BACKGROUND. When the 2009 H1N1 influenza A virus emerged in the United States, epidemiologic and clinical information about severe and fatal cases was limited. We report the first 47 fatal cases of 2009 H1N1 influenza in New York City. METHODS. The New York City Department of Health and Mental Hygiene conducted enhanced surveillance for hospitalizations and deaths associated with 2009 H1N1 influenza A virus. We collected basic demographic and clinical information for all patients who died and compared abstracted data from medical records for a sample of hospitalized patients who died and hospitalized patients who survived. RESULTS. From 24 April through 1 July 2009, 47 confirmed fatal cases of 2009 H1N1 influenza were reported to the New York City Department of Health and Mental Hygiene. Most decedents (60%) were ages 18-49 years, and only 4% were aged 65 years. Many (79%) had underlying risk conditions for severe seasonal influenza, and 58% were obese according to their body mass index. Thirteen (28%) had evidence of invasive bacterial coinfection. Approximately 50% of the decedents had developed acute respiratory distress syndrome. Among all hospitalized patients, decedents had presented for hospitalization later (median, 3 vs 2 days after illness onset; P < .05) and received oseltamivir later (median, 6.5 vs 3 days; P < .01) than surviving patients. Hospitalized patients who died were less likely to have received oseltamivir within 2 days of hospitalization than hospitalized patients who survived (61% vs 96%; P < .01). CONCLUSIONS. With community-wide transmission of 2009 H1N1 influenza A virus, timely medical care and antiviral therapy should be considered for patients with severe influenza-like illness or with underlying risk conditions for complications from influenza.

One multidrug-resistant Mycobacterium tuberculosis (MDRTB) strain, strain W, caused several nosocomial outbreaks in New York City (NYC) during 1 January 1990-31 July 1993. We reviewed all MDRTB cases verified during 1 August 1993-31 December 1999 that had isolates with either this DNA pattern or a variant of this strain, and we compared them to the outbreak cases. Of 427 DNA-confirmed cases from 1990-1999, 161 (37%) were from 1 August 1993-31 December 1999; these 161 cases, from 56 hospitals and 2 correctional sites, constituted 28% of all MDRTB cases in NYC during this period. Compared with those from 1 January 1990-31 July 1993, patients from 1 August 1993-31 December 1999 were less likely to be infected with human immunodeficiency virus, to have been born in the United States, to be homeless, to have been incarcerated, and to have epidemiological links; 16% of patients had nosocomial- and 9% had community-exposure links. This strain was disseminated widely in the community during the outbreaks; postoutbreak cases likely represent reactivated disease among individuals infected during the outbreak periods in the community.

From January 1, 1995, to December 31, 1997, we reviewed records of all New York City patients who had multidrug-resistant tuberculosis (MDRTB); we performed insertion sequence (IS) 6110 -based DNA genotyping on the isolates. Secondary genotyping was performed for low IS 6110 copy band strains. Patients with identical DNA pattern strains were considered clustered. From 1995 through 1997, MDRTB was diagnosed in 241 patients; 217 (90%) had no prior treatment history, and 166 (68.9%) were born in the United States or Puerto Rico. Compared with non-MDRTB patients, MDRTB patients were more likely to be born in the United States, have HIV infection, and work in health care. Genotyping results were available for 234 patients; 153 (65.4%) were clustered, 126 (82.3%) of them in eight clusters of > 4 patients. Epidemiologic links were identified for 30 (12.8%) patients; most had been exposed to patients diagnosed before the study period. These strains were likely transmitted in the early 1990s when MDRTB outbreaks and tuberculosis transmission were widespread in New York.

Laboratory cross-contamination resulted in the false diagnosis of tuberculosis in at least 45 individuals. Use of the Mycobacteria Growth Indicator Tube may have contributed to these contamination incidents by detecting small numbers of contaminating mycobacteria that may not have been detected with less sensitive media.

We investigated an increase in cases of multidrug-resistant tuberculosis (MDRTB) at a large urban facility where a prior nosocomial outbreak of MDRTB had occurred. Nosocomial transmission appeared to account for this outbreak as well, including a cluster of cases in a newborn nursery. Seven of 24 patients (29%) described in this investigation may have been exposed in the hospital nursery during an approximately 2-week period. We believe this to be the first documented outbreak of MDRTB in a hospital nursery. The transmission in the nursery demonstrates that the possibility of exposure to unrecognized active tuberculosis in nursery and hospital personnel is always present. Infection and active disease in the infants developed after a relatively short period of exposure. These findings underscore the need for adherence to published infection control guidelines in health care settings.