First Reported Nosocomial Outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 in a Pediatric Dialysis Unit
First Reported Nosocomial Outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 in a Pediatric Dialysis Unit
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DOI：
10.1093/cid/ciaa491
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发表时间：
2021-01-15
影响因子：
11.8
通讯作者：
Kampmeier, Stefanie
中科院分区：
文献类型：
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作者：
Schwierzeck, Vera;Koenig, Jens Christian;Kampmeier, Stefanie
背景2019冠状病毒病（COVID-19）是由严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）引起的危及生命的呼吸道疾病，于2019年12月首次在中国发现。目前，德国确诊COVID-19病例超过14万例。在这里，我们报告了在明斯特大学医院（UHM）的儿科透析病房SARS冠状病毒2感染的医院暴发。使用鼻咽拭子的单步实时逆转录聚合酶链反应（rRT-PCR）诊断指示患者并识别受感染的接触者。流行病学的联系进行了分析，病人访谈和病历审查。此外，还评估了每名接触者与指示病例的接触情况，并监测其临床症状。比较有症状和无症状病例的所有阳性检测结果的循环阈值（Ct）值。48例病例涉及这次医院内爆发。9名接触者出现实验室确诊的COVID-19感染。2例SARS-CoV-2阳性病例仍无临床症状。11例病例报告了流感样症状，但没有阳性结果。在出现典型COVID-19症状的病例中，Ct值显著较低，表明病毒脱落率较高（P = 0.007）。人与人之间的传播是UHM儿科透析室的医护人员（HCW）和患者之间SARS-CoV-2医院爆发的核心。半定量rRT-PCR结果表明，病毒载量高的个体在医院环境中存在传播SARS-CoV-2的风险。我们的流行病学观察强调，需要制定策略来追踪和监测SARS-CoV-2感染的医护人员，以防止COVID-19在医院环境中爆发。
Background. Coronavirus disease 2019 (COVID-19) is a life-threatening respiratory condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was initially detected in China in December 2019. Currently, in Germany >140 000 cases of COVID-19 are confirmed. Here we report a nosocomial outbreak of SARS-CoV-2 infections in the pediatric dialysis unit of the University Hospital Munster (UHM).Methods. Single-step real-time reverse-transcription polymerase chain reaction (rRT-PCR) from nasopharyngeal swabs was used to diagnose the index patient and identify infected contacts. Epidemiological links were analyzed by patient interviews and medical record reviews. In addition, each contact was assessed for exposure to the index case and monitored for clinical symptoms. Cycle threshold (Ct) values of all positive test results were compared between symptomatic and asymptomatic cases.Results. Forty-eight cases were involved in this nosocomial outbreak. Nine contact cases developed laboratory-confirmed COVID-19 infections. Two SARS-CoV-2-positive cases remained clinically asymptomatic. Eleven cases reported flulike symptoms without positive results. Ct values were significantly lower in cases presenting typical COVID-19 symptoms, suggesting high viral shedding (P = .007).Conclusions. Person-to-person transmission was at the heart of a hospital outbreak of SARS-CoV-2 between healthcare workers (HCWs) and patients in the pediatric dialysis unit at UHM. Semiquantitative rRT-PCR results suggest that individuals with high viral load pose a risk to spread SARS-CoV-2 in the hospital setting. Our epidemiological observation highlights the need to develop strategies to trace and monitor SARS-CoV-2-infected HCWs to prevent COVID-19 outbreaks in the hospital setting.