臺灣南部某醫學中心急診H1N1流感群聚事件調查及處置經驗

Outbreak Investigation of Swine H1N1 Flu at an Emergency Department of a Medical Center in Southern Taiwan

2009年全球爆發A型H1N1流感大流行。2014年8月中旬於南部某醫學中心急診發生類流感群聚事件，共有72位出現上呼吸道感染，包含29位住院病人分別住在6個病房及2個加護病房及43位醫療人員，其中A型流感確診病人20位、醫療人員21位，症狀包括：發燒（＞38℃） 55位（76.4%）、咳嗽46位（63.9%）、肌肉酸痛21位（29.2%）、喉嚨痛20位（27.8%）、頭痛14位（19.4%）。針對類流感個案進行流感快篩檢驗及其中5名個案採集喉頭拭子做上呼吸道病毒培養，檢驗結果：疑似指標個案為流感A型／swH1N1，3位醫謢人員及1位病人與指標個案相同亦為流感A型／swH1N1。此期間採取嚴格感染管制措施，包含：落實急診病人分流、增設呼吸道病人留置專區及集中照護、宣導病人及家屬咳嗽禮儀及佩戴口罩、臨床醫師提高警覺儘早執行流感快篩檢查，即時診斷治療，醫療人員正確配戴外科口罩、手部衛生及加強環境清潔消毒等措施，予135位曝觸的醫護人員使用流感預防性用藥後，8月21日之後無任何新個案發生。積極介入急診感染管制措施，可以使流感群突發獲有效控制。

In 2009, there was a global outbreak of swine-origin influenza A/H1N1 virus (pdmH1N1). However, (pdmH1N1) influenza virus outbreaks were rarely reported in Taiwan after the government authorities implemented nationwide vaccination programs using pdmH1N1-specific inactivated vaccine in November 2009. We conducted an investigation of influenza outbreak in an emergency department in southern Taiwan. We surveyed the index case, described the clinical manifestations, implemented the infection control procedures, and administered the influenza prophylactic drugs. Confirmed cases had influenza-like illness (ILI) and a positive laboratory test for pdmH1N1, and probable cases had ILI. We determined the impact of influenza vaccination on infection using Chi square test. During this influenza outbreak period in August 2014, we identified 72 probable cases with ILI (41 confirmed cases), and none had swine exposure. The clinical features included fever (55/72, 76.4%), cough (46/72, 63.9%), myralgia (21/72, 29.2%), sore throat (20/72, 27.8%), and headache (14/72, 19.4%). The patients were distributed across 6 wards and 2 intensive care units. Throat virus cultures obtained from 5 patients yielded pdmH1N1. Influenza prophylactic drugs were used for 135 patients and health care workers. There was no association between previous influenza vaccination and occurrence of influenza. In this pdmH1N1 infection at emergency department, we rapidly controlled the outbreak by using the infection control procedures and implementation of influenza prophylactic drugs.