Coronavirus Disease 2019 (COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China
Coronavirus Disease 2019 (COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China
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DOI：
10.1001/jamanetworkopen.2020.9666
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发表时间：
2020-05-21
影响因子：
13.8
通讯作者：
Wang, Wei
中科院分区：
文献类型：
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作者：
Lai, Xiaoquan;Wang, Minghuan;Wang, Wei
该病例系列探讨了患有冠状病毒病（COVID-19）的医疗保健工作者的感染风险和临床特征，并讨论了可能的预防措施。问题是什么是沃汉病毒病毒病毒疾病的卫生保健工作者的暴露细节和临床特征是什么， 中国？在这个单中心病例系列中的调查结果包括9684名卫生保健工作者，其中110名患有COVID-19，在疾病爆发的早期阶段，在低接入区工作的人中发现了更高的感染率，尤其是在护士中小于45岁。大多数患有COVID-19的医疗保健工作者患有非严重疾病，无症状携带者的患病率为0.9％，死亡率为0.9％。在这项研究中的意思是，医疗保健工作者的大多数感染发生在19日疫情的早期阶段和低接口地区。常规筛查可能有助于识别无症状携带者。重要的医疗保健工作者（HCWS）由于治疗2019年冠状病毒病患者（COVID-19）而具有高感染风险。但是，对其感染风险和临床特征的研究有限。探索HCW的感染风险和临床特征的目标，并讨论了可能的预防措施。设计，设置和参与者这个单中心案例系列包括中国武汉汤吉医院的9684 HCWS。数据从1月1日至2020年2月9日收集。确认的Covid-19。结构化问卷收集了主要结果和衡量标准，流行病学和人口统计学信息。从电子病历中收集了临床，实验室和放射学信息。随机抽样了总共335名医务人员，以估计高风险，无症状人群中亚临床感染的患病率。还收集了来自医疗保健环境中表面的样品。总体而言，汤吉医院9684个HCW中的110个在COVID-19的阳性，感染率为1.1％。其中70名（71.8％）是女性，她们的中位数（四分位数）年龄为36.5（30.0-47.0）。 17（15.5％）在发烧诊所或病房工作，表明一线HCW的感染率为0.5％（3110中的17）。 6574个非一线HCW（1.4％）中，共有93个感染。与45岁或45岁以上的一线医师相比，45岁以下的非一线护士更有可能被感染（入射率比，16.1; 95％CI，7.1-36.3; p <.001）。在无症状的一线HCW中，亚临床感染的患病率为0.74％（135中的1），非第一线HCW中的患病率为1.0％（200）。没有环境表面测试阳性。总体而言，在110 HCWS中，有93人（84.5％）患有Covid-19，但有1名（0.9％）死亡。最常见的5个症状是发烧（67 [60.9％]），肌痛或疲劳（66 [60.0％]），咳嗽（62 [56.4％]），喉咙痛（55 [50.0％]）和肌肉疼痛（50 [45.5％]）。与索引的患者（65 [59.1％]）和感染的同事（12 [10.9％]）以及社区获得的感染（14 [12.7％]）是HCWS的主要暴露途径。结论和相关性在此情况系列中，HCW的大多数感染发生在疾病爆发的早期阶段。该非第一线HCW的感染率高于一线HCWS，与观察到先前病毒疾病流行病的观察不同。快速识别有潜在感染和常规筛查的员工可以帮助保护HCW。
This case series explores infection risk and clinical characteristics of health care workers with coronavirus disease (COVID-19) and discusses possible prevention measures.Question What are the exposure details and clinical characteristics of health care workers with coronavirus disease (COVID-19) in Wuhan, China? Findings In this single-center case series including 9684 health care workers, 110 of whom had COVID-19, a higher rate of infection was found among those working in the low-contagion area during the early stage of the disease outbreak, especially among nurses younger than 45 years. Most health care workers with COVID-19 had nonsevere disease, with an asymptomatic carrier prevalence of 0.9% and a mortality rate of 0.9%. Meaning In this study, most infections among health care workers occurred during the early stage of the COVID-19 outbreak and in low-contagion areas; routine screening may be helpful in identifying asymptomatic carriers.Importance Health care workers (HCWs) have high infection risk owing to treating patients with coronavirus disease 2019 (COVID-19). However, research on their infection risk and clinical characteristics is limited. Objectives To explore infection risk and clinical characteristics of HCWs with COVID-19 and to discuss possible prevention measures. Design, Setting, and Participants This single-center case series included 9684 HCWs in Tongji Hospital, Wuhan, China. Data were collected from January 1 to February 9, 2020. Exposures Confirmed COVID-19. Main Outcomes and Measures Exposure, epidemiological, and demographic information was collected by a structured questionnaire. Clinical, laboratory, and radiologic information was collected from electronic medical records. A total of 335 medical staff were randomly sampled to estimate the prevalence of subclinical infection among a high-risk, asymptomatic population. Samples from surfaces in health care settings were also collected. Results Overall, 110 of 9684 HCWs in Tongji Hospital tested positive for COVID-19, with an infection rate of 1.1%. Of them, 70 (71.8%) were women, and they had a median (interquartile range) age of 36.5 (30.0-47.0) years. Seventeen (15.5%) worked in fever clinics or wards, indicating an infection rate of 0.5% (17 of 3110) among first-line HCWs. A total of 93 of 6574 non-first-line HCWs (1.4%) were infected. Non-first-line nurses younger than 45 years were more likely to be infected compared with first-line physicians aged 45 years or older (incident rate ratio, 16.1; 95% CI, 7.1-36.3; P < .001). The prevalence of subclinical infection was 0.74% (1 of 135) among asymptomatic first-line HCWs and 1.0% (2 of 200) among non-first-line HCWs. No environmental surfaces tested positive. Overall, 93 of 110 HCWs (84.5%) with COVID-19 had nonsevere disease, while 1 (0.9%) died. The 5 most common symptoms were fever (67 [60.9%]), myalgia or fatigue (66 [60.0%]), cough (62 [56.4%]), sore throat (55 [50.0%]), and muscle ache (50 [45.5%]). Contact with indexed patients (65 [59.1%]) and colleagues with infection (12 [10.9%]) as well as community-acquired infection (14 [12.7%]) were the main routes of exposure for HCWs. Conclusions and Relevance In this case series, most infections among HCWs occurred during the early stage of disease outbreak. That non-first-line HCWs had a higher infection rate than first-line HCWs differed from observation of previous viral disease epidemics. Rapid identification of staff with potential infection and routine screening among asymptomatic staff could help protect HCWs.