Pandemic (H1N1) 2009 Risk for Health Care Workers | CDC EID

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Volume 17, Number 6–June 2011
Research
Pandemic (H1N1) 2009 Risk for Frontline Health Care Workers
Caroline Marshall, Anne Kelso, Emma McBryde, Ian G. Barr, Damon P. Eisen, Joe Sasadeusz, Kirsty Buising, Allen C. Cheng, Paul Johnson, and Michael Richards
Author affiliations: Royal Melbourne Hospital, Melbourne (C. Marshall, E. McBryde, D.P. Eisen, J. Sasadeusz, M. Richards); University of Melbourne, Melbourne, Victoria, Australia (C. Marshall, P. Johnson); World Health Organisation Collaborating Centre for Reference and Research on Influenza, Melbourne (A. Kelso, I.G. Barr); St Vincent's Hospital, Melbourne (K. Buising); and Monash University and Alfred Hospital, Melbourne (A.C. Cheng)


Suggested citation for this article

Abstract
To determine whether frontline health care workers (HCWs) are at greater risk for contracting pandemic (H1N1) 2009 than nonclinical staff, we conducted a study of 231 HCWs and 215 controls. Overall, 79 (17.7%) of 446 had a positive antibody titer by hemagglutination inhibition, with 46 (19.9%) of 231 HCWs and 33 (15.3%) of 215 controls positive (OR 1.37, 95% confidence interval 0.84–2.22). Of 87 participants who provided a second serum sample, 1 showed a 4-fold rise in antibody titer; of 45 patients who had a nose swab sample taken during a respiratory illness, 7 had positive results. Higher numbers of children in a participant's family and working in an intensive care unit were risk factors for infection; increasing age, working at hospital 2, and wearing gloves were protective factors. This highly exposed group of frontline HCWs was no more likely to contract pandemic (H1N1) 2009 influenza infection than nonclinical staff, which suggests that personal protective measures were adequate in preventing transmission.


Australia was affected early in the (H1N1) 2009 influenza pandemic with 37,636 cases and 191 deaths reported. The state of Victoria was the first to observe a substantial peak in the number of persons infected (1). The pandemic was managed within the framework of the Australian Health Management Plan for Pandemic Influenza (2). Guidelines for use of personal protective equipment (PPE) were established in the Victorian Health Management Plan for Pandemic Influenza (3). Recommendations included use of N95 masks, gloves, protective eyewear, and long-sleeved gowns.

Influenza in health care workers (HCWs) is common, and acquisition in the workplace is well documented. An uncontrolled study found that after an influenza epidemic in Glasgow, Scotland, 120 (23.2%) of 518 HCWs seroconverted (4). Early in 2009, twelve HCWs with probable or possible work place acquisition of pandemic influenza were reported in the United States. None had worn full PPE (5).

That HCWs may be concerned about attending work during a potentially serious influenza pandemic is not surprising. During the severe acute respiratory syndrome outbreak of 2003, some HCWs reportedly stayed at home for fear of becoming infected and transmitting infection to family members. A number of surveys have found that 16%–33% of HCWs may not report to work in the event of an influenza pandemic (6–9).

HCWs need to know the transmission risks to make rational decisions about working during an influenza pandemic. Because HCWs are exposed in the community as well as the workplace, they should know about the additional risks for contracting influenza at work. This information is also imperative for pandemic workforce planning.

We sought to determine whether frontline HCWs were at greater risk for contracting pandemic (H1N1) 2009 influenza than the control group. Additionally, we sought information on factors that may have increased or decreased the risk for infection.

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Pandemic (H1N1) 2009 Risk for Health Care Workers | CDC EID


Suggested Citation for this Article
Marshall C, Kelso A, McBryde E, Barr IG, Eisen DP, Sasadeusz J, et al. Pandemic (H1N1) 2009 risk for frontline health care workers. Emerg Infect Dis [serial on the Internet]. 2011 Jun [date cited].
http://www.cdc.gov/EID/content/17/6/1000.htm


DOI: 10.3201/eid1706.101030


Comments to the Authors
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Caroline Marshall, Victorian Infectious Diseases Service, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Grattan St, Parkville, Victoria 3050, Australia; email: caroline.marshall@mh.org.au