Investigation of SARS-CoV-2 outbreaks in six care homes in London, April 2020
Investigation of SARS-CoV-2 outbreaks in six care homes in London, April 2020
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DOI：
10.1016/j.eclinm.2020.100533
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发表时间：
2020-09-01
影响因子：
15.1
通讯作者：
Zambon, Maria
中科院分区：
文献类型：
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作者：
Ladhani, Shamez N.;Chow, J. Yimmy;Zambon, Maria
背景：护理院正在经历与高病死率相关的COVID-19大规模暴发。我们对2020年4月报告疑似COVID-19疫情的六家伦敦养老院进行了详细调查。方法：采用RT-PCR法对居民和工作人员鼻拭子进行SARS - CoV-2检测，随访14 d。如果他们在检测时、检测前两周或检测后两周分别有症状，或在整个过程中无症状，则将他们分为有症状、有症状后或有症状前。同时进行病毒分离和全基因组测序（WGS）。结果：在6家疗养院中，105/264（39.8%）名居民为SARS冠状病毒阳性，其中有症状者28人（26.7%），症状后者10人（9.5%），症状前者21人（20.0%），无症状者46人（43.8%）。随访14 d时，有症状的SARS-CoV-2阳性居民的病死率最高（10/28,35.7%），而无症状居民（2/46,4.3%）、症状后居民（2/10,20.0%）和症状前居民（3/21,14.3%）的病死率最高。工作人员中53/254人（20.9%）呈新冠病毒阳性，26/53人（49.1%）无症状。有症状/无症状的居民/工作人员之间的RT-PCR周期阈值和活病毒恢复相似。较高的RT-PCR周期阈值（较低的病毒载量）样品与恢复感染性病毒的能力呈指数下降相关(P
Background: Care homes are experiencing large outbreaks of COVID-19 associated with high case-fatality rates. We conducted detailed investigations in six London care homes reporting suspected COVID-19 outbreaks during April 2020.Methods: Residents and staff had nasal swabs for SARS CoV-2 testing using RT-PCR and were followed-up for 14 days. They were categorized as symptomatic, post-symptomatic or pre-symptomatic if they had symptoms at the time of testing, in the two weeks before or two weeks after testing, respectively, or asymptomatic throughout. Virus isolation and whole genome sequencing (WGS) was also performed.Findings: Across the six care homes, 105/264 (39.8%) residents were SARS CoV-2 positive, including 28 (26.7%) symptomatic, 10 (9.5%) post-symptomatic, 21 (20.0%) pre-symptomatic and 46 (43.8%) who remained asymptomatic. Case-fatality at 14-day follow-up was highest among symptomatic SARS-CoV-2 positive residents (10/28, 35.7%) compared to asymptomatic (2/46, 4.3%), post-symptomatic (2/10, 20.0%) or pre-symptomatic (3/21,14.3%) residents. Among staff, 53/254 (20.9%) were SARS-CoV-2 positive and 26/53 (49.1%) remained asymptomatic. RT-PCR cycle-thresholds and live-virus recovery were similar between symptomatic/asymptomatic residents/staff. Higher RT-PCR cycle threshold values (lower virus load) samples were associated with exponentially decreasing ability to recover infectious virus (P