Influenza A(H1N1)pdm09 outbreak in a correctional facility, Central Region, Ghana, July-August, 2018

  • Vaccine preventable diseases
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Background: Influenza, a contagious respiratory illness caused by influenza viruses, usually leads to outbreaks among unvaccinated populations and in confined settings. On July, 30 2018 the Central Regional Health Directorate received reports of suspected influenza-like-illness outbreak among inmates of a Maximum Security Prisons (AMSP). Inmates reported to the prison infirmary with symptoms of cough and fever. We investigated the outbreak to determine its magnitude, identify risk factors and implement control and preventive measures
Methods: We conducted an unmatched case-control study. A case was cough and fever (history or temperature of 37.5oC or above) with illness onset on or after July 12, 2018 in any person in AMSP. For each case, two controls were randomly selected from the prison. We interviewed participants and reviewed their medical records for exposures. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between illness and potential exposures. We conducted environmental assessment and collected oropharyngeal swabs from case-patients for laboratory testing.
Results: Of 378 persons who met the case definition, 350 (93.1%) were inmates; 373 (98.7%) were males; median age was 37 years (range: 14–78 years). Forty-five case-patients and 90 controls were included in the analysis. Sleeping in the same room with a case-patient (OR: 8.3; CI: 2.3-14.9), working at prison infirmary (OR: 1.4; CI: 1.1-8.3) and previously smoked cigarette (OR: 12.7; CI: 4.3-31.9) were associated with influenza A illness. Three (3) of seven oropharyngeal specimens tested positive for Influenza A(H1N1)pdm09. Poor ventilation was noticed in the rooms of the inmates. Case patients were isolated, treated with Oseltamivir and reactive vaccination done.
Conclusions: Sleeping in the same room with a case-patient, working in prison infirmary and smoking cigarette were associated factors for this influenza A outbreak. Case isolation, management and reactive vaccination of inmates and correctional facility staff controlled the outbreak.

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