Human Influenza Clinical Trial
Official title:
TransFLUas: Transmission of Influenza Virus From Asymptomatic Healthcare Workers and Inpatients in the Acute Care Hospital Setting: A Prospective Study Over Two Consecutive Influenza Seasons
The epidemiology and transmission dynamics of influenza in hospitals are only poorly understood, particularly with respect to subjects without symptoms of influenza infection (e.g. without fever, cough, sore throat, nasal congestion, weakness, headache, loss of appetite, or myalgia). Knowledge about whether asymptomatic subjects are able to transmit influenza is of major importance. If they do transmit influenza, vaccination of patients and healthcare workers (HCW) before start of the influenza season, the permanent use of masks by HCW during influenza season, and quarantine for previously exposed inpatients may be the only available measures to reduce the number of influenza transmission events from asymptomatic subjects in acute care hospitals. Closure of this knowledge gap would be of major benefit to infection prevention and control recommendations, and may in turn reduce morbidity and mortality associated with influenza in hospitals through improved patient management.
The epidemiology and transmission dynamics of influenza in hospitals are only poorly
understood, particularly with respect to subjects without symptoms of influenza infection
(e.g. without fever, cough, sore throat, nasal congestion, weakness, headache, loss of
appetite, or myalgia). Knowledge about whether asymptomatic subjects are able to transmit
influenza is of major importance. If they do transmit influenza, vaccination of patients and
healthcare workers (HCW) before start of the influenza season, the permanent use of masks by
HCW during influenza season, and quarantine for previously exposed inpatients may be the only
available measures to reduce the number of influenza transmission events from asymptomatic
subjects in acute care hospitals.
The investigators' key aim is therefore to define whether exposure to asymptomatic subjects
with influenza infection constitutes a risk for influenza transmission in an acute care
hospital setting through active, prospective surveillance.
The investigators' secondary aims are to describe the prevalence of community-acquired
symptomatic and asymptomatic influenza upon hospital admission and the incidence of
asymptomatic and symptomatic nosocomial influenza among inpatients; to assess transmission
dynamics of symptomatic influenza infection in acute care; and to study the incidence of
asymptomatic and symptomatic influenza, absenteeism (i.e. being absent from work due to
influenza), presenteeism (i.e. being present at work despite influenza infection) associated
with influenza, and compliance with infection control recommendations to prevent spread of
influenza in acute care HCW.
The investigators plan to enroll 1,260 inpatients and 180 HCW from medical wards at the
University Hospital Zurich in a prospective study over two consecutive influenza seasons in
order to detect at least one transmission event from an asymptomatic individual shedding
influenza virus. Flocked mid-turbinate nasal swabs will be collected daily from consenting
inpatients starting from day of admission until two days after discharge and from HCW over
the influenza (winter) season and analyzed for influenza A and B using polymerase chain
reaction. Simultaneously, signs and symptoms of influenza infection (including cough, sore
throat, fever >37.8°C, nasal congestion, weakness, headache, loss of appetite or myalgia) as
well as contact patterns between inpatients and HCW will be recorded. Reconstruction of
influenza transmission chains will be based on phylogenetic analyses derived from
next-generation sequence data and epidemiological contact tracing.
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