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N Engl J Med. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school.

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  • N Engl J Med. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school.

    N Engl J Med. 2009 Dec 31;361(27):2628-36.

    Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school.

    Lessler J, Reich NG, Cummings DA; New York City Department of Health and Mental Hygiene Swine Influenza Investigation Team, Nair HP, Jordan HT, Thompson N. - Collaborators (64): Nair HP, Jordan HT, Thompson N, Ackelsberg J, Atamian J, Balter S, Barbot O, Beatrice ST, Berg D, Bergier E, Berger M, Bornschlegel K, Bregman B, Burke M, Campbell M, Camurati L, Cook H, Corey C, Crouch B, DiGrande L, Eisenhower D, Fine A, Friedman S, Fu J, Griffing F, Hanson H, Harper S, Hegde S, Johns M, Jones L, Jordan H, Kerker B, Konty K, Krigsman G, Laraque F, Layton M, Lee E, Lim S, Marx M, McGibbon E, McVeigh K, Nair HP, Norton J, Nguyen T, Olson C, Oleszko W, Papadouka V, Platt R, Paladini M, Pfeiffer MR, Reddy V, Sanderson M, Siemetzki U, Slavinski S, Stoute A, Ternier A, Thorpe LE, Tsoi B, Waddell EN, Weiss D, Weisfuse I, Wu C, Zimmerman C, Zucker JR. - Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. jlessler@jhsph.edu


    BACKGROUND:
    In April 2009, an outbreak of novel swine-origin influenza A (2009 H1N1 influenza) occurred at a high school in Queens, New York. We describe the outbreak and characterize the clinical and epidemiologic aspects of this novel virus.

    METHODS:
    The New York City Department of Health and Mental Hygiene characterized the outbreak through laboratory confirmation of the presence of the 2009 H1N1 virus in nasopharyngeal and oropharyngeal specimens and through information obtained from an online survey. Detailed information on exposure and the onset of symptoms was used to estimate the incubation period, generation time, and within-school reproductive number associated with 2009 H1N1 influenza, with the use of established techniques.

    RESULTS:
    From April 24 through May 8, infection with the 2009 H1N1 virus was confirmed in 124 high-school students and employees. In responses to the online questionnaire, more than 800 students and employees (35% of student respondents and 10% of employee respondents) reported having an influenza-like illness during this period. No persons with confirmed 2009 H1N1 influenza or with influenza-like illness had severe symptoms. A linkage with travel to Mexico was identified. The estimated median incubation period for confirmed 2009 H1N1 influenza was 1.4 days (95% confidence interval [CI], 1.0 to 1.8), with symptoms developing in 95% of cases by 2.2 days (95% CI, 1.7 to 2.6). The estimated median generation time was 2.7 days (95% CI, 2.0 to 3.5). We estimate that the within-school reproductive number was 3.3.

    CONCLUSIONS:
    The findings from this investigation suggest that 2009 H1N1 influenza in the high school was widespread but did not cause severe illness. The reasons for the rapid and extensive spread of influenza-like illnesses are unknown. The natural history and transmission of the 2009 H1N1 influenza virus appear to be similar to those of previously observed circulating pandemic and interpandemic influenza viruses.

    2009 Massachusetts Medical Society

    PMID: 20042754 [PubMed - in process]

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  • #2
    Re: N Engl J Med. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school.

    > The reasons for the rapid and extensive spread of
    > influenza-like illnesses are unknown

    ahh, why can't they identify who probably got it from whom
    and by what method of transmission ?

    How can it be that from Monday to Thursday they go from
    ~5 to >200 cases ? Doesn't match with the R0=3.3

    5=number of returning symptomatic Cancun-travelers (?)
    I'm interested in expert panflu damage estimates
    my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT

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