Investigation of influenza outbreak in one urban medical center for rehabilitation and palliative care, Bangkok, 23 July – 5 August 2024
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Abstract
On 23 July 2024, Ratchaphiphat hospital’s Surveillance and Rapid Response Team (SRRT) was notified of 13 influenza-like illness (ILI) outbreak in Intermediate care (IMC) ward and medicine ward of urban medical center for rehabilitation and palliative care, Bangkok. An investigation was conducted to confirm a diagnosis and outbreak, describe the epidemiological characteristics, identify precipitating factors of transmission and provide proper recommendations to control the outbreak. The investigation including active case finding and interviews were conducted among patients, healthcare workers and their relatives. The influenza cases were confirmed to be ILI ones by RT-PCR technique. An environmental study was also conducted. A retrospective cohort study was undertaken to identify risk factors of infection among patients. The result was shown in relative risk with 95% Confidence Intervals. Of 110 patients, 20 cases met the case definition (overall attack rate 18.18 %) including 2 confirmed influenza A H1N1 (2009) cases. The top 3 most signs and symptoms were fever, cough and sputum, respectively. The index case was admitted in ward and 2 days before she developed symptoms after having close contacts with a healthcare worker who was diagnosed with Influenza. The analytical study suggests that the history of going to physical therapy at rehabilitation building was a statistically significant risk factor (Adjusted odds ratio = 3.97, 95% CI = 1.26 - 12.56) due to increasing direct contact from physical therapy equipment in the rehabilitation building. Significant protective factor was wearing a mask all the time (Adjusted odds ratio = 0.19, 95% CI = 0.04 - 0.99). This study found that the outbreak or risk factor was caused by infection from healthcare worker to patients in the ward, direct contact from equipment in the rehabilitation building and delayed reporting to responsible persons. Therefore, immediate reporting to SRRT and cleaning shared equipment after every use are important measures for influenza prevention and control.
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