Real-Time Investigation of a Large Nosocomial Influenza A Outbreak Informed by Genomic Epidemiology.

BACKGROUND: Nosocomial respiratory virus outbreaks represent serious public health challenges. Rapid and precise identification of cases and tracing of transmission chains is critical to end outbreaks and to inform prevention measures. METHODS: We combined conventional surveillance with influenza A virus (IAV) genome sequencing to identify and contain a large IAV outbreak in a metropolitan healthcare system. A total of 381 individuals, including 91 inpatients and 290 healthcare workers (HCWs), were included in the investigation. RESULTS: During a 12-day period in early 2019, infection preventionists identified 89 HCWs and 18 inpatients as cases of influenza-like illness (ILI), using an amended definition without the requirement for fever. Sequencing of IAV genomes from available nasopharyngeal specimens identified 66 individuals infected with a nearly identical strain of influenza A H1N1pdm09 (43 HCWs, 17 inpatients, and 6 with unspecified affiliation). All HCWs infected with the outbreak strain had received the seasonal influenza virus vaccination. Characterization of 5 representative outbreak viral isolates did not show antigenic drift. In conjunction with IAV genome sequencing, mining of electronic records pinpointed the origin of the outbreak as a single patient and a few interactions in the emergency department that occurred 1 day prior to the index ILI cluster. CONCLUSIONS: We used precision surveillance to delineate a large nosocomial IAV outbreak, mapping the source of the outbreak to a single patient rather than HCWs as initially assumed based on conventional epidemiology. These findings have important ramifications for more-effective prevention strategies to curb nosocomial respiratory virus outbreaks.

Psychometric properties of the Child and Adolescent Mindfulness Measure (CAMM) in racial minority adolescents from low-income environments.

No study has yet assessed the psychometric properties of scores from any mindfulness measure in racial minority adolescents from low-income environments. The present study examined the reliability and validity of Child and Adolescent Mindfulness Measure (CAMM) scores in a nonclinical sample of late adolescents (N = 92) from low-income neighborhoods who predominantly identified as African American. Findings confirmed a one-factor structure for responses to the 10 CAMM items as well as adequate internal consistency (Cronbach's α = .88). In support of validity, CAMM scores demonstrated large significant negative correlations with scores from measures of constructs that should be negatively related to mindfulness, including depressive symptoms, worry, ruminative coping, and involuntary engagement responses to stress. Thus, CAMM scores appear to reliably and validly assess mindfulness in racial minority adolescents from low-income environments. Having a psychometrically sound mindfulness measure for this population will aid in understanding the mechanisms by which mindfulness-based interventions work, which could lead to improved interventions and outcomes for this population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).