Epidemiological investigation of an outbreak of pandemic influenza A (H1N1) 2009 in a boarding school: Serological analysis of 1570 cases |
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| Authors: | Tiegang Li Yang Liu Biao Di Ming Wang Jichuan Shen Ying Zhang Xi Chen Jun Yuan Jibin Wu Kuibiao Li Enjie Lu Yejian Wu Aihua Hao Xiongfei Chen Yulin Wang Jianhua Liu Sam Pickerill Bojian Zheng |
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| Institution: | 1. Guangzhou Center for Disease Control and Prevention, Zhongshan Road 3, No. 23, Guangzhou 510080, PR China;2. Ustar Biotechnologies (Hangzhou) Co. Ltd., Hangzhou, Zhejiang 310012, PR China;3. The University of Hong Kong, Pok Fu Lam, Hong Kong, China;1. Field Epidemiology Training Program (EPISUS), Health Surveillance Secretariat (SVS), Ministry of Health (MoH), Brasília, Brazil;2. National Agency for Health Surveillance (ANVISA), MoH, Brasília, Brazil;3. Brasilia University, Postgraduate Program of Tropical Medicine – Infectious Disease Epidemiology, Brazil;4. National Immunization Program (PNI), DEVEP, SVS, MoH, Brasília, Brazil;5. Santa Catarina State Health Department (SES/SC), Florianópolis, Brazil;6. Municipal Health Department (SMS), Curitiba, Brazil;7. São Paulo State Health Department (SES/SP), São Paulo, Brazil;8. Immunization Safety Branch, National Immunization Program (Current affiliation: Division of HIV/AIDS Prevention), Centers for Disease Control and Prevention, Atlanta, USA;9. Centers for Disease Control and Prevention, Atlanta, USA;1. National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece;2. Institute of Infection & Global Health (IGH), University of Liverpool, Liverpool, UK;3. Service of Microbiology, INIBIC-Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain;4. Service of Microbiology, Hospital Conxo-CHUS, and Department of Microbiology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain;5. Division of Clinical Virology, INIBIC-Complejo Hospitalario Universitario de A Coruña, Universidade da Coruña, A Coruña, Spain;1. Viroscience Department, Erasmus Medical Center, Rotterdam, the Netherlands;2. Virology Department, Centre for Infectious Diseases Research, Diagnostics and Screening, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands;3. Department for Statistics, Informatics and Mathematical Modelling, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands;1. Regenerative Bioscience Center, University of Georgia, 425 River Road, Athens, GA, 30602, USA;2. Department of Animal and Dairy Science, University of Georgia, 425 River Road, Athens, GA, 30602, USA;3. USDA, ARS, Southeast Poultry Research Laboratory, 934 College Station Road, Athens, GA, 30605, USA;1. Department of Public Health Microbiology, School of Public Health, Fudan University, Bldg 8#, Rd. Dong’an 130, Shanghai 200032, People''s Republic of China;2. Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, People''s Republic of China;3. Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Bldg 8#, Rd. Dong’an 130, Shanghai 200032, People''s Republic of China;4. Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, People''s Republic of China;5. Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada;1. Service de Bactériologie-Hygiène, Nantes, France;2. Université de Nantes, Thérapeutiques Cliniques et Expérimentales des Infections, UFR Médecine, EA3826, Nantes, France;3. Service de Réanimation Médicale, Nantes, France;4. Service de Maladies Infectieuses et Tropicales, Nantes, France |
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| Abstract: | BackgroundA large number of 2009 pandemic influenza A (H1N1) infections were localized in school populations.ObjectivesTo describe the epidemiology, clinical features and risk factors associated with an outbreak that occurred at a vocational boarding school in Guangzhou, P.R. China.Study designData were collected prospectively and retrospectively through the use of on-site doctors and a post-outbreak survey and blood collection. The survey was used to confirm symptoms, and to investigate a series of flu-related factors such as dormitory conditions, health habits, vaccine history and population contact history. Blood samples were taken for serological analysis. Pandemic H1N1 infection was initially confirmed by a real-time RT-PCR assay. Following the identification of the outbreak by the Guangzhou CDC on September 4, cases were diagnosed symptomatically and retrospectively by serological analysis using the hemagglutination inhibition assay and a neutralization assay.ResultsThe infection rate was 32% (505/1570) and the attack rate was 22.2% (349/1570). The asymptomatic infection rate was 9.9% (156/1570). Sharing a classroom (OR = 2.17, 95% CI: 1.62–2.91) and dormitory space (OR = 2.32, 95% CI: 1.84–2.93) was associated with higher rates of infection. Opening windows for ventilation was the only control measure that significantly protected against infection.ConclusionSocial isolation and quarantine should be used to prevent the spread of infection. Ventilation and a control of air flow between classrooms and dorms should be implemented as possible. School closures may be effective if implemented early. |
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