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Pop-Vicas AE, Anderson L, Hatas G, Stevens L, Buys A, O’Connor D, Wilson N, Riemersma K, Haddock Soto LA, Richardson A, Clemens C, Packham J, Shirley D, Safdar N. A severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial cluster with inter-facility spread: Lessons learned. Infect Control Hosp Epidemiol 2024; 45:635-643. [PMID: 38173365 PMCID: PMC11027079 DOI: 10.1017/ice.2023.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Despite infection control guidance, sporadic nosocomial coronavirus disease 2019 (COVID-19) outbreaks occur. We describe a complex severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cluster with interfacility spread during the SARS-CoV-2 δ (delta) pandemic surge in the Midwest. SETTING This study was conducted in (1) a hematology-oncology ward in a regional academic medical center and (2) a geographically distant acute rehabilitation hospital. METHODS We conducted contact tracing for each COVID-19 case to identify healthcare exposures within 14 days prior to diagnosis. Liberal testing was performed for asymptomatic carriage for patients and staff. Whole-genome sequencing was conducted for all available clinical isolates from patients and healthcare workers (HCWs) to identify transmission clusters. RESULTS In the immunosuppressed ward, 19 cases (4 patients, 15 HCWs) shared a genetically related SARS-CoV-2 isolate. Of these 4 patients, 3 died in the hospital or within 1 week of discharge. The suspected index case was a patient with new dyspnea, diagnosed during preprocedure screening. In the rehabilitation hospital, 20 cases (5 patients and 15 HCWs) positive for COVID-19, of whom 2 patients and 3 HCWs had an isolate genetically related to the above cluster. The suspected index case was a patient from the immune suppressed ward whose positive status was not detected at admission to the rehabilitation facility. Our response to this cluster included the following interventions in both settings: restricting visitors, restricting learners, restricting overflow admissions, enforcing strict compliance with escalated PPE, access to on-site free and frequent testing for staff, and testing all patients prior to hospital discharge and transfer to other facilities. CONCLUSIONS Stringent infection control measures can prevent nosocomial COVID-19 transmission in healthcare facilities with high-risk patients during pandemic surges. These interventions were successful in ending these outbreaks.
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Affiliation(s)
- Aurora E. Pop-Vicas
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura Anderson
- Department of Infection Control and Prevention, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Gabrielle Hatas
- Department of Infection Control and Prevention, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Linda Stevens
- Nursing Quality and Safety, University of Wisconsin Health University Hospital, Madison, Wisconsin
| | - Ashley Buys
- Employee Health Services, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - David O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Nancy Wilson
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Kasen Riemersma
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Luis A Haddock Soto
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Abby Richardson
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Christine Clemens
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Jennylynde Packham
- University of Wisconsin Health Rehabilitation Hospital, Madison, Wisconsin
| | - Daniel Shirley
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Memorial Veterans’ Affairs Medical Center, Madison, Wisconsin
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Han C. Changes in mortality rate of the general population during the COVID-19 pandemic: an interrupted time series study in Korea. Int J Epidemiol 2022; 51:1396-1407. [DOI: 10.1093/ije/dyac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/05/2022] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Unlike other countries, South Korea did not implement a large-scale lockdown or closure of businesses to manage the coronavirus disease 2019 (COVID-19) pandemic, but relied on changes in population behaviours and early isolation and treatment of patients. It is important to evaluate the effectiveness of such alternative strategies on the mortality of the general population.
Methods
Mortality and monthly population data from 2013 to 2020 were obtained. A quasi-Poisson regression model adjusting for age structure, seasonality and time was used to evaluate whether underlying trends for monthly mortality rate have changed with the pandemic. Stratification analyses based on sex and location of deaths (inside vs outside of medical facilities) were conducted.
Results
The risk estimates showed no changes in non-accidental mortality during the COVID-19 pandemic [relative risk (RR) (95% confidence interval, 95% CI), slope change: 1.00 (1.00, 1.01), step change: 0.99 (0.97, 1.01)] compared with those before the pandemic. In cause-specific analysis, there was an abrupt and sustained decrease in the mortality rate of respiratory diseases [RR (95% CI), step change: 0.81 (0.77, 0.84)]. In the analysis of deaths by location, an increase in non-accidental mortality [RR (95% CI), slope change: 1.01 (1.01, 1.02), step change: 1.16 (1.11, 1.22)] and several cause-specific mortalities was observed outside of medical facilities.
Conclusions
The non-accidental mortality rate in South Korea for the first year of the pandemic followed the historical trends. However, there was a decrease in mortality associated with respiratory diseases, and an increase in mortality occurring outside of medical facilities. The findings may be attributed to changes in public behaviours, and availability of medical resources during the pandemic.
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COVID-19 in Princess Marina Hospital, Botswana: An Outbreak Investigation. Interdiscip Perspect Infect Dis 2022; 2022:2663174. [PMID: 35432527 PMCID: PMC9006077 DOI: 10.1155/2022/2663174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
The Princess Marina Hospital in Gaborone, Botswana, had an outbreak of COVID-19 from early August 2020. The aim of this paper was to describe the outbreak investigation. The investigation's specific objectives were to describe the COVID-19 cases in terms of person, place, and time (PPT) and to determine measures to prevent further transmission of the infection. The data reported herein were collected over a 3-month period from beginning of August to end of October 2020. The investigation included all COVID-19 cases i.e. both patients and healthcare workers. It followed the steps of an outbreak investigation. These included assembling an investigation team comprising both the hospital and DHMT staff. All the wards reported their confirmed cases to the infection control team who in turn prepared line lists and case reports. Epicurves were produced from date of positive result. A total of 193 cases were reported, of which 110 (57.0%) were patients and 83 (43.0%) were healthcare workers. The median age was 35 years. Females accounted for 154 (79.8%) participants. Most of the wards were affected. The wards with the highest numbers of cases were female medical ward (39), emergency department (24), gynecology ward (17), and pediatric medical ward (10). Control measures included restricting movement into the hospital as well as clinical screening at all entry points. Furthermore, all patients were tested before admission into the wards. Surveillance of COVID-19 cases was continued beyond the 3 months reported in this paper. COVID-19 can spread rapidly in hospital settings affecting both patients and healthcare workers. Outbreak investigations including describing cases in terms of person, place, and time are critical if the most effective and efficient control measures are to be implemented.
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Ng CYH, Lim NA, Bao LXY, Quek AML, Seet RCS. Mitigating SARS-CoV-2 Transmission in Hospitals: A Systematic Literature Review. Public Health Rev 2022; 43:1604572. [PMID: 35296115 PMCID: PMC8906284 DOI: 10.3389/phrs.2022.1604572] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: Hospital outbreaks of SARS-CoV-2 infection are dreaded but preventable catastrophes. We review the literature to examine the pattern of SARS-CoV-2 transmission in hospitals and identify potential vulnerabilities to mitigate the risk of infection. Methods: Three electronic databases (PubMed, Embase and Scopus) were searched from inception to July 27, 2021 for publications reporting SARS-CoV-2 outbreaks in hospital. Relevant articles and grey literature reports were hand-searched. Results: Twenty-seven articles that described 35 SARS-CoV-2 outbreaks were included. Despite epidemiological investigations, the primary case could not be identified in 37% of outbreaks. Healthcare workers accounted for 40% of primary cases (doctors 17%, followed by ancillary staff 11%). Mortality among infected patients was approximately 15%. By contrast, none of the infected HCWs died. Several concerning patterns were identified, including infections involving ancillary staff and healthcare worker infections from the community and household contacts. Conclusion: Continuous efforts to train-retrain and enforce correct personal protective equipment use and regular routine screening tests (especially among ancillary staff) are necessary to stem future hospital outbreaks of SARS-CoV-2.
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Affiliation(s)
- Chester Yan Hao Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicole-Ann Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lena X. Y. Bao
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy M. L. Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Raymond C. S. Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Raymond C. S. Seet,
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Outbreak of COVID-19 among children and young adults in a cancer center daycare unit. Epidemiol Infect 2022; 150:e40. [PMID: 35184772 PMCID: PMC8886074 DOI: 10.1017/s0950268822000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nosocomial transmission of COVID-19 among immunocompromised hosts can have a serious impact on COVID-19 severity, underlying disease progression and SARS-CoV-2 transmission to other patients and healthcare workers within hospitals. We experienced a nosocomial outbreak of COVID-19 in the setting of a daycare unit for paediatric and young adult cancer patients. Between 9 and 18 November 2020, 473 individuals (181 patients, 247 caregivers/siblings and 45 staff members) were exposed to the index case, who was a nursing staff. Among them, three patients and four caregivers were infected. Two 5-year-old cancer patients with COVID-19 were not severely ill, but a 25-year-old cancer patient showed prolonged shedding of SARS-CoV-2 RNA for at least 12 weeks, which probably infected his mother at home approximately 7–8 weeks after the initial diagnosis. Except for this case, no secondary transmission was observed from the confirmed cases in either the hospital or the community. To conclude, in the day care setting of immunocompromised children and young adults, the rate of in-hospital transmission of SARS-CoV-2 was 1.6% when applying the stringent policy of infection prevention and control, including universal mask application and rapid and extensive contact investigation. Severely immunocompromised children/young adults with COVID-19 would have to be carefully managed after the mandatory isolation period while keeping the possibility of prolonged shedding of live virus in mind.
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Clyne B, Jordan K, Ahern S, Walsh KA, Byrne P, Carty PG, Drummond L, O'Brien KK, Smith SM, Harrington P, Ryan M, O'Neill M. Transmission of SARS-CoV-2 by children: a rapid review, 30 December 2019 to 10 August 2020. Euro Surveill 2022; 27. [PMID: 35115076 PMCID: PMC8815097 DOI: 10.2807/1560-7917.es.2022.27.5.2001651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BackgroundThe role of children in the transmission of SARS-CoV-2 during the early pandemic was unclear.AimWe aimed to review studies on the transmission of SARS-CoV-2 by children during the early pandemic.MethodsWe searched MEDLINE, Embase, the Cochrane Library, Europe PubMed Central and the preprint servers medRxiv and bioRxiv from 30 December 2019 to 10 August 2020. We assessed the quality of included studies using a series of questions adapted from related tools. We provide a narrative synthesis of the results.ResultsWe identified 28 studies from 17 countries. Ten of 19 studies on household and close contact transmission reported low rates of child-to-adult or child-to-child transmission. Six studies investigated transmission of SARS-CoV-2 in educational settings, with three studies reporting 183 cases from 14,003 close contacts who may have contracted COVID-19 from children index cases at their schools. Three mathematical modelling studies estimated that children were less likely to infect others than adults. All studies were of low to moderate quality.ConclusionsDuring the early pandemic, it appeared that children were not substantially contributing to household transmission of SARS-CoV-2. School-based studies indicated that transmission rates in this setting were low. Large-scale studies of transmission chains using data collected from contact tracing and serological studies detecting past evidence of infection would be needed to verify our findings.
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Affiliation(s)
- Barbara Clyne
- Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority, Dublin, Ireland
| | - Susan Ahern
- Health Information and Quality Authority, Dublin, Ireland
| | - Kieran A Walsh
- Health Information and Quality Authority, Dublin, Ireland
| | - Paula Byrne
- Health Information and Quality Authority, Dublin, Ireland
| | - Paul G Carty
- Health Information and Quality Authority, Dublin, Ireland
| | - Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Máirín Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin, Ireland
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To KKW, Sridhar S, Chiu KHY, Hung DLL, Li X, Hung IFN, Tam AR, Chung TWH, Chan JFW, Zhang AJX, Cheng VCC, Yuen KY. Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic. Emerg Microbes Infect 2021; 10:507-535. [PMID: 33666147 PMCID: PMC8006950 DOI: 10.1080/22221751.2021.1898291] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 02/06/2023]
Abstract
Without modern medical management and vaccines, the severity of the Coronavirus Disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) might approach the magnitude of 1894-plague (12 million deaths) and 1918-A(H1N1) influenza (50 million deaths) pandemics. The COVID-19 pandemic was heralded by the 2003 SARS epidemic which led to the discovery of human and civet SARS-CoV-1, bat SARS-related-CoVs, Middle East respiratory syndrome (MERS)-related bat CoV HKU4 and HKU5, and other novel animal coronaviruses. The suspected animal-to-human jumping of 4 betacoronaviruses including the human coronaviruses OC43(1890), SARS-CoV-1(2003), MERS-CoV(2012), and SARS-CoV-2(2019) indicates their significant pandemic potential. The presence of a large reservoir of coronaviruses in bats and other wild mammals, culture of mixing and selling them in urban markets with suboptimal hygiene, habit of eating exotic mammals in highly populated areas, and the rapid and frequent air travels from these areas are perfect ingredients for brewing rapidly exploding epidemics. The possibility of emergence of a hypothetical SARS-CoV-3 or other novel viruses from animals or laboratories, and therefore needs for global preparedness should not be ignored. We reviewed representative publications on the epidemiology, virology, clinical manifestations, pathology, laboratory diagnostics, treatment, vaccination, and infection control of COVID-19 as of 20 January 2021, which is 1 year after person-to-person transmission of SARS-CoV-2 was announced. The difficulties of mass testing, labour-intensive contact tracing, importance of compliance to universal masking, low efficacy of antiviral treatment for severe disease, possibilities of vaccine or antiviral-resistant virus variants and SARS-CoV-2 becoming another common cold coronavirus are discussed.
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Affiliation(s)
- Kelvin Kai-Wang To
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Siddharth Sridhar
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Derek Ling-Lung Hung
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Xin Li
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Ivan Fan-Ngai Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Anthony Raymond Tam
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Tom Wai-Hin Chung
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Jasper Fuk-Woo Chan
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Anna Jian-Xia Zhang
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, People’s Republic of China
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Bhattacharya A, Collin SM, Stimson J, Thelwall S, Nsonwu O, Gerver S, Robotham J, Wilcox M, Hopkins S, Hope R. Healthcare-associated COVID-19 in England: A national data linkage study. J Infect 2021; 83:565-572. [PMID: 34474055 PMCID: PMC8404398 DOI: 10.1016/j.jinf.2021.08.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. METHODS Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated, first positive on day 3-7; hospital-onset probable healthcare-associated, first positive on day 8-14; hospital-onset definite healthcare-associated, first positive from day 15 of admission until discharge; community-onset possible healthcare-associated, first positive test ≤14 days post-discharge. RESULTS One-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. Hospital-onset probable and definite cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. Community-onset community-acquired and community-onset possible healthcare-associated cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively. CONCLUSIONS Up to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.
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Affiliation(s)
- Alex Bhattacharya
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Simon M Collin
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - James Stimson
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Simon Thelwall
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Olisaeloka Nsonwu
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Sarah Gerver
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom
| | - Julie Robotham
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom
| | - Mark Wilcox
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Susan Hopkins
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom; Department of Health and Social Care, NHS Test & Trace, London, United Kingdom
| | - Russell Hope
- Healthcare-Associated Infection and Antimicrobial Resistance (HCAI and AMR) Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; National Institute of Health Research Health Protection Research Unit, Oxford University and Public Health England, United Kingdom.
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Thomas Craig KJ, Rizvi R, Willis VC, Kassler WJ, Jackson GP. Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review. JMIR Public Health Surveill 2021; 7:e32468. [PMID: 34612841 PMCID: PMC8496751 DOI: 10.2196/32468] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Contact tracing in association with quarantine and isolation is an important public health tool to control outbreaks of infectious diseases. This strategy has been widely implemented during the current COVID-19 pandemic. The effectiveness of this nonpharmaceutical intervention is largely dependent on social interactions within the population and its combination with other interventions. Given the high transmissibility of SARS-CoV-2, short serial intervals, and asymptomatic transmission patterns, the effectiveness of contact tracing for this novel viral agent is largely unknown. OBJECTIVE This study aims to identify and synthesize evidence regarding the effectiveness of contact tracing on infectious viral disease outcomes based on prior scientific literature. METHODS An evidence-based review was conducted to identify studies from the PubMed database, including preprint medRxiv server content, related to the effectiveness of contact tracing in viral outbreaks. The search dates were from database inception to July 24, 2020. Outcomes of interest included measures of incidence, transmission, hospitalization, and mortality. RESULTS Out of 159 unique records retrieved, 45 (28.3%) records were reviewed at the full-text level, and 24 (15.1%) records met all inclusion criteria. The studies included utilized mathematical modeling (n=14), observational (n=8), and systematic review (n=2) approaches. Only 2 studies considered digital contact tracing. Contact tracing was mostly evaluated in combination with other nonpharmaceutical interventions and/or pharmaceutical interventions. Although some degree of effectiveness in decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality was observed, these results were highly dependent on epidemic severity (R0 value), number of contacts traced (including presymptomatic and asymptomatic cases), timeliness, duration, and compliance with combined interventions (eg, isolation, quarantine, and treatment). Contact tracing effectiveness was particularly limited by logistical challenges associated with increased outbreak size and speed of infection spread. CONCLUSIONS Timely deployment of contact tracing strategically layered with other nonpharmaceutical interventions could be an effective public health tool for mitigating and suppressing infectious outbreaks by decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality.
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Affiliation(s)
- Kelly Jean Thomas Craig
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
| | - Rubina Rizvi
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
| | - Van C Willis
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
| | - William J Kassler
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
- Palantir Technologies, Denver, CO, United States
| | - Gretchen Purcell Jackson
- Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, Cambridge, MA, United States
- Vanderbilt University Medical Center, Nashville, TN, United States
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10
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Kostoff RN, Calina D, Kanduc D, Briggs MB, Vlachoyiannopoulos P, Svistunov AA, Tsatsakis A. Why are we vaccinating children against COVID-19? Toxicol Rep 2021; 8:1665-1684. [PMID: 34540594 PMCID: PMC8437699 DOI: 10.1016/j.toxrep.2021.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/11/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022] Open
Abstract
This article examines issues related to COVID-19 inoculations for children. The bulk of the official COVID-19-attributed deaths per capita occur in the elderly with high comorbidities, and the COVID-19 attributed deaths per capita are negligible in children. The bulk of the normalized post-inoculation deaths also occur in the elderly with high comorbidities, while the normalized post-inoculation deaths are small, but not negligible, in children. Clinical trials for these inoculations were very short-term (a few months), had samples not representative of the total population, and for adolescents/children, had poor predictive power because of their small size. Further, the clinical trials did not address changes in biomarkers that could serve as early warning indicators of elevated predisposition to serious diseases. Most importantly, the clinical trials did not address long-term effects that, if serious, would be borne by children/adolescents for potentially decades. A novel best-case scenario cost-benefit analysis showed very conservatively that there are five times the number of deaths attributable to each inoculation vs those attributable to COVID-19 in the most vulnerable 65+ demographic. The risk of death from COVID-19 decreases drastically as age decreases, and the longer-term effects of the inoculations on lower age groups will increase their risk-benefit ratio, perhaps substantially.
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Affiliation(s)
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania
| | - Darja Kanduc
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Italy
| | | | | | - Andrey A. Svistunov
- Department of Pharmacology, I.M.Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece
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11
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Sah P, Fitzpatrick MC, Zimmer CF, Abdollahi E, Juden-Kelly L, Moghadas SM, Singer BH, Galvani AP. Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. Proc Natl Acad Sci U S A 2021; 118:e2109229118. [PMID: 34376550 PMCID: PMC8403749 DOI: 10.1073/pnas.2109229118] [Citation(s) in RCA: 247] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.
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Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Charlotte F Zimmer
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Elaheh Abdollahi
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
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12
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Busa F, Bardanzellu F, Pintus MC, Fanos V, Marcialis MA. COVID-19 and School: To Open or Not to Open, That Is the Question. The First Review on Current Knowledge. Pediatr Rep 2021; 13:257-278. [PMID: 34205837 PMCID: PMC8293384 DOI: 10.3390/pediatric13020035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has led to an unprecedented closure of schools in terms of duration. The option of school closure, SARS-CoV-2 initially being poorly known, was influenced by the epidemiological aspects of the influenza virus. However, school closure is still under debate and seems unsupported by sure evidence of efficacy in the COVID-19 era. The aim of our narrative review is to discuss the available literature on SARS-CoV-2 spread among children and adolescents, in the school setting, trying to explain why children appear less susceptible to severe disease and less involved in viral spreading. We also tried to define the efficacy of school closure, through an overview of the effects of the choices made by the various countries, trying to identify which preventive measures could be effective for a safe reopening. Finally, we focused on the psychological aspects of such a prolonged closure for children and adolescents. SARS-CoV-2, children, COVID-19, influenza, and school were used as key words in our literature research, updated to 29 March 2021. To our knowledge, this is the first review summarizing the whole current knowledge on SARS-CoV-2 spreading among children and adolescents in the school setting, providing a worldwide overview in such a pandemic context.
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Affiliation(s)
| | - Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4,500, 09042 Monserrato, Italy; (F.B.); (M.C.P.); (V.F.); (M.A.M.)
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13
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Steffes LC, Cornfield DN. Coronavirus disease 2019 respiratory disease in children: clinical presentation and pathophysiology. Curr Opin Pediatr 2021; 33:302-310. [PMID: 33938476 DOI: 10.1097/mop.0000000000001013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Pediatric coronavirus disease 2019 (COVID-19) respiratory disease is a distinct entity from adult illness, most notable in its milder phenotype. This review summarizes the current knowledge of the clinical patterns, cellular pathophysiology, and epidemiology of COVID-19 respiratory disease in children with specific attention toward factors that account for the maturation-related differences in disease severity. RECENT FINDINGS Over the past 14 months, knowledge of the clinical presentation and pathophysiology of COVID-19 pneumonia has rapidly expanded. The decreased disease severity of COVID-19 pneumonia in children was an early observation. Differences in the efficiency of viral cell entry and timing of immune recognition and response between children and adults remain at the center of ongoing research. SUMMARY The clinical spectrum of COVID-19 respiratory disease in children is well defined. The age-related differences protecting children from severe disease and death remain incompletely understood.
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Affiliation(s)
- Lea C Steffes
- Division of Pulmonary, Asthma and Sleep Medicine, Department of Pediatrics, Center for Excellence in Pulmonary Biology, Stanford University Medical School, Stanford, California, USA
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14
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Galow L, Haag L, Kahre E, Blankenburg J, Dalpke AH, Lück C, Berner R, Armann JP. Lower household transmission rates of SARS-CoV-2 from children compared to adults. J Infect 2021; 83:e34-e36. [PMID: 33930468 PMCID: PMC8079264 DOI: 10.1016/j.jinf.2021.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Lukas Galow
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
| | - Luise Haag
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Elisabeth Kahre
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Judith Blankenburg
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Alexander H Dalpke
- Institute for Medical Microbiology and Virology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Christian Lück
- Institute for Medical Microbiology and Virology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Reinhard Berner
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jakob P Armann
- Department of Paediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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15
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Park K, Lee J, Lee K, Jung J, Kim SH, Lee J, Chalita M, Yoon SH, Chun J, Hur KH, Sung H, Kim MN, Lee HK. Epidemiologic Linkage of COVID-19 Outbreaks at Two University-affiliated Hospitals in the Seoul Metropolitan Area in March 2020. J Korean Med Sci 2021; 36:e38. [PMID: 33496089 PMCID: PMC7834897 DOI: 10.3346/jkms.2021.36.e38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) outbreaks emerged at two university-affiliated hospitals in Seoul (hospital A) and Uijeongbu City (hospital S) in the metropolitan Seoul area in March 2020. The aim of this study was to investigate epidemiological links between the outbreaks using whole genome sequencing (WGS) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS Fifteen patients were enrolled in the study, including four non-outbreak (A1-A4) and three outbreak cases (A5-A7) in hospital A and eight cases (S1-S8) in hospital S. Patients' hospital stays, COVID-19 symptoms, and transfer history were reviewed. RNA samples were submitted for WGS and genome-wide single nucleotide variants and phylogenetic relationships were analyzed. RESULTS The index patient (A5) in hospital A was transferred from hospital S on 26 March. Patients A6 and A7 were the family caregiver and sister, respectively, of the patient who shared a room with A5 for 4 days. Prior to transfer, A5 was at the next bed to S8 in the emergency room on 25 March. Patient S6, a professional caregiver, took care of the patient in the room next to S8's room for 5 days until 22 March and then S5 for another 3 days. WGS revealed that SARS-CoV-2 in A2, A3, and A4 belong to clades V/B.2, S/A, and G/B.1, respectively, whereas that of A5-A7 and S1-S5 are of the V/B.2.1 clade and closely clustered. In particular, SARS-CoV-2 in patients A5 and S5 showed perfect identity. CONCLUSION WGS is a useful tool to understand epidemiology of SARS-CoV-2. It is the first study to elucidate the role of patient transfer and caregivers as links of nosocomial outbreaks of COVID-19 in multiple hospitals.
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Affiliation(s)
- Kuenyoul Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jaewoong Lee
- Department of Laboratory Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | | | - Jiwon Jung
- Department of infectious disease, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sung Han Kim
- Department of infectious disease, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jina Lee
- Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | | | | | - Jongsik Chun
- ChunLab Inc., Seoul, Korea
- Department of Biological Sciences, Seoul National University, Seoul, Korea
| | - Kyu Hwa Hur
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
| | - Mi Na Kim
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
| | - Hae Kyung Lee
- Department of Laboratory Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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16
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Saha S, Saha S. Epidemiological burden of parents being the index cases of COVID-19 infected children. World J Methodol 2021; 11:1-14. [PMID: 33575170 PMCID: PMC7852346 DOI: 10.5662/wjm.v11.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the ongoing coronavirus disease 2019 (COVID-19) pandemic, when children remain home-confined secondary to the closure of schools, little is known of the burden of the parents being their index case.
AIM To determine the prevalence of parents being the index case of COVID-19 infected children.
METHODS A database search in PubMed and Scopus ensued to recruit studies reporting the index case information of COVID-19 infected individuals aged ≤ 18. The reviewed articles' quality evaluation included the use of the National Heart, Lung, and Blood Institute's tool. A random-effect meta-analysis ensued to determine the prevalence of the parent being and not-being the index case. Heterogeneity was assessed by I2 and Chi2 statistics. The publication bias was evaluated by funnel plots and Egger’s test.
RESULTS Overall, this review included 13 eligible studies sourcing data from 622 children of 33 nations. Study designs were heterogeneous and primarily included descriptive reports (38.4%). The prevalence of parent being the index case was 54% (95%CI: 0.29-0.79; I2: 62.3%, Chi2 P < 0.001). In > 70% of children, their index-case parent was symptomatic due to COVID-19 at the time of infection transmitting. Studies for which a risk of bias assessment was possible were of fair quality.
CONCLUSION There is a substantial global burden of parents being the index case of COVID-19 infected children, and frequently these parents are symptomatic. Therefore, from a public health perspective, early detection of these parents is crucial.
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Affiliation(s)
- Sumanta Saha
- National Institute of Epidemiology, Ayapakkam, Chennai, Tamil Nadu 600077, India
| | - Sujata Saha
- Department of Mathematics, Mankar College, Mankar 713144, India
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17
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Nunziata F, Poeta M, Vassallo E, Continisio GI, Lo Vecchio A, Guarino A, Bruzzese E. No Spread of SARS-CoV-2 From Infected Symptomatic Children to Parents: A Prospective Cohort Study in a Controlled Hospital Setting. Front Pediatr 2021; 9:720084. [PMID: 34414146 PMCID: PMC8369826 DOI: 10.3389/fped.2021.720084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: The transmission rates severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from children to adults are unclear due to a lack of controlled conditions. Materials and Methods: We investigated the occurrence of SARS-CoV-2 transmission among 12 discordant child-parent pairs in our ward. In each hospital isolation room, caregivers and children lived in close contact during the entire hospitalization period. Results: A total of 136 swab-positive children (mean age, 3.6 ± 4.9 median age, 1; IQR 0-6.2, range 0.1-17) attended by their caregivers were hospitalized. Of those, 12/136 (8.8%, mean age, 6.1 ± 5.3 median age, 4.5) were attended by caregivers who were swab and serology negative at admission despite previous close contact with positive children at home. Three children were completely dependent on their mothers, one of whom was being breastfed. The mean duration of overall exposure to the index case was 20.5 ± 8.2 days. Conclusion: None of the infected children transmitted SARS-CoV-2 infection to their caregivers, raising the hypothesis of a cluster of resistant mothers or of limited transmission from children to adults despite prolonged exposure and close contact. These data might provide reassurance regarding school openings and offer the chance of investigating SARS-CoV-2 variants in the future under the same quasi-experimental conditions.
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Affiliation(s)
- Francesco Nunziata
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Marco Poeta
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Edoardo Vassallo
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | | | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, Section of Paediatrics, University of Naples Federico II, Naples, Italy
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18
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Centeno‐Tablante E, Medina‐Rivera M, Finkelstein JL, Rayco‐Solon P, Garcia‐Casal MN, Rogers L, Ghezzi‐Kopel K, Ridwan P, Peña‐Rosas JP, Mehta S. Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci 2021; 1484:32-54. [PMID: 32860259 PMCID: PMC7970667 DOI: 10.1111/nyas.14477] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full-text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID-19 cases based on RT-PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID-19 were positive for SARS-CoV-2 RNA; of the exposed infants, four were positive and two were negative for COVID-19. Currently, there is no evidence of SARS-CoV-2 transmission through breast milk. Studies are needed with longer follow-up periods that collect data on infant feeding practices and on viral presence in breast milk.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn,
Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | - Lisa Rogers
- Department of Nutrition and Food
SafetyWorld Health OrganizationGenevaSwitzerland
| | | | - Pratiwi Ridwan
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| | | | - Saurabh Mehta
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
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19
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Papadimos TJ, Soghoian SE, Nanayakkara P, Singh S, Miller AC, Saddikuti V, Jayatilleke AU, Dubhashi SP, Firstenberg MS, Dutta V, Chauhan V, Sharma P, Galwankar SC, Garg M, Taylor N, Stawicki SP. COVID-19 Blind Spots: A Consensus Statement on the Importance of Competent Political Leadership and the Need for Public Health Cognizance. J Glob Infect Dis 2020; 12:167-190. [PMID: 33888955 PMCID: PMC8045535 DOI: 10.4103/jgid.jgid_397_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023] Open
Abstract
As the COVID-19 pandemic continues, important discoveries and considerations emerge regarding the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pathogen; its biological and epidemiological characteristics; and the corresponding psychological, societal, and public health (PH) impacts. During the past year, the global community underwent a massive transformation, including the implementation of numerous nonpharmacological interventions; critical diversions or modifications across various spheres of our economic and public domains; and a transition from consumption-driven to conservation-based behaviors. Providing essential necessities such as food, water, health care, financial, and other services has become a formidable challenge, with significant threats to the existing supply chains and the shortage or reduction of workforce across many sectors of the global economy. Food and pharmaceutical supply chains constitute uniquely vulnerable and critically important areas that require high levels of safety and compliance. Many regional health-care systems faced at least one wave of overwhelming COVID-19 case surges, and still face the possibility of a new wave of infections on the horizon, potentially in combination with other endemic diseases such as influenza, dengue, tuberculosis, and malaria. In this context, the need for an effective and scientifically informed leadership to sustain and improve global capacity to ensure international health security is starkly apparent. Public health "blind spotting," promulgation of pseudoscience, and academic dishonesty emerged as significant threats to population health and stability during the pandemic. The goal of this consensus statement is to provide a focused summary of such "blind spots" identified during an expert group intense analysis of "missed opportunities" during the initial wave of the pandemic.
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Affiliation(s)
- Thomas J. Papadimos
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Samara E. Soghoian
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Prabath Nanayakkara
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Sarman Singh
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Andrew C. Miller
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | | | | | - Siddharth P. Dubhashi
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Michael S. Firstenberg
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Vibha Dutta
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Vivek Chauhan
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Pushpa Sharma
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Sagar C. Galwankar
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Manish Garg
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Nicholas Taylor
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Stanislaw P. Stawicki
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
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