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HCWs with influenza may not present with fever
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Almost half of health care workers with influenza had no fever before their diagnosis, and they may have placed patients and co-workers at risk for influenza as a result, according to researchers from the University of Chicago.
“While a higher percentage of individuals with influenza experienced fever compared to individuals with other respiratory viruses, fever was present in only half of influenza-positive employees,” the researchers wrote in Clinical Infectious Diseases. “To prevent health care-associated influenza, hospitals should consider more stringent infection control measures for HCWs with respiratory symptoms, even if no fever is present.”
Jessica P. Ridgway, MD, and colleagues tested HCWs with respiratory symptoms for influenza and other respiratory pathogens. They collected nasal swabs from both nares that then were analyzed by PCR testing. The HCWs also completed a questionnaire about their symptoms and vaccination history and had their temperature measured.
From Jan. 3 to Feb. 28, 2014, 449 HCWs underwent 458 virus tests. Fifty-four percent were positive for any respiratory pathogen. The most common viruses were coronavirus (n = 142), influenza (n = 35) and respiratory syncytial virus (n = 33). Seven other HCWs were diagnosed with influenza by their primary care physician outside of this screening program, for a total of 41 employees with influenza.
Twenty-one employees with influenza (51.2%) reported a history of fever or were febrile during the evaluation. Among all the HCWs with influenza, 20 had received the influenza vaccine for the 2013-2014 season before their influenza diagnosis. The researchers found a nonsignificant trend toward fever being more common among the employees who had not received the influenza vaccination.
“Theoretically, HCWs with respiratory symptoms should wear masks and practice hand hygiene, and so the risk of transmission of respiratory viruses to patients should be limited,” the researchers wrote. “However, HCW compliance with face masks and other personal protective equipment is self-reported to be around 60% but often observed to be less than this. Until better hand hygiene and personal protective equipment compliance is demonstrated across multiple health care settings, it would be inadvisable to rely solely on these measures to preclude the spread of influenza in hospitals.” – by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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