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Molecular characterization of a nosocomial outbreak of influenza B virus in an acute care hospital setting

Journal article
Authors Martina Sansone
A. Wiman
M. L. Karlberg
M. Brytting
L. Bohlin
Lars-Magnus Andersson
Johan Westin
Rickard Nordén
Published in Journal of Hospital Infection
Volume 101
Issue 1
Pages 30-37
ISSN 0195-6701
Publication year 2019
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 30-37
Language en
Keywords Nosocomial transmission, Influenza B virus infection, Whole genome sequencing, Hospital outbreak, aerosol transmission, oseltamivir, infection, interventions, sars, pcr
Subject categories Infectious Medicine


Aim: To describe a hospital outbreak of influenza B virus (InfB) infection during season 2015/2016 by combining clinical and epidemiological data with molecular methods. Methods: Twenty patients diagnosed with InfB from a hospital outbreak over a four-week-period were included. Nasopharyngeal samples (NPS) positive for InfB by multiplex real-time polymerase chain reaction were sent for lineage typing and whole genome sequencing (WGS). Medical records were reviewed retrospectively for data regarding patient characteristics, localization, exposure and outcome, and assembled into a timeline. In order to find possible connections to the hospital outbreak, all patients with a positive NPS for influenza from the region over an extended time period were also reviewed. Findings: All 20 cases of InfB were of subtype B/Yamagata, and 17 of 20 patients could be linked to each other by either shared room or shared ward. WGS was successful or partially successful for 15 of the 17 viral isolates, and corroborated the epidemiological link supporting a close relationship. In the main affected ward, 19 of 75 inpatients were infected with InfB during the outbreak period, resulting in an attack rate of 25%. One probable case of influenza-related death was identified. Conclusion: InfB may spread within an acute care hospital, and advanced molecular methods may facilitate assessment of the source and extent of the outbreak. A multifaceted approach, including rapid diagnosis, early recognition of outbreak situations, simple rules for patient management and the use of regular infection control measures, may prevent nosocomial transmission of influenza virus. (C) 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

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