Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic
Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic
复制标题
DOI：
10.1001/jamanetworkopen.2020.9673
复制
发表时间：
2020-05-21
影响因子：
13.8
通讯作者：
Kluytmans, Jan A. J. W.
中科院分区：
文献类型：
--
作者：
Kluytmans-van Den Bergh, Marjolein F. Q.;Buiting, Anton G. M.;Kluytmans, Jan A. J. W.
在荷兰发现首例2019年冠状病毒病患者后的两周内，荷兰两家医院中自述有发热或呼吸道症状的医护人员中2019年冠状病毒病的患病率和临床表现是什么？在这项横断面研究中，包括1353名自我报告发烧或呼吸道症状的医护人员，其中6%感染了严重急性呼吸综合征冠状病毒2。大多数感染2019冠状病毒病的医护人员病情轻微，只有53%的人报告发烧。轻度临床表现（通常不包括发烧）的高患病率表明，目前推荐的2019年疑似冠状病毒病病例定义应不那么严格地使用。2020年2月27日，荷兰报告了首例2019冠状病毒病（COVID-19）患者。在接下来的几周内，在两家荷兰教学医院，9名卫生保健工作者（HCWs）被诊断为COVID-19，其中8人没有前往中国或意大利北部的旅行史，这引发了是否正在发生未被发现的社区传播的问题。目的了解自报发热或呼吸道症状的医护人员中COVID-19的流行情况和临床表现。设计、环境和参与者本横断面研究于2020年3月在荷兰南部的两家教学医院进行，当时正值COVID-19大流行的早期阶段。要求在参与研究的医院工作的有发热或呼吸道症状的医护人员自愿参加严重急性呼吸综合征冠状病毒感染筛查。数据分析于2020年3月进行。采用口咽标本半定量实时逆转录聚合酶链反应检测严重急性呼吸综合征冠状病毒2型感染的流行情况。进行了结构化访谈，以记录所有确诊COVID-19的医护人员的症状。结果9705名卫生保健工作者（男性1722人[18%]）中，1353人（14%）报告有发热或呼吸道症状，并接受了检测。其中，86名医护人员（6%）感染了严重急性呼吸综合征冠状病毒2（年龄中位数为49岁[范围22-66岁]；15名[17%]男性），占所有受雇医护人员的1%。大多数卫生保健工作者病情轻微，只有46人（53%）报告发烧。80例HCWs（93%）符合发热和/或咳嗽和/或呼吸短促的病例定义。通过筛查确定的卫生保健人员中，只有3人（3%）有去过中国或意大利北部的旅行史，3人（3%）报告在症状出现之前曾接触过已知诊断为COVID-19的住院患者。在首例荷兰病例发现后2周内，自报有发热或呼吸道症状的医护人员中有相当大比例感染了严重急性呼吸综合征冠状病毒2型，这可能是在当地传播早期在社区获得病毒的结果。轻度临床表现（通常不包括发烧）的高流行率表明，目前推荐的疑似COVID-19病例定义应不那么严格地使用。本横断面研究调查了荷兰自述发烧或呼吸道症状的医护人员中2019年冠状病毒病的患病率和临床表现。
Question What was the prevalence and clinical presentation of coronavirus disease 2019 among health care workers with self-reported fever or respiratory symptoms in 2 Dutch hospitals within 2 weeks after the first patient with coronavirus disease 2019 was detected in the Netherlands? Findings In this cross-sectional study that included 1353 health care workers with self-reported fever or respiratory symptoms, 6% were infected with severe acute respiratory syndrome coronavirus 2. Most health care workers with coronavirus disease 2019 experienced mild disease, and only 53% reported fever. Meaning The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected coronavirus disease 2019 should be used less stringently.Importance On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring. Objective To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms. Design, Setting, and Participants This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020. Main Outcomes and Measures The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19. Results Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms. Conclusions and Relevance Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently.This cross-sectional study examines the prevalence and clinical presentation of coronavirus disease 2019 among health care workers in the Netherlands with self-reported fever or respiratory symptoms.