Are presymptomatic SARS-CoV-2 infections in nursing home residents unrecognised symptomatic infections? Sequence and metadata from weekly testing in an extensive nursing home outbreak.
Are presymptomatic SARS-CoV-2 infections in nursing home residents unrecognised symptomatic infections? Sequence and metadata from weekly testing in an extensive nursing home outbreak.
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DOI：
10.1093/ageing/afab081
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发表时间：
2021-09-11
期刊：
影响因子：
6.7
通讯作者：
Buurman BM
中科院分区：
文献类型：
--
作者：
van den Besselaar JH;Sikkema RS;Koene FMHPA;van Buul LW;Oude Munnink BB;Frénay I;Witt RT;Koopmans MPG;Hertogh CMPM;Buurman BM
SARS-CoV-2的暴发导致了全球养老院的高病死率。目前尚不清楚症状前居民和工作人员在多大程度上促成了病毒的传播。评估无症状和无症状的居民和工作人员在荷兰NH大暴发期间在SARS-CoV-2传播中的贡献。在拥有185个床位的NH中进行观察性研究，采用两种连续的检测策略：仅检测有症状的病例，然后每周对工作人员和居民进行全设施范围的检测，而不考虑症状。用RT-PCR进行鼻咽和口咽SARS-CoV-2检测，包括对阳性样本进行测序，并进行标准化的症状评估。185名居民和244名工作人员参加了这次活动。测序确定了一个簇。在基于症状的测试策略期间，39名居民中有3人出现症状前症状，而在每周的设施范围测试期间，有38/74名居民出现症状前症状(P-Value<；0.001)。总体而言，59名SARS-CoV-2阳性人员中有51人(91.1%)有症状，两种检测策略之间没有差异(P值0.763)。与工作人员相比，居民几乎没有嗅觉和味觉丧失、喉咙痛、头痛或霉菌的报告(P-VALUE<；0.001)。症状前居民的CT中位数为21.3，与有症状居民(20.8)和无症状居民(20.5)比较差异无统计学意义(P>0.624)。居民和工作人员的症状没有得到足够的认识、报告或归因于可能的SARS-CoV-2感染。然而，没有(识别出)症状的居民表现出与有症状的居民相同的病毒脱落的可能性。每周检测是早期识别SARS-CoV-2病例的有效策略，从而迅速缓解疫情。
Sars-CoV-2 outbreaks resulted in a high case fatality rate in nursing homes (NH) worldwide. It is unknown to which extent presymptomatic residents and staff contribute to the spread of the virus. To assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch NH. Observational study in a 185-bed NH with two consecutive testing strategies: testing of symptomatic cases only, followed by weekly facility-wide testing of staff and residents regardless of symptoms. Nasopharyngeal and oropharyngeal testing with RT-PCR for SARs-CoV-2, including sequencing of positive samples, was conducted with a standardised symptom assessment. 185 residents and 244 staff participated. Sequencing identified one cluster. In the symptom-based test strategy period, 3/39 residents were presymptomatic versus 38/74 residents in the period of weekly facility-wide testing (P-value < 0.001). In total, 51/59 (91.1%) of SARS-CoV-2 positive staff was symptomatic, with no difference between both testing strategies (P-value 0.763). Loss of smell and taste, sore throat, headache or myalga was hardly reported in residents compared to staff (P-value <0.001). Median Ct-value of presymptomatic residents was 21.3, which did not differ from symptomatic (20.8) or asymptomatic (20.5) residents (P-value 0.624). Symptoms in residents and staff are insufficiently recognised, reported or attributed to a possible SARS-CoV-2 infection. However, residents without (recognised) symptoms showed the same potential for viral shedding as residents with symptoms. Weekly testing was an effective strategy for early identification of SARS-Cov-2 cases, resulting in fast mitigation of the outbreak.
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影响因子：
2.7
作者：
van Buul LW;van den Besselaar JH;Koene FMHPH;Buurman BM;Hertogh CMPM;COVID-19 NH-Study Group**;COVID-19 NH-Study Group
通讯作者：
COVID-19 NH-Study Group
影响因子：
33.9
作者：
Dora, Amy, V;Winnett, Alexander;Goetz, Matthew B.
通讯作者：
Goetz, Matthew B.
DOI：
10.15585/mmwr.mm6927e1
发表时间：
2020-07-10
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Sanchez GV;Biedron C;Fink LR;Hatfield KM;Polistico JMF;Meyer MP;Noe RS;Copen CE;Lyons AK;Gonzalez G;Kiama K;Lebednick M;Czander BK;Agbonze A;Surma AR;Sandhu A;Mika VH;Prentiss T;Zervos J;Dalal DA;Vasquez AM;Reddy SC;Jernigan J;Kilgore PE;Zervos MJ;Chopra T;Bezold CP;Rehman NK
通讯作者：
Rehman NK
影响因子：
6.3
作者：
D'Adamo, Heather;Yoshikawa, Thomas;Ouslander, Joseph G.
通讯作者：
Ouslander, Joseph G.
影响因子：
33.9
作者：
Kimball, Anne;Hatfield, Kelly M.;Jernigan, John A.
通讯作者：
Jernigan, John A.