258446 Pertussis transmission in a neonatal intensive care unit — Arizona, 2011

Tuesday, October 30, 2012 : 2:35 PM - 2:55 PM

Seema Yasmin, MB BChir , Arizona Department of Health Services, Epidemic Intelligence Service, Phoenix, AZ
Rebecca Sunenshine, MD , Maricopa County Department of Public Health, Phoenix, AZ
Caleb Wiedeman, MPH , Office of Infectious Diseases, Arizona Department of Health Services, Phoenix, AZ
Kristine Bisgard, DVM, MPH, ACVPM , Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA
Alice Carrigan, RN , Disease Surveillance, Maricopa County Department of Public Health, Phoenix, AZ
Tammy Sylvester, RN , Office of Epidemiology, Maricopa County Department of Public Health, Phoenix, AZ
Kathleen Howard, RN , Infection Control, St Joseph's Hospital and Medical Center, Phoenix
Aarikha D'Souza, MPH , Office of Infectious Diseases, Arizona Department of Health Services, Phoenix, AZ
Shoana Anderson, MPH , Bureau of Epidemiology and Disease Control, Office of Infectious Disease Services, Arizona Department of Health Services, Pheonix, AZ
Ken Komatsu , State Epidemiologist, Arizona Deparment of Health Services, Phoenix, AZ
Ronald Klein, RN , Disease Surveillance, Maricopa County Department of Public Health, Phoenix, AZ
Background: During September 13—15, 2011, hospital B reported 3 pertussis cases, including 2 confirmed by Bordetella pertussis isolation among infants discharged <30 days previously from a 71-bed neonatal intensive care unit (NICU A). We investigated NICU A to determine the extent of the outbreak, factors contributing to health care-associated transmission, and outbreak costs. Methods: Case definition was a cough >14 days during July 28—September 19 in a NICU-associated person. We observed NICU A practices and interviewed the parents of 35 hospitalized infants and 35 health care workers (HCW) furloughed for cough illness. Costs were calculated using HCW wages, time furloughed, the provision of vaccine, chemoprophylaxis and diagnostic testing, and NICU A labor costs. Results: We identified 15 case-patients; 5 infants (aged 1—15 weeks; 5 female), 10 HCWs (aged 32—50 years; 6 female). The index patient was an infant aged 7 weeks (gestational age 28 weeks) who experienced apnea on July 28 and cough on August 14 in NICU A; she had not been isolated. Pertussis was diagnosed after transfer to hospital B on September 9. Spacing of NICU A beds (16 inches apart), a 4:1 patient-to-nurse ratio, and absence of personal protective equipment (PPE) use were observed. Outbreak costs ($97,800) were primarily influenced by HCW furloughs ($55,349) and NICU A labor costs ($16,809). Of 365 HCWs, 330 required pertussis vaccine. Conclusions: This costly health care—associated pertussis outbreak might have been prevented with heightened awareness of apnea as a pertussis sign, compliance with HCW pertussis vaccination recommendations, and enforcement of PPE for HCWs with cough illness.

Learning Areas:
Clinical medicine applied in public health
Epidemiology

Learning Objectives:
1. List four precautions to decrease the spread of pertussis 2. Define the outbreak case definition for pertussis 3. List clinical signs of pertussis 4. Identify factors associated with the transmission of pertussis in health care settings

Keywords: Infectious Diseases, Outbreaks

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As an Epidemic Intelligence Service Officer, I was the lead investigator for this outbreak of pertussis in a neonatal intensive care unit. My expertise as a clinician and training as an epidemiologist aided with the review of case-patient medical records, the interviewing of suspect cases and an observational study condcuted at the health care facility.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4301.0: Outbreak Investigations