routinely offered influenza vaccine, and vaccination should be prioritized for all patients at high risk. Staff should remain alert to the possibility of influenza in patients with complex clinical problems and be ready to institute antiviral therapy while awaiting diagnosis during influenza outbreaks.

Nosocomial influenza is a well-recognized problem in acute-care hospital settings (1,2). Outbreaks of influenza A have been reported in general wards (3,4), pediatric units (5), neonatal intensive care units (ICUs) (6–8), hemopoietic and solid organ transplantation units (9–11), oncology and neurology units (12,13), and facilities for the elderly and for long-term care (14–17). Associated illness and death rates are particularly high in immunocompromised patients (18–20).

On June 11, 2009, the World Health Organization reported the first influenza pandemic of the 21st century (21,22). Although most cases of pandemic (H1N1) 2009 have been mild or subclinical, patients with severe disease have considerably affected hospital systems (23). Three nosocomial outbreaks of pandemic (H1N1) 2009 were reported in hemopoietic transplantation units and oncology wards. One outbreak was reportedly mild (24), and the other 2 involved aggressive illness, severe complications, and deaths (25,26).

In addition to outbreaks of nosocomial influenza, sporadic nosocomial influenza infections also occur but generally are not reported in the literature. We describe the clinical and epidemiologic characteristics of nosocomial pandemic (H1N1) 2009 infections during 2009–2010 in the United Kingdom that were identified during surveillance rather than through outbreak control activity.

Nosocomial Pandemic (H1N1) 2009, United Kingdom | CDC EID

Suggested Citation for this Article
Enstone JE, Myles PR, Openshaw PJM, Gadd EM, Lim WS, Semple MS, et al. Nosocomial pandemic (H1N1) 2009, United Kingdom, 2009–2010. Emerg Infect Dis [serial on the Internet]. 2011 Apr [date cited

DOI: 10.3201/eid1704.101679

Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Joanne E. Enstone, Epidemiology and Public Health, Clinical Sciences Building, University of Nottingham, Hucknall Rd, Nottingham NG5 1PB, UK;


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