The Role of Staff in Transmission of SARS-CoV-2 in Long-term Care Facilities.
The Role of Staff in Transmission of SARS-CoV-2 in Long-term Care Facilities.
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DOI：
10.1097/ede.0000000000001510
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发表时间：
2022-09-01
期刊：
影响因子：
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通讯作者：
Lopman BA
中科院分区：
文献类型：
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作者：
Adams C;Chamberlain A;Wang Y;Hazell M;Shah S;Holland DP;Khan F;Gandhi NR;Fridkin S;Zelner J;Lopman BA
美国长期护理机构(LTCFs)经历了不成比例的新冠肺炎发病率和死亡率负担。我们调查了2020年3月至2021年9月在佐治亚州富尔顿县60个长期合作医疗中心的居民和工作人员中SARS-CoV-2的传播情况。使用Wallinga-Teunis方法估计时变繁殖数、R(T)和线性混合回归模型，我们检验了病例特征与R(T)之间的关系。病例数、暴发规模和持续时间以及R(T)在2020年12月首次向LTCFs分发疫苗后迅速下降并保持在低水平，尽管2021年夏季社区发病率增加。工作人员病例比居民病例具有更高的传染性(平均个体繁殖数Ri=0.6[95%可信区间分别为0.4、0.7和0.1[95%CI=0.1、0.2])。未接种疫苗的居民病例比接种疫苗的居民病例具有更高的传染性(Ri=0.5[95%CI=0.4，0.6]和0.2[95%CI=0.0，0.8])，但估计不准确。新冠肺炎疫苗减缓了传播，并有助于减少长期信托基金的病例量。然而，由于数据限制，我们无法确定突破性接种病例是否比未接种病例的传染性更低。工作人员病例的传染性是居民病例的6倍，这与工作人员是长期合作中心SARS-CoV-2传播的主要推动者的假设一致。
US long-term care facilities (LTCFs) have experienced a disproportionate burden of COVID-19 morbidity and mortality. We examined SARS-CoV-2 transmission among residents and staff in 60 LTCFs in Fulton County, Georgia, from March 2020 to September 2021. Using the Wallinga-Teunis method to estimate the time-varying reproduction number, R(t), and linear-mixed regression models, we examined associations between case characteristics and R(t). Case counts, outbreak size and duration, and R(t) declined rapidly and remained low after vaccines were first distributed to LTCFs in December 2020, despite increases in community incidence in summer 2021. Staff cases were more infectious than resident cases (average individual reproduction number, Ri = 0.6 [95% confidence intervals [CI] = 0.4, 0.7] and 0.1 [95% CI = 0.1, 0.2], respectively). Unvaccinated resident cases were more infectious than vaccinated resident cases (Ri = 0.5 [95% CI = 0.4, 0.6] and 0.2 [95% CI = 0.0, 0.8], respectively), but estimates were imprecise. COVID-19 vaccines slowed transmission and contributed to reduced caseload in LTCFs. However, due to data limitations, we were unable to determine whether breakthrough vaccinated cases were less infectious than unvaccinated cases. Staff cases were six times more infectious than resident cases, consistent with the hypothesis that staff were the primary drivers of SARS-CoV-2 transmission in LTCFs.