Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility
Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility
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DOI：
10.1056/nejmoa2008457
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发表时间：
2020-05-28
影响因子：
158.5
通讯作者：
Jernigan, J. A.
中科院分区：
文献类型：
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作者：
Arons, M. M.;Hatfield, K. M.;Jernigan, J. A.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染可在专业护理机构内迅速传播。在一家专业护理机构中发现一例新冠肺炎病例后，我们评估了传播情况，并评估了基于SARS的筛查在识别居民感染方面的充分性。方法我们进行了两次连续的点患病率调查，间隔1周，其中该机构的同意居民接受了鼻咽和口咽SARS-CoV-2检测，包括实时逆转录酶聚合酶链反应（rRT-PCR），病毒培养和测序记录在前14天内出现的症状。7天后，对检测呈阳性的无症状居民进行重新评估。与SARS-CoV-2感染的居民被归类为典型症状（发热，咳嗽，或呼吸急促），症状只有不典型的症状，症状前，或无症状的症状。结果23天后，第一次阳性测试结果在这个熟练的护理设施的居民，57 89名居民（64%）检测为SARS-CoV-2阳性。在76名参与点患病率调查的居民中，48人（63%）检测呈阳性。在这48名居民中，27名（56%）在检测时无症状; 24名随后出现症状（发病时间中位数为4天）。来自这24名症状前居民的样本的中位rRT-PCR循环阈值为23.1，从17名居民中回收了活病毒。截至4月3日，在57名SARS-CoV-2感染者中，11人住院治疗（3人在重症监护室），15人死亡（死亡率，26%）。的34个居民的标本进行测序，27（79%）的序列，适合两个集群的差异一个nucleotide.Conclusions快速和广泛传播的SARS-CoV-2证明在这个熟练的护理设施。检测结果呈阳性的居民中，有一半以上在检测时无症状，极有可能促成了传播。预防控制策略仅集中在症状的居民是不足以防止传播后，SARS-CoV-2引入到这个facility.The作者评估了SARS-CoV-2的传播，并评估了在一个熟练的护理设施的适当性，基于筛查。在检测结果呈阳性的居民中，有一半以上在检测时无症状。预防控制策略只集中在有症状的居民不足以防止传播。
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents.Methods We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic.Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide.Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.The authors assessed transmission of SARS-CoV-2 and evaluated the adequacy of symptom-based screening in a skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission.