Nosocomial Outbreak of Coronavirus Disease 2019 by Possible Airborne Transmission Leading to a Superspreading Event
Nosocomial Outbreak of Coronavirus Disease 2019 by Possible Airborne Transmission Leading to a Superspreading Event
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DOI：
10.1093/cid/ciab313
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发表时间：
2021-08-23
影响因子：
11.8
通讯作者：
Yuen, Kwok-Yung
中科院分区：
文献类型：
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作者：
Cheng, Vincent Chi-Chung;Fung, Kitty Sau-Chun;Yuen, Kwok-Yung
背景2019年由于可能的空气传播导致的冠状病毒病超级传播的医院暴发尚未得到证实。对一起医院暴发疫情进行流行病学分析、环境采样和全基因组测序。一个涉及12名患者和9名医护人员（HCW）的超级传播事件在9天内发生在一个老式的普通病房的6个隔间中的3个隔间中，隔间内没有排气装置。严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）RNA的环境污染在空气格栅（距离患者头部>2 m且不在可及范围内）中显著高于高接触临床表面（36.4%，22例中的8例vs 3.4%，29例中的1例，P= 0.003）。9个污染排气格栅中有6个（66.7%）位于患者更衣室外。患者的临床发作率明显高于HCW（15.4%，78名暴露患者中有12名vs 4.6%，195名暴露HCW中有9名，P= 0.005）。此外，基于病房的HCW的临床发作率显著高于非基于病房的HCW（8.1%，7/68 vs 1.8%，2/109，P= 0.045）。在暴发期间，感染病房的医护人员的病人护理职责分配事件（平均值+/-标准差）显著高于未感染病房的医护人员（6.0 +/- 2.4 vs 3.0 +/- 2.9，P= 0.012）。本次暴发流行株属于SARS-CoV-2谱系B.1.36.27（GISAID进化枝GH），其WGS上存在独特的S-T470 N突变。由于可能的空气传播导致的医院点源超级传播事件表明，需要在进入医疗机构时进行严格的SARS-CoV-2筛查，并对通风系统进行更好的建筑设计，以防止此类爆发。在恢复临床服务之前，每个隔间都安装了便携式高效微粒过滤器，以改善通风。
Background. Nosocomial outbreaks with superspreading of coronavirus disease 2019 due to a possible airborne transmission have not been reported.Methods. Epidemiological analysis, environmental samplings, and whole-genome sequencing (WGS) were performed for a hospital outbreak.Results. A superspreading event that involved 12 patients and 9 healthcare workers (HCWs) occurred within 9 days in 3 of 6 cubicles at an old-fashioned general ward with no air exhaust built within the cubicles. The environmental contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was significantly higher in air grilles (>2 m from patients' heads and not within reach) than on high-touch clinical surfaces (36.4%, 8 of 22 vs 3.4%, 1 of 29, P=.003). Six (66.7%) of 9 contaminated air exhaust grilles were located outside patient cubicles. The clinical attack rate of patients was significantly higher than of HCWs (15.4%, 12 of 78 exposed patients vs 4.6%, 9 of 195 exposed HCWs, P=.005). Moreover, the clinical attack rate of ward-based HCWs was significantly higher than of nonward-based HCWs (8.1%, 7 of 68 vs 1.8%, 2 of 109, P=.045). The episodes (mean +/- standard deviation) of patient-care duty assignment in the cubicles was significantly higher among infected ward-based HCWs than among noninfected ward-based HCWs (6.0 +/- 2.4 vs 3.0 +/- 2.9, P=.012) during the outbreak period. The outbreak strains belong to SARS-CoV-2 lineage B.1.36.27 (GISAID clade GH) with the unique S-T470N mutation on WGS.Conclusions. This nosocomial point source superspreading event due to possible airborne transmission demonstrates the need for stringent SARS-CoV-2 screening at admission to healthcare facilities and better architectural design of ventilation systems to prevent such outbreaks. Portable high-efficiency particulate filters were installed in each cubicle to improve ventilation before resumption of clinical service.