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Chen R, Kezhekkekara SG, Kunasekaran MP, MacIntyre CR. Universal masking during COVID-19 outbreaks in aged care settings: A systematic review and meta-analysis. Ageing Res Rev 2024; 93:102138. [PMID: 38007047 DOI: 10.1016/j.arr.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Aged care facilities (ACF) are a high-risk COVID-19 transmission setting, and older residents are at greater risk of severe outcomes. This systematic review and meta-analysis assessed whether universal masking and COVID-19 vaccination reduce SARS-CoV-2 attack rates (ARs) in ACF. Articles published between 1 December 2019 and 28 February 2022 were screened across five databases (Medline, Embase, PubMed, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). Risk of bias was assessed using relevant Joanna Briggs Institute critical appraisal tools. Meta-analysis of single proportions, subgroup analysis, and meta-regression were performed to compare the effects of universal masking and vaccine doses on pooled SARS-CoV-2 ARs. Of 99 included articles, SARS-CoV-2 ARs for residents were available in 86 studies (representing 139 outbreaks), and for staff in 49 studies (78 outbreaks). Universal masking was associated with lower SARS-CoV-2 ARs in ACF outbreaks (AR = 34.9% [95% CI: 27.2-42.6%]) compared to facilities without universal masking (67.3% [54.2-80.4%], p < .0001). In ACF with universal masking prior to outbreak onset, facility-wide testing, and documentation of asymptomatic infection, the asymptomatic AR at time of testing was 11.4% (6.5-17.4%) in residents. Receipt of zero, one and two vaccination doses were associated with ARs of 64.9% (49.6-80.2%), 54.9% (33.7-76.1%) and 45.2% (29.2-61.3%), respectively. To protect residents from COVID-19, ACF should provide vaccination of residents and staff, universal masking for staff, and facility-wide testing during times of heightened community transmission.
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Affiliation(s)
- Rosalie Chen
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia.
| | - Shwetha G Kezhekkekara
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia; Australian Centre for Integration of Oral Health (ACIOH), Western Sydney University, Sydney, Australia
| | | | - C Raina MacIntyre
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, United States
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Chong Y, Goto T, Watanabe H, Tani N, Yonekawa A, Ikematsu H, Shimono N, Tanaka Y, Akashi K. Achievement of sufficient antibody response after a fourth dose of wild-type SARS-CoV-2 mRNA vaccine in nursing home residents. Immun Inflamm Dis 2023; 11:e962. [PMID: 37647452 PMCID: PMC10461422 DOI: 10.1002/iid3.962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Infection control during COVID-19 outbreaks in nursing facilities is a critical public health issue. Antibody responses before and after the fourth (second booster) dose of wild-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in nursing home residents have not been fully characterized. METHODS This study included 112 individuals: 54 nursing home residents (mean age: 84.4 years; 35 SARS-CoV-2-naive and 19 previously infected) and 58 healthcare workers (mean age: 47.7 years; 25 SARS-CoV-2-naive and 33 previously infected). Antispike and antinucleocapsid antibody responses to messenger RNA vaccination were evaluated using serum samples collected shortly and 5 months after the third dose, and shortly after the fourth dose. RESULTS The median immunoglobulin G (IgG) level in SARS-CoV-2-naive residents was similar to that in SARS-CoV-2-naive healthcare workers after the fourth dose (24,026.3 vs. 30,328.6 AU/mL, p = .79), whereas after the third dose the IgG level of SARS-CoV-2-naive residents was approximately twofold lower than that in SARS-CoV-2-naive healthcare workers. In residents with previous SARS-CoV-2 infection, timing of infection in relation to vaccination affected the kinetics of antibody responses. Residents infected after the third dose showed the highest IgG levels after the fourth dose among all groups (median: 64,328.8 AU/mL), in contrast to residents infected before initiating vaccination with antibody levels similar to those of SARS-CoV-2-naive residents. CONCLUSIONS Advanced aged nursing home residents, poor responders in the initial SARS-CoV-2 vaccine series, could achieve sufficient antibody responses after the fourth (second booster) vaccination, comparable to those of younger adults.
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Affiliation(s)
- Yong Chong
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine)FukuokaJapan
| | - Takeyuki Goto
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine)FukuokaJapan
| | - Haruka Watanabe
- Department of Clinical Immunology, Rheumatology, and Infectious DiseaseKyushu University HospitalFukuokaJapan
| | - Naoki Tani
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine)FukuokaJapan
| | - Akiko Yonekawa
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine)FukuokaJapan
| | - Hideyuki Ikematsu
- Division of Influenza ResearchJapan Physicians AssociationTokyoJapan
| | - Nobuyuki Shimono
- Department of Center for the Study of Global InfectionCenter for the Study of Global Infection, Kyushu University HospitalFukuokaJapan
| | - Yosuke Tanaka
- Department of Internal MedicineMedical Corporation SOUSEIKAI, Kanenokuma HospitalFukuokaJapan
| | - Koichi Akashi
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine)FukuokaJapan
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Zhang J, Yu Y, Petrovic M, Pei X, Tian QB, Zhang L, Zhang WH. Impact of the COVID-19 pandemic and corresponding control measures on long-term care facilities: a systematic review and meta-analysis. Age Ageing 2023; 52:6987654. [PMID: 36668818 DOI: 10.1093/ageing/afac308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/04/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. OBJECTIVE To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staff. METHOD We conducted a systematic search of six databases for articles published between December 2019 and 5 November 2021, and performed meta-analyses and subgroup analyses to identify the impact of COVID-19 on LTCFs and the association between control measures and infection rate. RESULTS We included 108 studies from 19 countries. These studies included 1,902,044 residents and 255,498 staff from 81,572 LTCFs, among whom 296,024 residents and 36,807 staff were confirmed SARS-CoV-2 positive. The pooled infection rate was 32.63% (95%CI: 30.29 ~ 34.96%) for residents, whereas it was 10.33% (95%CI: 9.46 ~ 11.21%) for staff. In LTCFs that cancelled visits, new patient admissions, communal dining and group activities, and vaccinations, infection rates in residents and staff were lower than the global rate. We reported the residents' hospitalisation rate to be 29.09% (95%CI: 25.73 ~ 32.46%), with a case-fatality rate of 22.71% (95%CI: 21.31 ~ 24.11%) and mortality rate of 15.81% (95%CI: 14.32 ~ 17.30%). Significant publication biases were observed in the residents' case-fatality rate and the staff infection rate, but not in the infection, hospitalisation, or mortality rate of residents. CONCLUSION SARS-CoV-2 infection rates would be very high among LTCF residents and staff without appropriate control measures. Cancelling visits, communal dining and group activities, restricting new admissions, and increasing vaccination would significantly reduce the infection rates.
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Affiliation(s)
- Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,The Research Center for Medical Sociology, Tsinghua University, 100084 Beijing, China
| | - Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Xiaomei Pei
- Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 050017 Shijiazhuang, Hebei, China
| | - Qing-Bao Tian
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, 710061 Xi'an, Shaanxi, China
| | - Lei Zhang
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne 3053, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne 3800, Australia.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 450001 Zhengzhou, Henan, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium.,School of Public Health, Université libre de Bruxelles (ULB), Bruxelles 1070, Belgium
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Evaluation of SARS-CoV-2 antibody persistence and viral spread in stool: a long-term care experience before COVID-19 vaccination. Ir J Med Sci 2023; 192:263-268. [PMID: 35829907 PMCID: PMC9277604 DOI: 10.1007/s11845-022-03095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Due to elderly residents, nursing homes/assisted living facilities were the most affected places in COVID-19 pandemic. Besides symptomatic patients, asymptomatic patients were detected during routine screening. AIM This study aims to determine the factors that affect antibody response and viral shedding in stool samples after natural exposure to the virus in residents and staff who recovered from COVID-19 before the vaccine was available. METHODS This prospective cross-sectional study was conducted at the nation's highest-capacity Residential and Nursing Home. Blood samples were collected between December 15, 2020 and January 15, 2021 from participating residents and staff for anti-SARS-CoV-2 antibody testing. Stool samples were obtained for SARS-CoV-2 PCR testing 2 months after COVID-19. The Social Sciences (SPSS) program version 15.0 was used for statistical analysis. The Mann-Whitney U test compared SARS-CoV-2 antibody concentration between two groups. RESULTS Four hundred sixty-four (52.3%) residents and 424 (47.7%) staff participated. Entirely 259 (29.2%) participants were anti-SARS-CoV-2 IgG (+) and 255 (28.7%) were SARS-CoV-2 PCR (+). Both antibody and PCR positivity was detected in 196 (76.9%). In PCR (-) group, 63 (10.0%) participants were SARS-CoV-2 IgG (+). Antibody titers were found highest in SARS-CoV-2 PCR (+) male residents. SARS-CoV-2 IgG titers were significantly high in SARS-CoV-2 PCR (+) and hospitalized participants regardless of age. Stool samples were obtained from 61(23.9%) participants and were found negative. CONCLUSION A durable SARS-CoV-2 IgG antibody response was monitored at least 9 months after the participants were diagnosed with COVID-19. SARS-CoV-2 antibody positivity was detected 76.9% in PCR (+) and 10.0% in PCR (-) participants. Knowing the duration of detectable antibodies is an important finding for developing disease prevention and public health strategies.
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