Investigation of Triple Mixed Outbreak of Influenza A (H1N1) pdm09, SARS-CoV-2 and Hcov-229E among students of a Senior High School, Eastern Region, Ghana-July 2021

A school nurse in a senior high school in the Eastern region noticed an unusual rise in presentation of cough and sore throat among students from June 1-7, 2021. He reported to the Lower Manya Krobo Municipal Health Directorate. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) was notified of a suspected respiratory disease outbreak. We investigated the cause of the outbreak, its magnitude and implemented control measures.

We reviewed school health records and came up with a suspected case definition to search for more cases. A suspected case was any person from the school with cough, sore throat with or without fever and one or more of the following; headache, general bodily pains, cold, and difficulty in breathing from 1st June 2021. Oropharyngeal swabs were taken from suspected cases for confirmation. We conducted a 1:2 unmatched case-control study to assess the risk factors for the outbreak. A confirmed case was a suspected case with a positive test result. We assessed the school’s environment using a checklist. Unconditional multivariate logistic regression was performed.

The overall attack rate for the respiratory infections was 17/1000 (40/2347) with males being more infected (21/1000). Triple mixed infection was detected with overall positivity rate of 14.3% (40/279). SARS-CoV-2- (35%, 14/40), HCov-229E - (22.5%, 9/40) and Influenza A (H1N1) pdm09-(22.5%, 9/40), while 22.5% (9/40) had co-infection of (H1N1) Pdm09 and HCov-229E. We observed overcrowding in the dormitories with an average of 122 students sleeping in a 72-bed capacity dormitory. Factors associated to being infected were use of face masks at the dining hall (aOR=0.20, 95%CI: 0.04, 0.98) and travel within the last 21days (aOR=8.17, 95%CI:1.44, 46.04).

A mixed outbreak of three respiratory viruses was confirmed with co-infection in quarter. Prompt investigation, cooperation between all stakeholders and timely interventions were successful in controlling the outbreak

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