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Huynh PK, Setty AR, Tran QM, Yadav OP, Yodo N, Le TQ. A domain-knowledge modeling of hospital-acquired infection risk in Healthcare personnel from retrospective observational data: A case study for COVID-19. PLoS One 2022; 17:e0272919. [PMID: 36409727 PMCID: PMC9678325 DOI: 10.1371/journal.pone.0272919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hospital-acquired infections of communicable viral diseases (CVDs) have been posing a tremendous challenge to healthcare workers globally. Healthcare personnel (HCP) is facing a consistent risk of viral infections, and subsequently higher rates of morbidity and mortality. MATERIALS AND METHODS We proposed a domain-knowledge-driven infection risk model to quantify the individual HCP and the population-level risks. For individual-level risk estimation, a time-variant infection risk model is proposed to capture the transmission dynamics of CVDs. At the population-level, the infection risk is estimated using a Bayesian network model constructed from three feature sets, including individual-level factors, engineering control factors, and administrative control factors. For model validation, we investigated the case study of the Coronavirus disease, in which the individual-level and population-level infection risk models were applied. The data were collected from various sources such as COVID-19 transmission databases, health surveys/questionaries from medical centers, U.S. Department of Labor databases, and cross-sectional studies. RESULTS Regarding the individual-level risk model, the variance-based sensitivity analysis indicated that the uncertainty in the estimated risk was attributed to two variables: the number of close contacts and the viral transmission probability. Next, the disease transmission probability was computed using a multivariate logistic regression applied for a cross-sectional HCP data in the UK, with the 10-fold cross-validation accuracy of 78.23%. Combined with the previous result, we further validated the individual infection risk model by considering six occupations in the U.S. Department of Labor O*Net database. The occupation-specific risk evaluation suggested that the registered nurses, medical assistants, and respiratory therapists were the highest-risk occupations. For the population-level risk model validation, the infection risk in Texas and California was estimated, in which the infection risk in Texas was lower than that in California. This can be explained by California's higher patient load for each HCP per day and lower personal protective equipment (PPE) sufficiency level. CONCLUSION The accurate estimation of infection risk at both individual level and population levels using our domain-knowledge-driven infection risk model will significantly enhance the PPE allocation, safety plans for HCP, and hospital staffing strategies.
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Affiliation(s)
- Phat K. Huynh
- Department of Industrial and Management Systems Engineering, University of South Florida, Tampa, FL, United States of America
- Department of Industrial and Manufacturing Engineering, North Dakota State University, Fargo, North Dakota, United States of America
| | - Arveity R. Setty
- University of North Dakota, Fargo, North Dakota, United States of America
- Sanford Hospital, Fargo, North Dakota, United States of America
| | - Quan M. Tran
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Om P. Yadav
- Department of Industrial and Systems Engineering, North Carolina A&T State University, Greensboro, North Carolina, United States of America
| | - Nita Yodo
- Department of Industrial and Manufacturing Engineering, North Dakota State University, Fargo, North Dakota, United States of America
| | - Trung Q. Le
- Department of Industrial and Management Systems Engineering, University of South Florida, Tampa, FL, United States of America
- Department of Industrial and Manufacturing Engineering, North Dakota State University, Fargo, North Dakota, United States of America
- * E-mail:
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Leal J, Farkas B, Mastikhina L, Flanagan J, Skidmore B, Salmon C, Dixit D, Smith S, Tsekrekos S, Lee B, Vayalumkal J, Dunn J, Harrison R, Cordoviz M, Dubois R, Chandran U, Clement F, Bush K, Conly J, Larios O. Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review. Antimicrob Resist Infect Control 2022; 11:102. [PMID: 35953854 PMCID: PMC9366810 DOI: 10.1186/s13756-022-01133-8] [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: 02/04/2022] [Accepted: 06/27/2022] [Indexed: 02/08/2023] Open
Abstract
Background In many jurisdictions healthcare workers (HCWs) are using respirators for aerosol-generating medical procedures (AGMPs) performed on adult and pediatric populations with all suspect/confirmed viral respiratory infections (VRIs). This systematic review assessed the risk of VRIs to HCWs in the presence of AGMPs, the role respirators versus medical/surgical masks have on reducing that risk, and if the risk to HCWs during AGMPs differed when caring for adult or pediatric patient populations. Main text We searched MEDLINE, EMBASE, Cochrane Central, Cochrane SR, CINAHL, COVID-19 specific resources, and MedRxiv for English and French articles from database inception to September 9, 2021. Independent reviewers screened abstracts using pre-defined criteria, reviewed full-text articles, selected relevant studies, abstracted data, and conducted quality assessments of all studies using the ROBINS-I risk of bias tool. Disagreements were resolved by consensus. Thirty-eight studies were included; 23 studies on COVID-19, 10 on SARS, and 5 on MERS/ influenza/other respiratory viruses. Two of the 16 studies which assessed associations found that HCWs were 1.7 to 2.5 times more likely to contract COVID-19 after exposure to AGMPs vs. not exposed to AGMPs. Eight studies reported statistically significant associations for nine specific AGMPs and transmission of SARS to HCWS. Intubation was consistently associated with an increased risk of SARS. HCWs were more likely (OR 2.05, 95% CI 1.2–3.4) to contract human coronaviruses when exposed to an AGMP in one study. There were no reported associations between AGMP exposure and transmission of influenza or in a single study on MERS. There was limited evidence supporting the use of a respirator over a medical/surgical mask during an AGMP to reduce the risk of viral transmission. One study described outcomes of HCWs exposed to a pediatric patient during intubation. Conclusion Exposure to an AGMP may increase the risk of transmission of COVID-19, SARS, and human coronaviruses to HCWs, however the evidence base is heterogenous and prone to confounding, particularly related to COVID-19. There continues to be a significant research gap in the epidemiology of the risk of VRIs among HCWs during AGMPs, particularly for pediatric patients. Further evidence is needed regarding what constitutes an AGMP. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01133-8.
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Yao W, Tan L, Liu L. Visualization and analysis of mapping knowledge domains for coronavirus research. Medicine (Baltimore) 2022; 101:e29508. [PMID: 35758392 PMCID: PMC9276283 DOI: 10.1097/md.0000000000029508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In recent years, many countries around the world have been threatened by COVs. The aim of this study was to better grasp developments and trends in research on coronavirus around the world and to promote theoretical research into their prevention and control. METHODS Research on coronavirus was reviewed and analyzed using bibliometrics based on a total of 4860 publications collected from the Web of Science Core Collection database. Yearly quantitative distribution of literature, country/region distribution, organization distribution, main source journal distribution, subject category distribution, research knowledge bases, and research hotspots and frontiers were all analyzed, and CiteSpace and VOSviewer were used to plot knowledge domain maps, Excel was used to plot keyword strategy diagram. RESULTS Coronavirus research could be roughly divided into 4 stages: preliminary development stage (before 2000), rapid growth stage (2000-2005), slow decline stage (2006-2011) and sustained growth stage (since 2012). America had taken the leading position in this field. The study of COVs involves many subject categories, mainly includes virology, veterinary sciences, biology, and immunology. At present, the key words in the field of coronavirus research were mainly divided into 6 major hot clusters, namely, the introduction and structure analysis of coronavirus, the research on the outbreak source and transmission of coronavirus, the research on the infection pathway of coronavirus in human body, the research on the pathogenesis of coronavirus, the research on the diagnosis and symptoms of coronavirus infection, and the research on the treatment of coronavirus. CONCLUSION Coronavirus, which occurs all over the world, often causes huge casualties and economic losses, and poses a serious threat to the safe and stable operation of the social and economic system. Objective literature review and analysis can help scholars in related fields to deepen their overall understanding. And, there are several key issues that should be further explored in future research.
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Affiliation(s)
- Weizhi Yao
- School of Economics and Management, Southeast University, Nanjing, China
| | - Ling Tan
- School of Applied Meteorology, Nanjing University of Information Science & Technology, Nanjing, China
| | - Liang Liu
- School of Economics and Management, Southeast University, Nanjing, China
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Nyberg A, Rajaleid K, Demmelmaier I. The Work Environment during Coronavirus Epidemics and Pandemics: A Systematic Review of Studies Using Quantitative, Qualitative, and Mixed-Methods Designs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116783. [PMID: 35682365 PMCID: PMC9180570 DOI: 10.3390/ijerph19116783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 02/05/2023]
Abstract
We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.
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Affiliation(s)
- Anna Nyberg
- Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 564, SE-751 22 Uppsala, Sweden;
- Correspondence: ; Tel.: +46-8-708-234318
| | - Kristiina Rajaleid
- Stress Research Institute, Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden;
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, P.O. Box 564, SE-751 22 Uppsala, Sweden;
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Chen Y, Wang Y, Quan N, Yang J, Wu Y. Associations Between Wearing Masks and Respiratory Viral Infections: A Meta-Analysis and Systematic Review. Front Public Health 2022; 10:874693. [PMID: 35570912 PMCID: PMC9092448 DOI: 10.3389/fpubh.2022.874693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Respiratory viral infections (RVIs) are a major health concern, and some previous studies have shown that wearing masks was effective in preventing RVIs, while others failed to show such effect. Therefore, a systematic review and meta-analysis was conducted to investigate the effectiveness of wearing masks. Methods PubMed, ScienceDirect, Web of Science, the Cochrane Library, EMBASE, MEDLINE, China National Knowledge Infrastructure (CNKI), and Chinese Scientific Journal Database (VIP database) were searched for studies evaluating the effectiveness of wearing masks. The risk ratio (RR) was used to measure the effectiveness of wearing masks in preventing RVIs for randomized controlled trials (RCTs) and cohort studies, and the odds ratio (OR) was used for case-control studies. Forest plots were used to visually assess pooled estimates and corresponding 95% CIs. The I2 test was used to examine the heterogeneity, and subgroup analysis was used to explore the possible explanations for heterogeneity or compare the results between subgroups. Sensitivity analysis was conducted to assess robustness of the synthesized results. Begg's test and Egger's test were used to assess the publications bias. Results Thirty-one studies (13,329 participants) were eligible for meta-analyses. Overall, the results showed that wearing masks was effective in preventing RVIs. The sensitivity analysis showed that the results of those meta-analyses were robust and reliable. There was no significant publication bias in meta-analysis of case-control studies and most subgroup analyses. Conclusions Wearing masks might be effective in preventing RVIs. To reduce their RVI risk, people should wear masks when they go out in public. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021296092.
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Affiliation(s)
- Yiming Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Faculty of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Yuelin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Faculty of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Ningbin Quan
- Department of Epidemiology and Health Statistics, School of Public Health, Faculty of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Jun Yang
- Department of Nutrition and Toxicology, School of Public Health, Faculty of Medicine, Hangzhou Normal University, Hangzhou, China
- National Key Laboratory for the Diagnosis and Treatment for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yinyin Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Faculty of Medicine, Hangzhou Normal University, Hangzhou, China
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Surface Functionalization of Non-Woven Fabrics Using a Novel Silica-Resin Coating Technology: Antiviral Treatment of Non-Woven Fabric Filters in Surgical Masks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063639. [PMID: 35329324 PMCID: PMC8952221 DOI: 10.3390/ijerph19063639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
Masks are effective for preventing the spread of COVID-19 and other respiratory infections. If antimicrobial properties can be applied to the non-woven fabric filters in masks, they can become a more effective countermeasure against human-to-human and environmental infections. We investigated the possibilities of carrying antimicrobial agents on the fiber surfaces of non-woven fabric filters by applying silica-resin coating technology, which can form silica-resin layers on such fabrics at normal temperature and pressure. Scanning electron microscopy and electron probe microanalysis showed that a silica-resin layer was formed on the fiber surface of non-woven fabric filters. Bioassays for coronavirus and quantitative reverse transcription-polymerase chain reactions (RT-PCR) revealed that all antimicrobial agents tested loaded successfully onto non-woven fabric filters without losing their inactivation effects against the human coronavirus (inhibition efficacy: >99.999%). These results indicate that this technology could be used to load a functional substance onto a non-woven fabric filter by vitrifying its surface. Silica-resin coating technology also has the potential of becoming an important breakthrough not only in the prevention of infection but also in various fields, such as prevention of building aging, protection of various cultural properties, the realization of a plastic-free society, and prevention of environmental pollution.
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Hui DS, Azhar EI, Memish ZA, Zumla A. Human Coronavirus Infections—Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and SARS-CoV-2. ENCYCLOPEDIA OF RESPIRATORY MEDICINE 2022. [PMCID: PMC7241405 DOI: 10.1016/b978-0-12-801238-3.11634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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COVID-19 vaccine hesitancy concerns: Findings from a Ghana clinical radiography workforce survey. Radiography (Lond) 2021; 28:537-544. [PMID: 34654631 PMCID: PMC8498685 DOI: 10.1016/j.radi.2021.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 12/23/2022]
Abstract
Introduction Vaccination is a key global strategy to mitigate the clinical impact of the COVID-19 virus. As part of local efforts to manage the outbreak, the government of Ghana announced its intention to vaccinate its population starting with essential and high-risk workers including radiographers. However, there were reports of hesitance to receiving the vaccine among the radiography workforce. This study was undertaken prior to the intended vaccination exercise to assess the willingness and concerns of radiographers to undergo the COVID-19 vaccination and to suggest recommendations to improve the vaccine uptake. Methods An ethically-approved online survey strategy was employed for this cross-sectional study conducted between 24th–28th February 2021. The survey employed quantitative questions and open text response options. Quantitative and open text responses were analysed using statistical and thematic analyses, respectively. Results There were 108 responses (response rate of 46.3%). The majority (n = 64, 59.3%) were willing to have the vaccine, however, some (n = 44, 40.7%) were not. The main reason behind their willingness to have the vaccine was its ability to reduce the spread of infections and lower mortality (n = 35, 54.7%). However, doubts about the vaccine's efficacy and side effects (n = 26, 56.8%), conspiracy theory concerns about its effects on the Ghanaian race (n = 4, 9.1%), and fertility concerns (n = 2, 4.5%) were some reasons for their hesitance to receive the vaccine. The open text commentary further revealed that the vaccine was thought of as a lifesaving medication, however, clinical safety concerns, lack of education/information and religious beliefs were affecting peoples' willingness to be vaccinated. Conclusion Our findings demonstrate the need for an urgent public health educational intervention to address the COVID-19 vaccine hesitancy concerns raised by radiographers to help increase the vaccine uptake. Implication for practice The study provides pertinent information to improve COVID-19 vaccine uptake among radiographers to limit the spread of infections.
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Shaterian N, Abdi F, Atarodi Kashani Z, Shaterian N, Darvishmotevalli M. Facemask and Respirator in Reducing the Spread of Respiratory Viruses; a Systematic Review. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e56. [PMID: 34580654 PMCID: PMC8464015 DOI: 10.22037/aaem.v9i1.1286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Respiratory viruses spread fast, and some manners have been recommended for reducing the spread of these viruses, including the use of a facemask or respirator, maintaining hand hygiene, and perfoming social distancing. This systematic review aimed to assess the impact of facemasks and respirators on reducing the spread of respiratory viruses. Methods We conducted a systematic review using MeSH terms, and reported findings according to PRISMA. PubMed, Embase, Cochrane Library, Scopus, ProQuest, Web of Science(WoS), and Google Scholar were searched for articles published between 2009 and 2020. Two independent reviewers determined whether the studies met inclusion criteria. The risk of bias of studies was assessed using Newcastle-Ottawa (NOS) and Consolidated Standards of Reporting Trials (CONSORT). Results A total of 1505 articles were initially retrieved and 10 were finally included in our analysis (sample size: 3065). 96.8% of non-infected participants used facemask or respirator in contact with people infected with a respiratory virus, facemask and respirator have a significant effect on reducing the spread of respiratory viruses. Conclusion Evidence support that using a facemask or respirator can reduce the spread of all types of respiratory viruses; therefore, this result can be generalized to the present pandemic of a respiratory virus (SARS-COV-2) and it is recommended to use a facemask or respirator for reducing the spread of this respiratory virus.
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Affiliation(s)
- Negin Shaterian
- Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdi
- School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran.,Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Negar Shaterian
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Darvishmotevalli
- Research Center for Health, Safety and Environment , Alborz University of Medical Sciences, Karaj, Iran
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Li J, Qiu Y, Zhang Y, Gong X, He Y, Yue P, Zheng X, Liu L, Liao H, Zhou K, Hua Y, Li Y. Protective efficient comparisons among all kinds of respirators and masks for health-care workers against respiratory viruses: A PRISMA-compliant network meta-analysis. Medicine (Baltimore) 2021; 100:e27026. [PMID: 34449478 PMCID: PMC8389967 DOI: 10.1097/md.0000000000027026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 07/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is no definite conclusion about comparison of better effectiveness between N95 respirators and medical masks in preventing health-care workers (HCWs) from respiratory infectious diseases, so that conflicting results and recommendations regarding the protective effects may cause difficulties for selection and compliance of respiratory personal protective equipment use for HCWs, especially facing with pandemics of corona virus disease 2019. METHODS We systematically searched MEDLINE, Embase, PubMed, China National Knowledge Infrastructure, Wanfang, medRxiv, and Google Scholar from initiation to November 10, 2020 for randomized controlled trials, case-control studies, cohort studies, and cross-sectional studies that reported protective effects of masks or respirators for HCWs against respiratory infectious diseases. We gathered data and pooled differences in protective effects according to different types of masks, pathogens, occupations, concurrent measures, and clinical settings. The study protocol is registered with PROSPERO (registration number: 42020173279). RESULTS We identified 4165 articles, reviewed the full text of 66 articles selected by abstracts. Six randomized clinical trials and 26 observational studies were included finally. By 2 separate conventional meta-analyses of randomized clinical trials of common respiratory viruses and observational studies of pandemic H1N1, pooled effects show no significant difference between N95 respirators and medical masks against common respiratory viruses for laboratory-confirmed respiratory virus infection (risk ratio 0.99, 95% confidence interval [CI] 0.86-1.13, I2 = 0.0%), clinical respiratory illness (risk ratio 0.89, 95% CI 0.45-1.09, I2 = 83.7%, P = .002), influenza-like illness (risk ratio 0.75, 95% CI 0.54-1.05, I2 = 0.0%), and pandemic H1N1 for laboratory-confirmed respiratory virus infection (odds ratio 0.92, 95% CI 0.49-1.70, I2 = 0.0%, P = .967). But by network meta-analysis, N95 respirators has a significantly stronger protection for HCWs from betacoronaviruses of severe acute respiratory syndrome, middle east respiratory syndrome, and corona virus disease 2019 (odds ratio 0.43, 95% CI 0.20-0.94). CONCLUSIONS Our results provide moderate and very-low quality evidence of no significant difference between N95 respirators and medical masks for common respiratory viruses and pandemic H1N1, respectively. And we found low quality evidence that N95 respirators had a stronger protective effectiveness for HCWs against betacoronaviruses causative diseases compared to medical masks. The evidence of comparison between N95 respirators and medical masks for corona virus disease 2019 is open to question and needs further study.
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Abbas M, Goto M, Tartari E, Perencevich E, Pittet D. Revisiting the evidence for physical distancing, face masks, and eye protection. Lancet 2021; 398:661-663. [PMID: 34419200 PMCID: PMC8376238 DOI: 10.1016/s0140-6736(21)01739-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/22/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals, Geneva, CH-1211, Switzerland; Healthcare Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Michihiko Goto
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA; Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Ermira Tartari
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Eli Perencevich
- Infection Control Programme, Geneva University Hospitals, Geneva, CH-1211, Switzerland; Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, USA; Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Didier Pittet
- Infection Control Programme, Geneva University Hospitals, Geneva, CH-1211, Switzerland.
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Alnuqaydan AM, Almutary AG, Sukamaran A, Yang BTW, Lee XT, Lim WX, Ng YM, Ibrahim R, Darmarajan T, Nanjappan S, Chellian J, Candasamy M, Madheswaran T, Sharma A, Dureja H, Prasher P, Verma N, Kumar D, Palaniveloo K, Bisht D, Gupta G, Madan JR, Singh SK, Jha NK, Dua K, Chellappan DK. Middle East Respiratory Syndrome (MERS) Virus-Pathophysiological Axis and the Current Treatment Strategies. AAPS PharmSciTech 2021; 22:173. [PMID: 34105037 PMCID: PMC8186825 DOI: 10.1208/s12249-021-02062-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
Middle East respiratory syndrome (MERS) is a lethal respiratory disease with its first case reported back in 2012 (Jeddah, Saudi Arabia). It is a novel, single-stranded, positive-sense RNA beta coronavirus (MERS-CoV) that was isolated from a patient who died from a severe respiratory illness. Later, it was found that this patient was infected with MERS. MERS is endemic to countries in the Middle East regions, such as Saudi Arabia, Jordan, Qatar, Oman, Kuwait and the United Arab Emirates. It has been reported that the MERS virus originated from bats and dromedary camels, the natural hosts of MERS-CoV. The transmission of the virus to humans has been thought to be either direct or indirect. Few camel-to-human transmissions were reported earlier. However, the mode of transmission of how the virus affects humans remains unanswered. Moreover, outbreaks in either family-based or hospital-based settings were observed with high mortality rates, especially in individuals who did not receive proper management or those with underlying comorbidities, such as diabetes and renal failure. Since then, there have been numerous reports hypothesising complications in fatal cases of MERS. Over the years, various diagnostic methods, treatment strategies and preventive measures have been strategised in containing the MERS infection. Evidence from multiple sources implicated that no treatment options and vaccines have been developed in specific, for the direct management of MERS-CoV infection. Nevertheless, there are supportive measures outlined in response to symptom-related management. Health authorities should stress more on infection and prevention control measures, to ensure that MERS remains as a low-level threat to public health.
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Affiliation(s)
- Abdullah M Alnuqaydan
- Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Abdulmajeed G Almutary
- Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Arulmalar Sukamaran
- School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Brian Tay Wei Yang
- School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Xiao Ting Lee
- School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Wei Xuan Lim
- School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Yee Min Ng
- School of Pharmacy, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Rania Ibrahim
- School of Health Sciences, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Thiviya Darmarajan
- School of Health Sciences, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Satheeshkumar Nanjappan
- Department of Natural Products, National Institute of Pharmaceutical Education & Research (NIPER-Kolkata), Chunilal Bhawan, Maniktala, Kolkata, West Bengal, 700054, India
| | - Jestin Chellian
- Department of Life Sciences, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Mayuren Candasamy
- Department of Life Sciences, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Thiagarajan Madheswaran
- Department of Pharmaceutical Technology, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Ankur Sharma
- Department of Life Science, School of Basic Science and Research, Sharda University, Knowledge Park, Uttar Pradesh, 201310, India
| | - Harish Dureja
- Faculty of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, India
| | - Parteek Prasher
- Department of Chemistry, University of Petroleum & Energy Studies, Energy Acres, Dehradun, 248007, India
| | - Nitin Verma
- Chitkara University School of Pharmacy, Chitkara University, Atal Shiksha Kunj, Atal Nagar, Himachal Pradesh, 174103, India
| | - Deepak Kumar
- School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India
| | - Kishneth Palaniveloo
- Institute of Ocean and Earth Sciences, Institute for Advanced Studies Building, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Dheeraj Bisht
- Department of Pharmaceutical Sciences Bhimtal, Kumaun University Nainital, Uttarakhand, 263136, India
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Jaipur, India
| | - Jyotsana R Madan
- Department of Pharmaceutics, Smt. Kashibai Navale College of Pharmacy, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T Road, Phagwara, Punjab, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET), Sharda University, Greater Noida, Uttar Pradesh, 201310, India
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
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Garcia GPA, Fracarolli IFL, Santos HECD, Souza VRDS, Cenzi CM, Marziale MHP. Use of personal protective equipment to care for patients with COVID-19: scoping review. ACTA ACUST UNITED AC 2021; 42:e20200150. [PMID: 34037178 DOI: 10.1590/1983-1447.2021.20200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To summarize the knowledge about recommendations for the use of personal protective equipment necessary for the provision of care by health professionals to patients suspected or infected by the new coronavirus. METHOD Scoping review with search for primary studies, reviews and preprints articles in English, Portuguese and Spanish, in the last 20 years on the bases WOS/ISI, SCOPUS, MEDLINE/PuBMed, CINAHL, LILACS and SciELO. Unpublished studies in journals were surveyed on bioRxiv and SciELO preprints. RESULTS 23 studies were eligible. Experiences with coronavirus prior to SARS-CoV-2 revealed that the equipment was an essential barrier in preventing transmission and followed the recommendations for standard precautions, contact, droplet and aerosol. In 13 (57%) studies, this equipment complied international recommendations and in 10 (45%) local recommendations. CONCLUSION The personal protective equipment used does not follow global standardization according to type, quality and adequate provision, exposing these professionals to the risk of contamination.
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Affiliation(s)
- Gracielle Pereira Aires Garcia
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | - Isabela Fernanda Larios Fracarolli
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | - Heloisa Ehmke Cardoso Dos Santos
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
| | | | - Camila Maria Cenzi
- Universidade Federal de Mato Grosso (UFMT), Faculdade de Enfermagem. Cuiabá, Mato Grosso, Brasil
| | - Maria Helena Palucci Marziale
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós-graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil
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14
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Bella A, Akbar MT, Kusnadi G, Herlinda O, Regita PA, Kusuma D. Socioeconomic and Behavioral Correlates of COVID-19 Infections among Hospital Workers in the Greater Jakarta Area, Indonesia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5048. [PMID: 34064580 PMCID: PMC8151868 DOI: 10.3390/ijerph18105048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/23/2022]
Abstract
(1) Background: because of close contacts with COVID-19 patients, hospital workers are among the highest risk groups for infection. This study examined the socioeconomic and behavioral correlates of COVID-19 infection among hospital workers in Indonesia, the country hardest-hit by the disease in the Southeast Asia region. (2) Methods: we conducted a cross-sectional study, which collected data from 1397 hospital staff from eight hospitals in the Greater Jakarta area during April-July 2020. The data was collected using an online self-administered questionnaire and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) tests. We employed descriptive statistics and adjusted and unadjusted logistic regressions to analyze the data of hospital workers as well as the subgroups of healthcare and non-healthcare workers. (3) Results: from a total of 1397 hospital staff in the study, 22 (1.6%) were infected. In terms of correlates, being a healthcare worker (adjusted odds ratio (AOR) = 8.31, 95% CI 1.27-54.54) and having a household size of more than five (AOR = 4.09, 1.02-16.43) were significantly associated with a higher risk of infection. On the other hand, those with middle- and upper-expenditure levels were shown to have a lower risk of infection (AOR = 0.06, 0.01-0.66). Behavioral factors associated with COVID-19 infection among healthcare and non-healthcare workers included knowledge of standard personal protective equipment (PPE) (AOR = 0.08, 0.01-0.54) and application of the six-step handwashing technique (AOR = 0.32, 0.12-0.83). (4) Conclusion: among hospital staff, correlates of COVID-19 infection included being a healthcare worker, household size, expenditure level, knowledge and use of PPE, and application of appropriate hand washing techniques.
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Affiliation(s)
- Adrianna Bella
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Mochamad Thoriq Akbar
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Gita Kusnadi
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Olivia Herlinda
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Putri Aprilia Regita
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London SW7 2AZ, UK
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15
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Pan YQ, Guo F, Bahoussi AN, Shi RZ, Li YQ, Xing L. Genetic drift of MERS-CoV in Saudi Arabia during 2012-2019. Zoonoses Public Health 2021; 68:527-532. [PMID: 33966359 DOI: 10.1111/zph.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/09/2021] [Indexed: 11/26/2022]
Abstract
Middle East respiratory syndrome (MERS) is caused by MERS-CoV that infects both human and camel. Camel is supposed to be the natural reservoir for human infection while the sources for most of the primary human infection cases are still not known. We identified two conserved pyrimidine nucleotides that flank UAAU element in MERS-CoV 5'-UTR. These conserved pyrimidine nucleotides distinguish MERS-CoVs into 3 types, that is, UUAAUU, CUAAUU and CUAAUC (referred to as U----U, C----U, and C----C types, respectively). Human MERS-CoV displays a genetic drift from U----U, C----U, to C----C from 2012 to 2019. Camel virus displays a genetic drift from U----U to C----U with a time lag when compared with human virus. The discrepancy in genetic drift seems not to support the notion that camel serves as the only natural reservoir for human infection.
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Affiliation(s)
- Yuan-Qing Pan
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, China
| | - Fan Guo
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, China
| | | | - Rui-Zhu Shi
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, China
| | - Ya-Qian Li
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, China
| | - Li Xing
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, China.,Key laboratory of Medical Molecular Cell Biology of Shanxi Province, Shanxi University, Taiyuan, China.,Shanxi Provincial Key Laboratory for Prevention and Treatment of Major Infectious Diseases, Taiyuan, China
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16
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Bin Nafisah SA, Mzahim BY, Aleid BS, Sheerah SA, Almatrafi DQ, Ciottone GR, AlAnazi KH, Khan AA. The risk of coronavirus to healthcare providers during aerosol-generating procedures: A systematic review and meta-analysis. Ann Thorac Med 2021; 16:165-171. [PMID: 34012483 PMCID: PMC8109685 DOI: 10.4103/atm.atm_497_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022] Open
Abstract
CONTEXT: Several medical procedures are thought to increase the risk of transmission of infectious agents to health-care providers (HCPs) through an aerosol-generating mechanism. AIMS: Given the significant influenza and coronavirus pandemics that have occurred in the 20th and 21st century, including the current severe acute respiratory syndrome coronavirus 2 global pandemic, the objective of this analysis is to assess the occurrence of disease transmission to HCPs from the performance aerosol-generating procedures (AGPs). SETTINGS AND DESIGN: This was a systematic review and meta-analysis SUBJECTS AND METHODS: We performed a systematic meta-analysis looking at the odds ratio (OR) of AGP, causing infection among HCPs. We searched the following databases: MEDLINE (PubMed), ProQuest, Cochrane databases, and the Gray literature (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform). In addition, we conducted nondatabase search activities. The search terms used were “MERS-CoV,” “COVID,” and “SARS” combined with “provider” or “healthcare provider.” STATISTICAL ANALYSIS USED: RevMan meta-analysis was used for statistical analysis. RESULTS: Following the search, we reviewed 880 studies, of which six studies were eligible. The estimated odd ratio utilizing a control group of HCPs who were exposed to AGP but did not develop the infection was 1.85 (95% confidence interval [CI]: 1.33, 2.57). The OR remained the same when we added another control group who, despite not being exposed to AGP, had developed the infection. The OR remained 1.85 (95% CI: 1.33, 2.55). However, there is an increase in the OR to 1.89 (95% CI: 1.38, 2.59) when we added HCPs who did not use adequate personal protective equipment (PPE) during the procedures to the total estimates. CONCLUSIONS: The performance of AGP with inadequate PPE can result in an increased risk of disease transmission to HCWs.
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Affiliation(s)
| | - Bandr Y Mzahim
- Department of Emergency, research center of King Fahd Medical City, Riyadh, Saudi Arabia
| | - Bakhitah S Aleid
- Department of Emergency, research center of King Fahd Medical City, Riyadh, Saudi Arabia
| | - Shahad A Sheerah
- Department of Emergency, research center of King Fahd Medical City, Riyadh, Saudi Arabia
| | - Daliah Q Almatrafi
- Department of Emergency, research center of King Fahd Medical City, Riyadh, Saudi Arabia
| | - Gregory R Ciottone
- Infection Control of the Ministry of Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Khalid H AlAnazi
- Infection Prevention and Control, Ministry of health (MOH), Saudi Arabia
| | - Anas A Khan
- Department of Emergency, Global Center for Mass Gatherings Medicine, Ministry of Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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17
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Zhang X, Ji Z, Yue Y, Liu H, Wang J. Infection Risk Assessment of COVID-19 through Aerosol Transmission: a Case Study of South China Seafood Market. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:4123-4133. [PMID: 32543176 PMCID: PMC7323058 DOI: 10.1021/acs.est.0c02895] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 05/18/2023]
Abstract
The Corona Virus Disease 2019 (COVID-19) is rapidly spreading throughout the world. Aerosol is a potential transmission route. We conducted the quantitative microbial risk assessment (QMRA) to evaluate the aerosol transmission risk by using the South China Seafood Market as an example. The key processes were integrated, including viral shedding, dispersion, deposition in air, biologic decay, lung deposition, and the infection risk based on the dose-response model. The available hospital bed for COVID-19 treatment per capita (1.17 × 10-3) in Wuhan was adopted as a reference for manageable risk. The median risk of a customer to acquire SARS-CoV-2 infection via the aerosol route after 1 h of exposure in the market with one infected shopkeeper was about 2.23 × 10-5 (95% confidence interval: 1.90 × 10-6 to 2.34 × 10-4). The upper bound could increase and become close to the manageable risk with multiple infected shopkeepers. More detailed risk assessment should be conducted in poorly ventilated markets with multiple infected cases. The uncertainties were mainly due to the limited information on the dose-response relation and the viral shedding which need further studies. The risk rapidly decreased outside the market due to the dilution by ambient air and became below 10-6 at 5 m away from the exit.
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Affiliation(s)
- Xiaole Zhang
- Institute of Environmental Engineering
(IfU), ETH Zürich, Zürich,
CH-8093, Switzerland
- Laboratory for Advanced Analytical
Technologies, Empa, Dübendorf,
CH-8600, Switzerland
| | - Zheng Ji
- Institute of Environmental Engineering
(IfU), ETH Zürich, Zürich,
CH-8093, Switzerland
- School of Geography and Tourism,
Shaanxi Normal University,
Xi’an, Shaanxi 710119, China
- International Joint
Research Centre of Shaanxi Province for Pollutant Exposure and
Eco-Environmental Health, Xi’an, Shaanxi
710119, China
| | - Yang Yue
- Institute of Environmental Engineering
(IfU), ETH Zürich, Zürich,
CH-8093, Switzerland
- Laboratory for Advanced Analytical
Technologies, Empa, Dübendorf,
CH-8600, Switzerland
| | - Huan Liu
- Institute of Environmental Engineering
(IfU), ETH Zürich, Zürich,
CH-8093, Switzerland
- Department of Environmental
Engineering, Zhejiang University, Hangzhou,
310058, China
| | - Jing Wang
- Institute of Environmental Engineering
(IfU), ETH Zürich, Zürich,
CH-8093, Switzerland
- Laboratory for Advanced Analytical
Technologies, Empa, Dübendorf,
CH-8600, Switzerland
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18
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Fung M, Otani I, Pham M, Babik J. Zoonotic coronavirus epidemics: Severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019. Ann Allergy Asthma Immunol 2021; 126:321-337. [PMID: 33310180 PMCID: PMC7834857 DOI: 10.1016/j.anai.2020.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review the virology, immunology, epidemiology, clinical manifestations, and treatment of the following 3 major zoonotic coronavirus epidemics: severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19). DATA SOURCES Published literature obtained through PubMed database searches and reports from national and international public health agencies. STUDY SELECTIONS Studies relevant to the basic science, epidemiology, clinical characteristics, and treatment of SARS, MERS, and COVID-19, with a focus on patients with asthma, allergy, and primary immunodeficiency. RESULTS Although SARS and MERS each caused less than a thousand deaths, COVID-19 has caused a worldwide pandemic with nearly 1 million deaths. Diagnosing COVID-19 relies on nucleic acid amplification tests, and infection has broad clinical manifestations that can affect almost every organ system. Asthma and atopy do not seem to predispose patients to COVID-19 infection, but their effects on COVID-19 clinical outcomes remain mixed and inconclusive. It is recommended that effective therapies, including inhaled corticosteroids and biologic therapy, be continued to maintain disease control. There are no reports of COVID-19 among patients with primary innate and T-cell deficiencies. The presentation of COVID-19 among patients with primary antibody deficiencies is variable, with some experiencing mild clinical courses, whereas others experiencing a fatal disease. The landscape of treatment for COVID-19 is rapidly evolving, with both antivirals and immunomodulators demonstrating efficacy. CONCLUSION Further data are needed to better understand the role of asthma, allergy, and primary immunodeficiency on COVID-19 infection and outcomes.
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Affiliation(s)
- Monica Fung
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California.
| | - Iris Otani
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Michele Pham
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer Babik
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California
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19
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Ness MM, Saylor J, Di Fusco LA, Evans K. Healthcare providers' challenges during the coronavirus disease (COVID-19) pandemic: A qualitative approach. Nurs Health Sci 2021; 23:389-397. [PMID: 33580590 PMCID: PMC8012981 DOI: 10.1111/nhs.12820] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/08/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
The uncertain trajectory of COVID-19 has led to significant psychosocial impacts on nurses and other healthcare providers. Given the critical role of these providers in pandemic response, this study sought to gain a better understanding of the challenges faced by healthcare providers caring for adult patients during the COVID-19 pandemic. A descriptive, qualitative study was conducted via semi-structured interviews. A purposeful sample of healthcare providers (n = 23) caring for patients during the COVID-19 pandemic was recruited to participate in interviews via snowball sampling and an information systems-supported recruiting process (e-recruiting). Thematic analysis revealed four themes: (1) Managing isolation, fear, and increased anxiety; (2) adapting to changes in healthcare practice and policy; (3) addressing emotional and physical needs of patients and their families; and (4) navigating evolving workplace safety. New evidence was introduced about nurses practicing outside their usual role. Nurses and other healthcare providers consistently reported increased anxiety during the pandemic. Hospital administrations can proactively support healthcare providers during this and future pandemics by ensuring access to mental health programs, standardizing communication, and developing plans that address equipment and supply availability.
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Affiliation(s)
- Michelle M Ness
- Department of Nursing, Towson University, Towson, Maryland, USA
| | - Jennifer Saylor
- School of Nursing, University of Delaware, Newark, Delaware, USA
| | | | - Kristen Evans
- Conway School of Nursing, The Catholic University of America, Washington, District of Columbia, USA
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20
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Risk factors and protective measures for healthcare worker infection during highly infectious viral respiratory epidemics: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2021; 43:639-650. [PMID: 33487203 PMCID: PMC8564050 DOI: 10.1017/ice.2021.18] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate risk factors for HCW infection in viral respiratory pandemics (SARS-CoV-2, MERS, SARS CoV-1, influenza A H1N1, influenza H5N1) and improve understanding of HCW risk management amidst the COVID-19 pandemic. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases were searched from conception until July 2020 for studies comparing infected HCWs (cases) and non-infected HCWs (controls) and risk factors for infection. Outcomes included HCW types, infection prevention practices, and medical procedures. Pooled effect estimates with pathogen-specific stratified meta-analysis and inverse variance meta-regression analysis were completed. GRADE framework was used to rate certainty of evidence. PROSPERO (CRD42020176232) 6 April 2020. RESULTS Fifty-four comparative studies were included (n=191,004 HCWs). Compared to non-frontline HCWs, frontline HCWs were at increased infection risk (OR 1.66 95%CI 1.24 to 2.22) and greater for HCWs involved in endotracheal intubations (risk difference [95%CI]: 35.2% [21.4 to 47.9]). Use of gloves, gown, surgical mask, N95 respirator, face protection, and infection training were each strongly protective against infection. Meta-regression showed reduced infection risk in frontline HCWs working in facilities with infection designated wards (OR -1.04, 95%CI -1.53 to -0.33, p=0.004) and performing aerosol-generating medical procedures in designated centres (OR -1.30 95%CI -2.52 to -0.08; p=0.037). CONCLUSIONS During highly infectious respiratory pandemics, widely available protective measures such as use of gloves, gowns, and face masks are strongly protective against infection and should be instituted, preferably in dedicated settings, to protect frontline HCW during waves of respiratory virus pandemics.
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Alsharif KF, Alzahrani AB, Alharbi AO, Algregri TO, Almuafa BH, Alsulami MO, Alzahrani KJ, Almuqati MS, Abdel-Moneim AS. The prevalence of MERS-CoV among military personnel and their families: A single-center study. J Med Virol 2021; 93:2815-2819. [PMID: 33128396 DOI: 10.1002/jmv.26642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/09/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a Betacoronavirus that results in a severe fatal respiratory disease; however, it is also associated with mild inapparent infections. The western part of the Kingdom of Saudi Arabia (KSA) contains the holy places where millions of Muslims gathered from all over the world, all year round, with a high probability of mass disease transmission. The aim of this study was to estimate the prevalence of MERS-CoV among military personnel and their families during the period 2014-2019, in the western part of the KSA. A total of 35,203 sputum samples collected from patients with respiratory distress were screened for the presence of MERS-CoV using real-time reverse-transcription polymerase chain reaction in the examined patients. MERS-CoV infections were detected at a very low percentage in the examined patients. Only 42 of the examined subjects (0.12%) were found positive for MERS-CoV. Most infected cases (32/42) cases were detected in 2014, and the rest of the cases were reported in 2015-2019. The cases with fatal consequences (n = 20) were only detected in 2014. It was concluded that there is a very low prevalence of MERS-CoV infections among the military personnel and their families.
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Affiliation(s)
- Khalaf F Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Al-Taif, Saudi Arabia
| | | | | | | | | | | | - Khalid J Alzahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Al-Taif, Saudi Arabia
| | | | - Ahmed S Abdel-Moneim
- Department of Microbiology, College of Medicine, Taif University, Al-Taif, Saudi Arabia
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Aljondi R, Alghamdi SS, Abdelaziz I, Bushara L, Alghamdi S, Aljehani A, Zailae A, Alghamdi JS, Feteih I, Mahmoud MZ, Tajaldeen A. Knowledge of COVID-19 infection control among healthcare workers in radiology departments in Saudi Arabia. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2020. [PMCID: PMC8760371 DOI: 10.1080/16878507.2020.1856587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiological examinations have played a crucial role in the identification and management of COVID-19 patients. Therefore, knowledge and awareness of infection control among healthcare workers in radiology departments are important to prevent disease transmission. This study aimed to assess the knowledge and practice of infection control for COVID-19 among healthcare workers in radiology departments in Saudi Arabia. A cross-sectional, online questionnaire was administered among healthcare workers in radiology departments in Saudi Arabia in May 2020. The questionnaire consisted of demographic characteristics, profession, knowledge of infection control for COVID-19, and good practice of infection control measures for COVID-19 in radiology departments. A descriptive statistical analysis and chi-square test were performed using SPSS software. A total of 234 (91%) of healthcare workers replied that they have good knowledge about the precautions needed during the examination of positive COVID-19 cases in radiology departments, and 216 (84%) replied that they knew the necessary precautions when using portable X-ray machine. Moreover, 191 (>74%) of those surveyed agreed that wearing personal protective equipment and following the CDC sequence. There was significant association between profession and good clinical practices in radiology departments regarding COVID-19. Such knowledge could limit the spread of COVID-19 among the healthcare workers in radiology departments.
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Affiliation(s)
- Rowa Aljondi
- Department of Applied Radiologic Technology, Collage of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Salem Saeed Alghamdi
- Department of Applied Radiologic Technology, Collage of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Ikhlas Abdelaziz
- Department of Applied Radiologic Technology, Collage of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Lubna Bushara
- Department of Applied Radiologic Technology, Collage of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Somayah Alghamdi
- Radiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Ali Zailae
- Radiology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Jamaan S. Alghamdi
- Diagnostic Radiology Technology Department, College of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Iyad Feteih
- Collage of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mustafa Z. Mahmoud
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdulrahman Tajaldeen
- Radiological Science Department, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Alserehi HA, Alqunaibet AM, Al-Tawfiq JA, Alharbi NK, Alshukairi AN, Alanazi KH, Bin Saleh GM, Alshehri AM, Almasoud A, Hashem AM, Alruwaily AR, Alaswad RH, Al-Mutlaq HM, Almudaiheem AA, Othman FM, Aldakeel SA, Abu Ghararah MR, Jokhdar HA, Algwizani AR, Almudarra SS, Albarrag AM. Seroprevalence of SARS-CoV-2 (COVID-19) among healthcare workers in Saudi Arabia: comparing case and control hospitals. Diagn Microbiol Infect Dis 2020; 99:115273. [PMID: 33296851 PMCID: PMC7677039 DOI: 10.1016/j.diagmicrobio.2020.115273] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 01/27/2023]
Abstract
Healthcare workers (HCWs) stand at the frontline for fighting coronavirus disease 2019 (COVID-19) pandemic. This puts them at higher risk of acquiring the infection than other individuals in the community. Defining immunity status among health care workers is therefore of interest since it helps to mitigate the exposure risk. This study was conducted between May 20th and 30th, 2020. Eighty-five hospitals across Kingdom of Saudi Arabia were divided into 2 groups: COVID-19 referral hospitals are those to which RT-PCR-confirmed COVID-19 patients were admitted or referred for management (Case-hospitals). COVID-19 nonaffected hospitals where no COVID-19 patients had been admitted or managed and no HCW outbreak (Control hospitals). Next, seroprevalence of severe acute respiratory syndrome coronavirus 2 among HCWs was evaluated; there were 12,621 HCWs from the 85 hospitals. There were 61 case-hospitals with 9379 (74.3%) observations, and 24 control-hospitals with 3242 (25.7%) observations. The overall positivity rate by the immunoassay was 299 (2.36%) with a significant difference between the case-hospital (2.9%) and the control-group (0.8%) (P value <0.001). There was a wide variation in the positivity rate between regions and/or cities in Saudi Arabia, ranging from 0% to 6.31%. Of the serology positive samples, 100 samples were further tested using the SAS2pp neutralization assay; 92 (92%) samples showed neutralization activity. The seropositivity rate in Kingdom of Saudi Arabia is low and varies across different regions with higher positivity in case-hospitals than control-hospitals. The lack of neutralizing antibodies (NAb) in 8% of the tested samples could mean that assay is a more sensitive assay or that neutralization assay has a lower detection limits; or possibly that some samples had cross-reaction to spike protein of other coronaviruses in the assay, but these were not specific to neutralize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Affiliation(s)
- Haleema Ali Alserehi
- Executive Department of Global Health, Epidemiology, surveillance and preparedness affairs, Executive Department of Research, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia.
| | - Ada Mohammed Alqunaibet
- Executive Department of Global Health, Epidemiology, surveillance and preparedness affairs, Executive Department of Research, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, and Quality and Patient Safety Departement, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Naif Khalaf Alharbi
- Vaccine Development Unit, Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abeer Nizar Alshukairi
- Department of medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | | | - Amer Mohammed Alshehri
- Public Health Lab, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Abdulrahman Almasoud
- Vaccine Development Unit, Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Anwar M Hashem
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amaal Rabie Alruwaily
- Executive Department of Global Health, Epidemiology, surveillance and preparedness affairs, Executive Department of Research, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Rehab Habeeb Alaswad
- Executive Department of Global Health, Epidemiology, surveillance and preparedness affairs, Executive Department of Research, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Hind Mohammed Al-Mutlaq
- Executive Department of Global Health, Epidemiology, surveillance and preparedness affairs, Executive Department of Research, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Abdulllah Ali Almudaiheem
- Executive Department of Global Health, Epidemiology, surveillance and preparedness affairs, Executive Department of Research, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Fatmah Mahmoud Othman
- Research department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | | | | | - Sami Saeed Almudarra
- Executive Department of Global Health, Epidemiology, surveillance and preparedness affairs, Executive Department of Research, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Ahmed Mohammed Albarrag
- Public Health Lab, Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia; Department of Pathology, School of Medicine, King Saud University, Riyadh, Saudi Arabia
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24
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Kwee TC, Kwee RM. Chest CT in COVID-19: What the Radiologist Needs to Know. Radiographics 2020; 40:1848-1865. [PMID: 33095680 PMCID: PMC7587296 DOI: 10.1148/rg.2020200159] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022]
Abstract
Chest CT has a potential role in the diagnosis, detection of complications, and prognostication of coronavirus disease 2019 (COVID-19). Implementation of appropriate precautionary safety measures, chest CT protocol optimization, and a standardized reporting system based on the pulmonary findings in this disease will enhance the clinical utility of chest CT. However, chest CT examinations may lead to both false-negative and false-positive results. Furthermore, the added value of chest CT in diagnostic decision making is dependent on several dynamic variables, most notably available resources (real-time reverse transcription-polymerase chain reaction [RT-PCR] tests, personal protective equipment, CT scanners, hospital and radiology personnel availability, and isolation room capacity) and the prevalence of both COVID-19 and other diseases with overlapping manifestations at chest CT. Chest CT is valuable to detect both alternative diagnoses and complications of COVID-19 (acute respiratory distress syndrome, pulmonary embolism, and heart failure), while its role for prognostication requires further investigation. The authors describe imaging and managing care of patients with COVID-19, with topics including (a) chest CT protocol, (b) chest CT findings of COVID-19 and its complications, (c) the diagnostic accuracy of chest CT and its role in diagnostic decision making and prognostication, and (d) reporting and communicating chest CT findings. The authors also review other specific topics, including the pathophysiology and clinical manifestations of COVID-19, the World Health Organization case definition, the value of performing RT-PCR tests, and the radiology department and personnel impact related to performing chest CT in COVID-19. ©RSNA, 2020.
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Affiliation(s)
- Thomas C. Kwee
- From the Department of Radiology, Nuclear Medicine and Molecular
Imaging, University Medical Center Groningen, University of Groningen,
Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands (T.C.K.); and
Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard-Geleen, the
Netherlands (R.M.K.)
| | - Robert M. Kwee
- From the Department of Radiology, Nuclear Medicine and Molecular
Imaging, University Medical Center Groningen, University of Groningen,
Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, the Netherlands (T.C.K.); and
Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard-Geleen, the
Netherlands (R.M.K.)
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25
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Qaseem A, Etxeandia-Ikobaltzeta I, Yost J, Miller MC, Abraham GM, Obley AJ, Forciea MA, Jokela JA, Humphrey LL, Centor RM, Andrews R, Bledsoe TA, Haeme R, Kansagara DL, Marcucci M. Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1). Ann Intern Med 2020; 173:642-649. [PMID: 32551813 PMCID: PMC7357230 DOI: 10.7326/m20-3234] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. In this article, the American College of Physicians (ACP) provides recommendations based on the best available evidence through 14 April 2020 on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection. The ACP plans periodic updates of these recommendations on the basis of ongoing surveillance of the literature for 1 year from the initial search date.
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.)
| | | | - Jennifer Yost
- American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.)
| | | | - George M Abraham
- University of Massachusetts Medical School and Saint Vincent Hospital, Worcester, Massachusetts (G.M.A.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
| | | | - Janet A Jokela
- University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.)
| | - Linda L Humphrey
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.)
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26
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Chou R, Dana T, Jungbauer R, Weeks C, McDonagh MS. Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings : A Living Rapid Review. Ann Intern Med 2020; 173:542-555. [PMID: 32579379 PMCID: PMC7322812 DOI: 10.7326/m20-3213] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recommendations on masks for preventing coronavirus disease 2019 (COVID-19) vary. PURPOSE To examine the effectiveness of N95, surgical, and cloth masks in community and health care settings for preventing respiratory virus infections, and effects of reuse or extended use of N95 masks. DATA SOURCES Multiple electronic databases, including the World Health Organization COVID-19 database and medRxiv preprint server (2003 through 14 April 2020; surveillance through 2 June 2020), and reference lists. STUDY SELECTION Randomized trials of masks and risk for respiratory virus infection, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and observational studies of mask use and coronavirus infection risk were included. New evidence will be incorporated by using living review methods. DATA EXTRACTION One reviewer abstracted data and assessed methodological limitations; a second reviewer provided verification. DATA SYNTHESIS 39 studies (18 randomized controlled trials and 21 observational studies; 33 867 participants) were included. No study evaluated reuse or extended use of N95 masks. Evidence on SARS-CoV-2 was limited to 2 observational studies with serious limitations. Community mask use was possibly associated with decreased risk for SARS-CoV-1 infection in observational studies. In high- or moderate-risk health care settings, observational studies found that risk for infection with SARS-CoV-1 and Middle East respiratory syndrome coronavirus probably decreased with mask use versus nonuse and possibly decreased with N95 versus surgical mask use. Randomized trials in community settings found possibly no difference between N95 versus surgical masks and probably no difference between surgical versus no mask in risk for influenza or influenza-like illness, but compliance was low. In health care settings, N95 and surgical masks were probably associated with similar risks for influenza-like illness and laboratory-confirmed viral infection; clinical respiratory illness had inconsistency. Bothersome symptoms were common. LIMITATIONS There were few SARS-CoV-2 studies, observational studies have methodological limitations, and the review was done by using streamlined methods. CONCLUSION Evidence on mask effectiveness for respiratory infection prevention is stronger in health care than community settings. N95 respirators might reduce SARS-CoV-1 risk versus surgical masks in health care settings, but applicability to SARS-CoV-2 is uncertain. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., R.J., C.W., M.S.M.)
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., R.J., C.W., M.S.M.)
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., R.J., C.W., M.S.M.)
| | - Chandler Weeks
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., R.J., C.W., M.S.M.)
| | - Marian S McDonagh
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., R.J., C.W., M.S.M.)
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27
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Barnett BP, Wahlin K, Krawczyk M, Spencer D, Welsbie D, Afshari N, Chao D. Potential of Ocular Transmission of SARS-CoV-2: A Review. Vision (Basel) 2020; 4:vision4030040. [PMID: 32883010 PMCID: PMC7559808 DOI: 10.3390/vision4030040] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE OF REVIEW to provide a prospective on the current mechanisms by which SARS-CoV-2 enters cells and replicates, and its implications for ocular transmission. The literature was analyzed to understand ocular transmission as well as molecular mechanisms by which SARS-CoV-2 enters cells and replicates. Analysis of gene expression profiles from available datasets, published immunohistochemistry, as well as current literature was reviewed, to assess the likelihood that ocular inoculation of SARS-CoV-2 results in systemic infection. RECENT FINDINGS The ocular surface and retina have the necessary proteins, Transmembrane Serine Protease 2 (TMPRSS2), CD147, Angiotensin-Converting Enzyme 2 (ACE2) and Cathepsin L (CTSL) necessary to be infected with SARS-CoV-2. In addition to direct ocular infection, virus carried by tears through the nasolacrimal duct to nasal epithelium represent a means of ocular inoculation. SUMMARY There is evidence that SARS-CoV-2 may either directly infect cells on the ocular surface, or virus can be carried by tears through the nasolacrimal duct to infect the nasal or gastrointestinal epithelium.
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Affiliation(s)
- Brad P. Barnett
- NVISION Eye Centers—South Sacramento, 7501 Hospital Dr. Suite 105, Sacramento, CA 95823, USA
- Correspondence: ; Tel.: +91-6423-4040; Fax: +91-6689-2100
| | - Karl Wahlin
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA; (K.W.); (M.K.); (D.S.); (D.W.); (N.A.); (D.C.)
| | - Michal Krawczyk
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA; (K.W.); (M.K.); (D.S.); (D.W.); (N.A.); (D.C.)
| | - Doran Spencer
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA; (K.W.); (M.K.); (D.S.); (D.W.); (N.A.); (D.C.)
| | - Derek Welsbie
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA; (K.W.); (M.K.); (D.S.); (D.W.); (N.A.); (D.C.)
| | - Natalie Afshari
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA; (K.W.); (M.K.); (D.S.); (D.W.); (N.A.); (D.C.)
| | - Daniel Chao
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA; (K.W.); (M.K.); (D.S.); (D.W.); (N.A.); (D.C.)
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28
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Schünemann HJ, Khabsa J, Solo K, Khamis AM, Brignardello-Petersen R, El-Harakeh A, Darzi A, Hajizadeh A, Bognanni A, Bak A, Izcovich A, Cuello-Garcia CA, Chen C, Borowiack E, Chamseddine F, Schünemann F, Morgano GP, Muti-Schünemann GEU, Chen G, Zhao H, Neumann I, Brozek J, Schmidt J, Hneiny L, Harrison L, Reinap M, Junek M, Santesso N, El-Khoury R, Thomas R, Nieuwlaat R, Stalteri R, Yaacoub S, Lotfi T, Baldeh T, Piggott T, Zhang Y, Saad Z, Rochwerg B, Perri D, Fan E, Stehling F, Akl IB, Loeb M, Garner P, Aston S, Alhazzani W, Szczeklik W, Chu DK, Akl EA. Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19: A Living Systematic Review of Multiple Streams of Evidence. Ann Intern Med 2020; 173:204-216. [PMID: 32442035 PMCID: PMC7281716 DOI: 10.7326/m20-2306] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19). PURPOSE To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19. DATA SOURCES 21 standard, World Health Organization-specific and COVID-19-specific databases, without language restrictions, until 1 May 2020. STUDY SELECTION Studies of any design and language comparing different oxygenation approaches in patients with coronavirus infections, including severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS), or with hypoxemic respiratory failure. Animal, mechanistic, laboratory, and preclinical evidence was gathered regarding aerosol dispersion of coronavirus. Studies evaluating risk for virus transmission to health care workers from aerosol-generating procedures (AGPs) were included. DATA EXTRACTION Independent and duplicate screening, data abstraction, and risk-of-bias assessment (GRADE for certainty of evidence and AMSTAR 2 for included systematic reviews). DATA SYNTHESIS 123 studies were eligible (45 on COVID-19, 70 on SARS, 8 on MERS), but only 5 studies (1 on COVID-19, 3 on SARS, 1 on MERS) adjusted for important confounders. A study in hospitalized patients with COVID-19 reported slightly higher mortality with noninvasive ventilation (NIV) than with invasive mechanical ventilation (IMV), but 2 opposing studies, 1 in patients with MERS and 1 in patients with SARS, suggest a reduction in mortality with NIV (very-low-certainty evidence). Two studies in patients with SARS report a reduction in mortality with NIV compared with no mechanical ventilation (low-certainty evidence). Two systematic reviews suggest a large reduction in mortality with NIV compared with conventional oxygen therapy. Other included studies suggest increased odds of transmission from AGPs. LIMITATION Direct studies in COVID-19 are limited and poorly reported. CONCLUSION Indirect and low-certainty evidence suggests that use of NIV, similar to IMV, probably reduces mortality but may increase the risk for transmission of COVID-19 to health care workers. PRIMARY FUNDING SOURCE World Health Organization. (PROSPERO: CRD42020178187).
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Affiliation(s)
- Holger J Schünemann
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Joanne Khabsa
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Karla Solo
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | | | - Romina Brignardello-Petersen
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Amena El-Harakeh
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Andrea Darzi
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Anisa Hajizadeh
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Antonio Bognanni
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Anna Bak
- Evidence Prime, Krakow, Poland (A.B., E.B.)
| | - Ariel Izcovich
- German Hospital of Buenos Aires, Buenos Aires, Argentina (A.I.)
| | - Carlos A Cuello-Garcia
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Chen Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China (C.C.)
| | | | - Fatimah Chamseddine
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Finn Schünemann
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Gian Paolo Morgano
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | | | - Guang Chen
- Beijing University of Chinese Medicine, Beijing, China (G.C.)
| | - Hong Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China (H.Z.)
| | - Ignacio Neumann
- McMaster University, Hamilton, Ontario, Canada, and Pontificia Universidad Católica de Chile, Santiago, Chile (I.N.)
| | - Jan Brozek
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Joel Schmidt
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Layal Hneiny
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Leila Harrison
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Marge Reinap
- London School of Hygiene and Tropical Medicine, London United Kingdom (M.R.)
| | - Mats Junek
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Nancy Santesso
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Rayane El-Khoury
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Rebecca Thomas
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom (R.T., P.G.)
| | - Robby Nieuwlaat
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Rosa Stalteri
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Sally Yaacoub
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Tamara Lotfi
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Tejan Baldeh
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Thomas Piggott
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Yuan Zhang
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Zahra Saad
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Bram Rochwerg
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Dan Perri
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Eddy Fan
- Toronto General Hospital, Toronto, Ontario, Canada (E.F.)
| | | | - Imad Bou Akl
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Paul Garner
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom (R.T., P.G.)
| | - Stephen Aston
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom (S.A.)
| | - Waleed Alhazzani
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | | | - Derek K Chu
- McMaster University, Hamilton, Ontario, Canada (H.J.S., K.S., R.B., A.D., A.H., A.B., C.A.C., F.S., G.P.M., J.B., J.S., L.H., M.J., N.S., R.N., R.S., T.L., T.B., T.P., Y.Z., B.R., D.P., M.L., W.A., D.K.C.)
| | - Elie A Akl
- American University of Beirut Medical Center, Beirut, Lebanon (J.K., A.E., F.C., L.H., R.E., S.Y., Z.S., I.B.A., E.A.A.)
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Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers: A Living Rapid Review. Ann Intern Med 2020; 173:120-136. [PMID: 32369541 PMCID: PMC7240841 DOI: 10.7326/m20-1632] [Citation(s) in RCA: 391] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Health care workers (HCWs) are at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PURPOSE To examine the burden of SARS-CoV-2, SARS-CoV-1, and Middle East respiratory syndrome (MERS)-CoV on HCWs and risk factors for infection, using rapid and living review methods. DATA SOURCES Multiple electronic databases, including the WHO database of publications on coronavirus disease and the medRxiv preprint server (2003 through 27 March 2020, with ongoing surveillance through 24 April 2020), and reference lists. STUDY SELECTION Studies published in any language reporting incidence of or outcomes associated with coronavirus infections in HCWs and studies on the association between risk factors (demographic characteristics, role, exposures, environmental and administrative factors, and personal protective equipment [PPE] use) and HCW infections. New evidence will be incorporated on an ongoing basis by using living review methods. DATA EXTRACTION One reviewer abstracted data and assessed methodological limitations; verification was done by a second reviewer. DATA SYNTHESIS 64 studies met inclusion criteria; 43 studies addressed burden of HCW infections (15 on SARS-CoV-2), and 34 studies addressed risk factors (3 on SARS-CoV-2). Health care workers accounted for a significant proportion of coronavirus infections and may experience particularly high infection incidence after unprotected exposures. Illness severity was lower than in non-HCWs. Depression, anxiety, and psychological distress were common in HCWs during the coronavirus disease 2019 outbreak. The strongest evidence on risk factors was on PPE use and decreased infection risk. The association was most consistent for masks but was also observed for gloves, gowns, eye protection, and handwashing; evidence suggested a dose-response relationship. No study evaluated PPE reuse. Certain exposures (such as involvement in intubations, direct patient contact, or contact with bodily secretions) were associated with increased infection risk. Infection control training was associated with decreased risk. LIMITATION There were few studies on risk factors for SARS-CoV-2, the studies had methodological limitations, and streamlined rapid review methods were used. CONCLUSION Health care workers experience significant burdens from coronavirus infections, including SARS-CoV-2. Use of PPE and infection control training are associated with decreased infection risk, and certain exposures are associated with increased risk. PRIMARY FUNDING SOURCE World Health Organization.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
| | - David I Buckley
- Pacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon (D.I.B., R.F.)
| | - Shelley Selph
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon (D.I.B., R.F.)
| | - Annette M Totten
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)
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30
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Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395:1973-1987. [PMID: 32497510 PMCID: PMC7263814 DOI: 10.1016/s0140-6736(20)31142-9] [Citation(s) in RCA: 2238] [Impact Index Per Article: 559.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING World Health Organization.
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Affiliation(s)
- Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Stephanie Duda
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sally Yaacoub
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada.
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31
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Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020. [PMID: 32497510 DOI: 10.1016/s0140-6736(20)31142-31149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING World Health Organization.
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Affiliation(s)
- Derek K Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Stephanie Duda
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karla Solo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sally Yaacoub
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Michael G DeGroote Cochrane Canada and GRADE Centres, Hamilton, ON, Canada.
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Khurana A, Saxena S. Immunosuppressive agents for dermatological indications in the ongoing COVID-19 pandemic: Rationalizing use and clinical applicability. Dermatol Ther 2020; 33:e13639. [PMID: 32436617 PMCID: PMC7280701 DOI: 10.1111/dth.13639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
The ongoing COVID-19 epidemic has brought to the fore many concerns related to use of immunosuppressive agents (ISAs) in dermatology. While it is unclear whether the patients on ISAs for skin conditions are more prone to develop COVID-19, and what impact the ISA may have on the clinical outcome if a patient does get infected, rationalizations based on the specific immune effects of each drug, and existing literature on incidence of various infections with each, are possible. In this review, we provide the readers with practically useful insights into these aspects, related to the conventional ISAs, and briefly mention the clinical outcome data available on related scenarios from other patient groups so far. In the end, we have attempted to provide some clinically useful points regarding practical use of each dermatologically relevant conventional ISA in the current scenario.
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Affiliation(s)
- Ananta Khurana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Snigdha Saxena
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
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Tajima Y, Suda Y, Yano K. A case report of SARS-CoV-2 confirmed in saliva specimens up to 37 days after onset: Proposal of saliva specimens for COVID-19 diagnosis and virus monitoring. J Infect Chemother 2020; 26:1086-1089. [PMID: 32571647 PMCID: PMC7293472 DOI: 10.1016/j.jiac.2020.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 02/05/2023]
Abstract
We present the case of a 71-year-old man who, despite becoming asymptomatic after having some mild symptoms of COVID-19, had SARS-CoV-2 RNA detected for 37 days after onset, from his concentrated and purified saliva specimens using sugar chain-immobilized gold nanoparticles. It was suggested that the early morning saliva specimens were more likely to show positive results than those obtained later in the day.
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Affiliation(s)
- Yasuhisa Tajima
- Department of Infectious Diseases, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu-shi, Shizuoka-ken, 432-8580, Japan.
| | - Yasuo Suda
- Department of Chemistry, Biotechnology and Chemical Engineering, Graduate School of Science and Engineering, Kagoshima University, 1-21-24 Korimoto, Kagoshima-shi, Kagoshima-ken, 890-0065, Japan
| | - Kunio Yano
- Department of Infectious Diseases, Hamamatsu Medical Center, 328 Tomitsukacho, Naka-ku, Hamamatsu-shi, Shizuoka-ken, 432-8580, Japan
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Cimolai N. Features of enteric disease from human coronaviruses: Implications for COVID-19. J Med Virol 2020; 92:1834-1844. [PMID: 32462689 PMCID: PMC7283829 DOI: 10.1002/jmv.26066] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/25/2020] [Indexed: 01/19/2023]
Abstract
Coronaviruses have long been studied in both human and veterinary fields. Whereas the initial detection of endemic human respiratory coronaviruses was problematic, detection of these and newly discovered human coronaviruses has been greatly facilitated with major advances in the laboratory. Nevertheless, technological factors can affect the accuracy and timeliness of virus detection. Many human coronaviruses can be variably found in stool samples. All human coronaviruses have been variably associated with symptoms of gastroenteritis. Coronaviruses can occasionally be cultured from enteric specimens, but most detection is accomplished with genetic amplification technologies. Excretion of viral RNA in stool can extend for a prolonged period. Culture‐positive stool samples have been found to exceed a fourteen day period after onset of infection for some coronaviruses. Virus can also sometimes be cultured from patients' respiratory samples during the late incubation period. Relatively asymptomatic patients may excrete virus. Both viable and nonviable virus can be found in the immediate environment of the patient, the health care worker, and less often the public. These lessons from the past study of animal and human coronaviruses can be extended to presumptions for severe acute respiratory syndrome coronavirus 2. Already, the early reports from the coronavirus disease‐2019 pandemic are confirming some concerns. These data have the cumulative potential to cause us to rethink some current and common public health and infection control strategies. coronaviruses are variably found in human enteric samples during the course of infection. abdominal and intestinal illnesses are associated with coronavirus infections. enteric excretion of live virus and viral RNA have been confirmed. occasionally, live virus can be found in stool samples to exceed a fourteen day period after disease onset, and virus can also be cultured from these samples during the late incubation period or from asymptomatic individuals.
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Affiliation(s)
- Nevio Cimolai
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, Children's and Women's Health Centre of British Columbia, The University of British Columbia, Vancouver, British Columbia, Canada
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35
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Harris C, Carson G, Baillie JK, Horby P, Nair H. An evidence-based framework for priority clinical research questions for COVID-19. J Glob Health 2020; 10:011001. [PMID: 32257173 PMCID: PMC7125419 DOI: 10.7189/jogh.10.011001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND On 31 December, 2019, the World Health Organization China Country Office was informed of cases of pneumonia of unknown aetiology. Since then, there have been over 75 000 cases globally of the 2019 novel coronavirus (COVID-19), 2000 deaths, and over 14 000 cases recovered. Outbreaks of novel agents represent opportunities for clinical research to inform real-time public health action. In 2018, we conducted a systematic review to identify priority research questions for Severe Acute Respiratory Syndrome-related coronavirus (SARS-CoV) and Middle East Respiratory Syndrome-related coronavirus (MERS-CoV). Here, we review information available on COVID-19 and provide an evidenced-based framework for priority clinical research in the current outbreak. METHODS Three bibliographic databases were searched to identify clinical studies published on SARS-CoV and MERS-CoV in the outbreak setting. Studies were grouped thematically according to clinical research questions addressed. In February 2020, available information on COVID19 was reviewed and compared to the results of the SARS-CoV and MERS-CoV systematic review. RESULTS From the research objectives for SARS-CoV and MERS-CoV, ten themes in the literature were identified: Clinical characterisation, prognosis, diagnosis, clinical management, viral pathogenesis, epidemiological characterisation, infection prevention and control/transmission, susceptibility, psychosocial, and aetiology. For COVID19, some information on clinical presentation, diagnostic testing, and aetiology is available but many clinical research gaps have yet to be filled. CONCLUSIONS Based on a systematic review of other severe coronaviruses, we summarise the state of clinical research for COVID-19, highlight the research gaps, and provide recommendations for the implementation of standardised protocols. Data based on internationally standardised protocols will inform clinical practice real-time.
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Affiliation(s)
- Carlyn Harris
- Emory University School of Medicine, Atlanta, Georgia, USA
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Gail Carson
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - J Kenneth Baillie
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Peter Horby
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 5:CD011621. [PMID: 32412096 PMCID: PMC8785899 DOI: 10.1002/14651858.cd011621.pub5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants) coveralls were more difficult to doff than isolation gowns (very low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). According to three studies that tested more recently introduced full-body PPE ensembles, there may be no difference in contamination. Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Cochrane Work Review Group, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Blair Rajamaki
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Bronagh Blackwood
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland
| | | | - F Selcen Kilinc Balci
- National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Pittsburgh, PA, USA
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Pruc M, Golik D, Szarpak L, Adam I, Smereka J. COVID-19 in healthcare workers. Am J Emerg Med 2020; 39:236. [PMID: 32414525 PMCID: PMC7207112 DOI: 10.1016/j.ajem.2020.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Michal Pruc
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Dawid Golik
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Lukasz Szarpak
- Faculty of Medicine, Lazarski University, Warsaw, Poland.
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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38
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Infection Control for CT Equipment and Radiographers' Personal Protection During the Coronavirus Disease (COVID-19) Outbreak in China. AJR Am J Roentgenol 2020; 215:940-944. [PMID: 32352309 DOI: 10.2214/ajr.20.23112] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE. Because CT plays an important role in diagnosis, isolation, treatment, and effective evaluation of coronavirus disease (COVID-19), infection prevention and control management of CT examination rooms is important. CONCLUSION. We describe modifications to the CT examination process, strict disinfection of examination rooms, arrangement of waiting areas, and efforts to increase radiographers' awareness of personal protection made at our institution during the COVID-19 outbreak. In addition, we discuss the potential of using artificial intelligence in imaging patients with contagious diseases.
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Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus and Severe Acute Respiratory Syndrome Coronavirus. Semin Respir Crit Care Med 2020; 41:568-578. [PMID: 32305045 PMCID: PMC7516363 DOI: 10.1055/s-0040-1709160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Emerging infectious diseases continue to be of a significant importance worldwide with the potential to cause major outbreaks and global pandemics. In 2002, the world had witnessed the appearance of the severe acute respiratory syndrome coronavirus in China which disappeared abruptly within 6 months. About a decade later, a new and emerging novel coronavirus named the Middle East respiratory syndrome coronavirus (MERS-CoV) was described in a patient from Saudi Arabia. These two coronaviruses shared multiple similarities in the epidemiology, clinical presentations, and posed challenges in its prevention and management. Seven years since its discovery, MERS-CoV continues to be a lethal zoonotic pathogen capable of causing severe pneumonia with high case fatality rates and the ability to cause large health care-associated outbreaks.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziad A Memish
- Director Research & Innovation Center, Research Center Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.,Department of Medicine, Al-Faisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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40
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Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2020; 4:CD011621. [PMID: 32293717 PMCID: PMC7158881 DOI: 10.1002/14651858.cd011621.pub4] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola, severe acute respiratory syndrome (SARS), or coronavirus (COVID-19), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Personal protective equipment (PPE) can reduce the risk by covering exposed body parts. It is unclear which type of PPE protects best, what is the best way to put PPE on (i.e. donning) or to remove PPE (i.e. doffing), and how to train HCWs to use PPE as instructed. OBJECTIVES To evaluate which type of full-body PPE and which method of donning or doffing PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to 20 March 2020. SELECTION CRITERIA We included all controlled studies that evaluated the effect of full-body PPE used by HCW exposed to highly infectious diseases, on the risk of infection, contamination, or noncompliance with protocols. We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training on the same outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias in included trials. We conducted random-effects meta-analyses were appropriate. MAIN RESULTS Earlier versions of this review were published in 2016 and 2019. In this update, we included 24 studies with 2278 participants, of which 14 were randomised controlled trials (RCT), one was a quasi-RCT and nine had a non-randomised design. Eight studies compared types of PPE. Six studies evaluated adapted PPE. Eight studies compared donning and doffing processes and three studies evaluated types of training. Eighteen studies used simulated exposure with fluorescent markers or harmless microbes. In simulation studies, median contamination rates were 25% for the intervention and 67% for the control groups. Evidence for all outcomes is of very low certainty unless otherwise stated because it is based on one or two studies, the indirectness of the evidence in simulation studies and because of risk of bias. Types of PPE The use of a powered, air-purifying respirator with coverall may protect against the risk of contamination better than a N95 mask and gown (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.17 to 0.43) but was more difficult to don (non-compliance: RR 7.5, 95% CI 1.81 to 31.1). In one RCT (59 participants), people with a long gown had less contamination than those with a coverall, and coveralls were more difficult to doff (low-certainty evidence). Gowns may protect better against contamination than aprons (small patches: mean difference (MD) -10.28, 95% CI -14.77 to -5.79). PPE made of more breathable material may lead to a similar number of spots on the trunk (MD 1.60, 95% CI -0.15 to 3.35) compared to more water-repellent material but may have greater user satisfaction (MD -0.46, 95% CI -0.84 to -0.08, scale of 1 to 5). Modified PPE versus standard PPE The following modifications to PPE design may lead to less contamination compared to standard PPE: sealed gown and glove combination (RR 0.27, 95% CI 0.09 to 0.78), a better fitting gown around the neck, wrists and hands (RR 0.08, 95% CI 0.01 to 0.55), a better cover of the gown-wrist interface (RR 0.45, 95% CI 0.26 to 0.78, low-certainty evidence), added tabs to grab to facilitate doffing of masks (RR 0.33, 95% CI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31). Donning and doffing Using Centers for Disease Control and Prevention (CDC) recommendations for doffing may lead to less contamination compared to no guidance (small patches: MD -5.44, 95% CI -7.43 to -3.45). One-step removal of gloves and gown may lead to less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28) than separate removal. Double-gloving may lead to less viral or bacterial contamination compared to single gloving (RR 0.34, 95% CI 0.17 to 0.66) but not to less fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28). Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4) and to fewer contamination spots (MD -5, 95% CI -8.08 to -1.92). Extra sanitation of gloves before doffing with quaternary ammonium or bleach may decrease contamination, but not alcohol-based hand rub. Training The use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7). A video lecture on donning PPE may lead to better skills scores (MD 30.70, 95% CI 20.14 to 41.26) than a traditional lecture. Face-to-face instruction may reduce noncompliance with doffing guidance more (odds ratio 0.45, 95% CI 0.21 to 0.98) than providing folders or videos only. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort, and may therefore even lead to more contamination. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. Modifications to PPE design, such as tabs to grab, may decrease the risk of contamination. For donning and doffing procedures, following CDC doffing guidance, a one-step glove and gown removal, double-gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than folder-based training. We still need RCTs of training with long-term follow-up. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best. Consensus on simulation of exposure and assessment of outcome is urgently needed. We also need more real-life evidence. Therefore, the use of PPE of HCW exposed to highly infectious diseases should be registered and the HCW should be prospectively followed for their risk of infection.
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Affiliation(s)
- Jos H Verbeek
- Academic Medical Center, University of Amsterdam, Cochrane Work Review Group, Amsterdam, Netherlands, 1105AZ
| | - Blair Rajamaki
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| | - Sharea Ijaz
- University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK, BS1 2NT
| | | | | | - Bronagh Blackwood
- Queen's University Belfast, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Building, 97 Lisburn Road, Belfast, Northern Ireland, UK, BT9 7LB
| | - Christina Tikka
- Finnish Institute of Occupational Health, TYÖTERVEYSLAITOS, Finland, FI-70032
| | - Jani H Ruotsalainen
- Finnish Medicines Agency, Assessment of Pharmacotherapies, Microkatu 1, Kuopio, Finland, FI-70210
| | - F Selcen Kilinc Balci
- Centers for Disease Control and Prevention (CDC), National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH), 626 Cochrans Mill Road, Pittsburgh, PA, USA, 15236
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41
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Harris C, Carson G, Baillie JK, Horby P, Nair H. An evidence-based framework for priority clinical research questions for COVID-19. J Glob Health 2020. [PMID: 32257173 PMCID: PMC7125419 DOI: 10.7189/jogh.10-011001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background On 31 December, 2019, the World Health Organization China Country Office was informed of cases of pneumonia of unknown aetiology. Since then, there have been over 75 000 cases globally of the 2019 novel coronavirus (COVID-19), 2000 deaths, and over 14 000 cases recovered. Outbreaks of novel agents represent opportunities for clinical research to inform real-time public health action. In 2018, we conducted a systematic review to identify priority research questions for Severe Acute Respiratory Syndrome-related coronavirus (SARS-CoV) and Middle East Respiratory Syndrome-related coronavirus (MERS-CoV). Here, we review information available on COVID-19 and provide an evidenced-based framework for priority clinical research in the current outbreak. Methods Three bibliographic databases were searched to identify clinical studies published on SARS-CoV and MERS-CoV in the outbreak setting. Studies were grouped thematically according to clinical research questions addressed. In February 2020, available information on COVID19 was reviewed and compared to the results of the SARS-CoV and MERS-CoV systematic review. Results From the research objectives for SARS-CoV and MERS-CoV, ten themes in the literature were identified: Clinical characterisation, prognosis, diagnosis, clinical management, viral pathogenesis, epidemiological characterisation, infection prevention and control/transmission, susceptibility, psychosocial, and aetiology. For COVID19, some information on clinical presentation, diagnostic testing, and aetiology is available but many clinical research gaps have yet to be filled. Conclusions Based on a systematic review of other severe coronaviruses, we summarise the state of clinical research for COVID-19, highlight the research gaps, and provide recommendations for the implementation of standardised protocols. Data based on internationally standardised protocols will inform clinical practice real-time.
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Affiliation(s)
- Carlyn Harris
- Emory University School of Medicine, Atlanta, Georgia, USA.,Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Gail Carson
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - J Kenneth Baillie
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Centre for Inflammation Research and Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Peter Horby
- International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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42
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Memish ZA, Perlman S, Van Kerkhove MD, Zumla A. Middle East respiratory syndrome. Lancet 2020; 395:1063-1077. [PMID: 32145185 PMCID: PMC7155742 DOI: 10.1016/s0140-6736(19)33221-0] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) is a lethal zoonotic pathogen that was first identified in humans in Saudi Arabia and Jordan in 2012. Intermittent sporadic cases, community clusters, and nosocomial outbreaks of MERS-CoV continue to occur. Between April 2012 and December 2019, 2499 laboratory-confirmed cases of MERS-CoV infection, including 858 deaths (34·3% mortality) were reported from 27 countries to WHO, the majority of which were reported by Saudi Arabia (2106 cases, 780 deaths). Large outbreaks of human-to-human transmission have occurred, the largest in Riyadh and Jeddah in 2014 and in South Korea in 2015. MERS-CoV remains a high-threat pathogen identified by WHO as a priority pathogen because it causes severe disease that has a high mortality rate, epidemic potential, and no medical countermeasures. This Seminar provides an update on the current knowledge and perspectives on MERS epidemiology, virology, mode of transmission, pathogenesis, diagnosis, clinical features, management, infection control, development of new therapeutics and vaccines, and highlights unanswered questions and priorities for research, improved management, and prevention.
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Affiliation(s)
- Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Research Center, King Saud Medical City Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stanley Perlman
- Department of Microbiology and Immunology, and Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Maria D Van Kerkhove
- Infectious Hazards Management, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK.
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43
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Al Hosani FI, Kim L, Khudhair A, Pham H, Al Mulla M, Al Bandar Z, Pradeep K, Elkheir KA, Weber S, Khoury M, Donnelly G, Younis N, El Saleh F, Abdalla M, Imambaccus H, Haynes LM, Thornburg NJ, Harcourt JL, Miao C, Tamin A, Hall AJ, Russell ES, Harris AM, Kiebler C, Mir RA, Pringle K, Alami NN, Abedi GR, Gerber SI. Serologic Follow-up of Middle East Respiratory Syndrome Coronavirus Cases and Contacts-Abu Dhabi, United Arab Emirates. Clin Infect Dis 2020; 68:409-418. [PMID: 29905769 PMCID: PMC7108211 DOI: 10.1093/cid/ciy503] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Although there is evidence of person-to-person transmission of Middle East respiratory syndrome coronavirus (MERS-CoV) in household and healthcare settings, more data are needed to describe and better understand the risk factors and transmission routes in both settings, as well as the extent to which disease severity affects transmission. Methods A seroepidemiological investigation was conducted among MERS-CoV case patients (cases) and their household contacts to investigate transmission risk in Abu Dhabi, United Arab Emirates. Cases diagnosed between 1 January 2013 and 9 May 2014 and their household contacts were approached for enrollment. Demographic, clinical, and exposure history data were collected. Sera were screened by MERS-CoV nucleocapsid protein enzyme-linked immunosorbent assay and indirect immunofluorescence, with results confirmed by microneutralization assay. Results Thirty-one of 34 (91%) case patients were asymptomatic or mildly symptomatic and did not require oxygen during hospitalization. MERS-CoV antibodies were detected in 13 of 24 (54%) case patients with available sera, including 1 severely symptomatic, 9 mildly symptomatic, and 3 asymptomatic case patients. No serologic evidence of MERS-CoV transmission was found among 105 household contacts with available sera. Conclusions Transmission of MERS-CoV was not documented in this investigation of mostly asymptomatic and mildly symptomatic cases and their household contacts. These results have implications for clinical management of cases and formulation of isolation policies to reduce the risk of transmission.
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Affiliation(s)
| | - Lindsay Kim
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,United States Public Health Service, Rockville, Maryland
| | | | - Huong Pham
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | | | | | | | - Stefan Weber
- Sheikh Khalifa Medical Laboratory, Abu Dhabi, United Arab Emirates
| | - Mary Khoury
- Sheikh Khalifa Medical Laboratory, Abu Dhabi, United Arab Emirates
| | - George Donnelly
- Sheikh Khalifa Medical Laboratory, Abu Dhabi, United Arab Emirates
| | - Naima Younis
- Department of Health-Abu Dhabi, United Arab Emirates
| | - Feda El Saleh
- Department of Health-Abu Dhabi, United Arab Emirates
| | - Muna Abdalla
- Department of Health-Abu Dhabi, United Arab Emirates
| | - Hala Imambaccus
- Sheikh Khalifa Medical Laboratory, Abu Dhabi, United Arab Emirates
| | - Lia M Haynes
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Natalie J Thornburg
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jennifer L Harcourt
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Congrong Miao
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Azaibi Tamin
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Elizabeth S Russell
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron M Harris
- United States Public Health Service, Rockville, Maryland.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Craig Kiebler
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roger A Mir
- Division of Health Informatics and Surveillance, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Pringle
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Negar N Alami
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Glen R Abedi
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Susan I Gerber
- Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Demographic Variations of MERS-CoV Infection among Suspected and Confirmed Cases: An Epidemiological Analysis of Laboratory-Based Data from Riyadh Regional Laboratory. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9629747. [PMID: 32149148 PMCID: PMC7049846 DOI: 10.1155/2020/9629747] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/17/2020] [Accepted: 01/23/2020] [Indexed: 01/01/2023]
Abstract
Introduction. Middle East respiratory syndrome coronavirus was first recognized in September 2012 in Saudi Arabia. The clinical presentations of MERS and non-MERS SARI are often similar. Therefore, the identification of suspected cases that may have higher chances of being diagnosed as cases of MERS-CoV is essential. However, the real challenge is to flag these patients through some demographic markers. The nature of these markers has not previously been investigated in Saudi Arabia, and hence, this study aims to identify them.
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45
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Ramshaw RE, Letourneau ID, Hong AY, Hon J, Morgan JD, Osborne JCP, Shirude S, Van Kerkhove MD, Hay SI, Pigott DM. A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences. Sci Data 2019; 6:318. [PMID: 31836720 PMCID: PMC6911100 DOI: 10.1038/s41597-019-0330-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
As a World Health Organization Research and Development Blueprint priority pathogen, there is a need to better understand the geographic distribution of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and its potential to infect mammals and humans. This database documents cases of MERS-CoV globally, with specific attention paid to zoonotic transmission. An initial literature search was conducted in PubMed, Web of Science, and Scopus; after screening articles according to the inclusion/exclusion criteria, a total of 208 sources were selected for extraction and geo-positioning. Each MERS-CoV occurrence was assigned one of the following classifications based upon published contextual information: index, unspecified, secondary, mammal, environmental, or imported. In total, this database is comprised of 861 unique geo-positioned MERS-CoV occurrences. The purpose of this article is to share a collated MERS-CoV database and extraction protocol that can be utilized in future mapping efforts for both MERS-CoV and other infectious diseases. More broadly, it may also provide useful data for the development of targeted MERS-CoV surveillance, which would prove invaluable in preventing future zoonotic spillover. Measurement(s) | Middle East Respiratory Syndrome • geographic location | Technology Type(s) | digital curation | Factor Type(s) | geographic distribution of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) • year | Sample Characteristic - Organism | Middle East respiratory syndrome-related coronavirus | Sample Characteristic - Location | Earth (planet) |
Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11108801
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Affiliation(s)
- Rebecca E Ramshaw
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Ian D Letourneau
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Amy Y Hong
- Bloomberg School of Public Health, Johns Hopkins University, 615N Wolfe St, Baltimore, MD, 21205, United States
| | - Julia Hon
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Julia D Morgan
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Joshua C P Osborne
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Shreya Shirude
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - Maria D Van Kerkhove
- Department of Infectious Hazards Management, Health Emergencies Programme, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States.,Department of Health Metrics Sciences, School of Medicine, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States. .,Department of Health Metrics Sciences, School of Medicine, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA, United States.
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The risk factors associated with MERS-CoV patient fatality: A global survey. Diagn Microbiol Infect Dis 2019; 96:114876. [PMID: 31959375 PMCID: PMC7126953 DOI: 10.1016/j.diagmicrobio.2019.114876] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 01/04/2023]
Abstract
Risk factors associated with Middle East respiratory syndrome coronavirus (MERS-CoV) infection outcome were established by analyses of WHO data from September 23, 2012 to 18 June 2018. Of the 2220 reported cases, 1408 cases, including 451 MERS-CoV deaths, were analyzed. The case fatality rate was 32% (95% CI: 29.4-34.5). Compared to MERS patients ≤30 years old, those with >30 years had the adjusted odds ratio estimate for death of 2.38 [95% CI: 1.75-3.22]. This index was 1.43 [95% CI: 1.06-1.92] for Saudi patients in comparison to non-Saudi; 1.76 [95% CI: 1.39-2.22] for patient with comorbidity in comparison to those without comorbidity; 0.58 [95% CI: 0.44-0.75] for those who had close contact to a camel in the past 14 days and 0.42 [95% CI: 0.31-0.57] for patients with >14 days with onset of signs and hospital admission compared to patients with ≤14 days.
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Verbeek JH, Rajamaki B, Ijaz S, Tikka C, Ruotsalainen JH, Edmond MB, Sauni R, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2019; 7:CD011621. [PMID: 31259389 PMCID: PMC6601138 DOI: 10.1002/14651858.cd011621.pub3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In epidemics of highly infectious diseases, such as Ebola Virus Disease (EVD) or Severe Acute Respiratory Syndrome (SARS), healthcare workers (HCW) are at much greater risk of infection than the general population, due to their contact with patients' contaminated body fluids. Contact precautions by means of personal protective equipment (PPE) can reduce the risk. It is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCW use PPE as instructed. OBJECTIVES To evaluate which type of full body PPE and which method of donning or doffing PPE have the least risk of self-contamination or infection for HCW, and which training methods increase compliance with PPE protocols. SEARCH METHODS We searched MEDLINE (PubMed up to 15 July 2018), Cochrane Central Register of Trials (CENTRAL up to 18 June 2019), Scopus (Scopus 18 June 2019), CINAHL (EBSCOhost 31 July 2018), and OSH-Update (up to 31 December 2018). We also screened reference lists of included trials and relevant reviews, and contacted NGOs and manufacturers of PPE. SELECTION CRITERIA We included all controlled studies that compared the effects of PPE used by HCW exposed to highly infectious diseases with serious consequences, such as Ebola or SARS, on the risk of infection, contamination, or noncompliance with protocols. This included studies that used simulated contamination with fluorescent markers or a non-pathogenic virus.We also included studies that compared the effect of various ways of donning or doffing PPE, and the effects of training in PPE use on the same outcomes. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We planned to perform meta-analyses but did not find sufficiently similar studies to combine their results. MAIN RESULTS We included 17 studies with 1950 participants evaluating 21 interventions. Ten studies are Randomised Controlled Trials (RCTs), one is a quasi RCT and six have a non-randomised controlled design. Two studies are awaiting assessment.Ten studies compared types of PPE but only six of these reported sufficient data. Six studies compared different types of donning and doffing and three studies evaluated different types of training. Fifteen studies used simulated exposure with fluorescent markers or harmless viruses. In simulation studies, contamination rates varied from 10% to 100% of participants for all types of PPE. In one study HCW were exposed to Ebola and in another to SARS.Evidence for all outcomes is based on single studies and is very low quality.Different types of PPEPPE made of more breathable material may not lead to more contamination spots on the trunk (Mean Difference (MD) 1.60 (95% Confidence Interval (CI) -0.15 to 3.35) than more water repellent material but may have greater user satisfaction (MD -0.46; 95% CI -0.84 to -0.08, scale of 1 to 5).Gowns may protect better against contamination than aprons (MD large patches -1.36 95% CI -1.78 to -0.94).The use of a powered air-purifying respirator may protect better than a simple ensemble of PPE without such respirator (Relative Risk (RR) 0.27; 95% CI 0.17 to 0.43).Five different PPE ensembles (such as gown vs. coverall, boots with or without covers, hood vs. cap, length and number of gloves) were evaluated in one study, but there were no event data available for compared groups.Alterations to PPE design may lead to less contamination such as added tabs to grab masks (RR 0.33; 95% CI 0.14 to 0.80) or gloves (RR 0.22 95% CI 0.15 to 0.31), a sealed gown and glove combination (RR 0.27; 95% CI 0.09 to 0.78), or a better fitting gown around the neck, wrists and hands (RR 0.08; 95% CI 0.01 to 0.55) compared to standard PPE.Different methods of donning and doffing proceduresDouble gloving may lead to less contamination compared to single gloving (RR 0.36; 95% CI 0.16 to 0.78).Following CDC recommendations for doffing may lead to less contamination compared to no guidance (MD small patches -5.44; 95% CI -7.43 to -3.45).Alcohol-based hand rub used during the doffing process may not lead to less contamination than the use of a hypochlorite based solution (MD 4.00; 95% CI 0.47 to 34.24).Additional spoken instruction may lead to fewer errors in doffing (MD -0.9, 95% CI -1.4 to -0.4).Different types of trainingThe use of additional computer simulation may lead to fewer errors in doffing (MD -1.2, 95% CI -1.6 to -0.7).A video lecture on donning PPE may lead to better skills scores (MD 30.70; 95% CI 20.14,41.26) than a traditional lecture.Face to face instruction may reduce noncompliance with doffing guidance more (OR 0.45; 95% CI 0.21 to 0.98) than providing folders or videos only.There were no studies on effects of training in the long term or on resource use.The quality of the evidence is very low for all comparisons because of high risk of bias in all studies, indirectness of evidence, and small numbers of participants. AUTHORS' CONCLUSIONS We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. Alterations to PPE, such as tabs to grab may decrease contamination. Double gloving, following CDC doffing guidance, and spoken instructions during doffing may reduce contamination and increase compliance. Face-to-face training in PPE use may reduce errors more than video or folder based training. Because data come from single small studies with high risk of bias, we are uncertain about the estimates of effects.We still need randomised controlled trials to find out which training works best in the long term. We need better simulation studies conducted with several dozen participants to find out which PPE protects best, and what is the safest way to remove PPE. Consensus on the best way to conduct simulation of exposure and assessment of outcome is urgently needed. HCW exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection in the field.
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Affiliation(s)
- Jos H Verbeek
- University of Eastern FinlandCochrane Work Review GroupKuopioFinland70201
| | - Blair Rajamaki
- University of Eastern FinlandInstitute of Public Health and Clinical Nutrition, Occupational Health UnitKuopioFinland
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolBristolUKBS1 2NT
| | - Christina Tikka
- Finnish Institute of Occupational HealthCochrane Work Review GroupTYÖTERVEYSLAITOSFinlandFI‐70032
| | - Jani H Ruotsalainen
- Coronel Institute of Occupational HealthCochrane Work Review GroupAcademic Medical Center, University of AmsterdamPO Box 22700AmsterdamNetherlands1100 DE
| | - Michael B Edmond
- University of Iowa Hospitals and ClinicsC512 GH, 200 Hawkins DriveIowa CityIAUSA52241
| | - Riitta Sauni
- Finnish Institute of Occupational HealthP.O.Box 486TampereFinlandFI‐33101
| | - F Selcen Kilinc Balci
- Centers for Disease Control and Prevention (CDC)National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety and Health (NIOSH)626 Cochrans Mill RoadPittsburghPAUSA15236
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Yip L, Finn M, Granados A, Prost K, McGeer A, Gubbay JB, Scott J, Mubareka S. Influenza virus RNA recovered from droplets and droplet nuclei emitted by adults in an acute care setting. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:341-348. [PMID: 31050610 PMCID: PMC7157967 DOI: 10.1080/15459624.2019.1591626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Transmission in hospital settings of seasonal influenza viruses and novel agents such as the Middle East respiratory syndrome coronavirus (MERS-CoV) is well-described but poorly understood. The characterization of potentially infectious bio-aerosols in the healthcare setting remains an important yet ill-defined factor in the transmission of respiratory viruses. Empiric data describing the distribution of bio-aerosols enable discernment of potential exposure risk to respiratory viruses. We sought to determine the distribution of influenza virus RNA emitted into the air by participants with laboratory-confirmed influenza, and whether these emissions had the potential to reach healthcare workers' breathing zones. Two-stage cyclone bio-aerosol samplers from the Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health were placed 0.5-1.0 m (near field) and 2.1-2.5 m (far field) from infected patient participants, as well as in the corridor immediately outside their rooms. In addition, healthcare worker participants providing care to infected participants were recruited to wear a polytetrafluoroethylene (PTFE) filter cassette in their breathing zones. Viral RNA was detected from the air emitted by 37.5% of the 16 participants infected with influenza virus and distributed both in near and far fields and in all tested particle sizes (<1 µm, 1-4 µm, and >4 µm). Viral RNA was recovered in droplet nuclei and beyond 1 m from naturally-infected participants in the healthcare setting and from the breathing zone of one healthcare worker. There was no correlation between patient participant nasal viral load and recovery of viral RNA from the air, and we did not identify any significant association between RNA detection from the air and patient demographics or clinical presentation. A more substantial study is required to identify patient determinants of virus emission into the air and delineate implications for evidence-based policy for prevention and control.
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Affiliation(s)
- Lily Yip
- Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mairead Finn
- Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Andrea Granados
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Karren Prost
- Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Jonathan B. Gubbay
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - James Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Samira Mubareka
- Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- CONTACT Samira Mubareka 2075 Bayview Ave suite B103, Toronto, ON M4N 3M5, Canada
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Bodmer BS, Fiedler AH, Hanauer JRH, Prüfer S, Mühlebach MD. Live-attenuated bivalent measles virus-derived vaccines targeting Middle East respiratory syndrome coronavirus induce robust and multifunctional T cell responses against both viruses in an appropriate mouse model. Virology 2018; 521:99-107. [PMID: 29902727 PMCID: PMC7118890 DOI: 10.1016/j.virol.2018.05.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/04/2018] [Accepted: 05/31/2018] [Indexed: 12/15/2022]
Abstract
Cases of Middle East respiratory syndrome coronavirus (MERS-CoV) continue to occur, making it one of the WHO´s targets for accelerated vaccine development. One vaccine candidate is based on live-attenuated measles virus (MV) vaccine encoding the MERS-CoV spike glycoprotein (MERS-S). MVvac2-MERS-S(H) induces robust humoral and cellular immunity against MERS-S mediating protection. Here, the induction and nature of immunity after vaccination with MVvac2-MERS-S(H) or novel MVvac2-MERS-N were further characterized. We focused on the necessity for vector replication and the nature of induced T cells, since functional CD8+ T cells contribute importantly to clearance of MERS-CoV. While no immunity against MERS-CoV or MV was detected in MV-susceptible mice after immunization with UV-inactivated virus, replication-competent MVvac2-MERS-S(H) triggered robust neutralizing antibody titers also in adult mice. Furthermore, a significant fraction of MERS CoV-specific CD8+ T cells and MV-specific CD4+ T cells simultaneously expressing IFN-γ and TNF-α were induced, revealing that MVvac2-MERS-S(H) induces multifunctional cellular immunity.
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Affiliation(s)
- Bianca S Bodmer
- Product Testing of IVMPs, Div. of Veterinary Medicine, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany; German Center for Infection Research, Langen, Germany
| | - Anna H Fiedler
- Product Testing of IVMPs, Div. of Veterinary Medicine, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany; German Center for Infection Research, Langen, Germany
| | - Jan R H Hanauer
- Product Testing of IVMPs, Div. of Veterinary Medicine, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - Steffen Prüfer
- Product Testing of IVMPs, Div. of Veterinary Medicine, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - Michael D Mühlebach
- Product Testing of IVMPs, Div. of Veterinary Medicine, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany; German Center for Infection Research, Langen, Germany.
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Kang HS, Son YD, Chae SM, Corte C. Working experiences of nurses during the Middle East respiratory syndrome outbreak. Int J Nurs Pract 2018; 24:e12664. [PMID: 29851209 PMCID: PMC7165521 DOI: 10.1111/ijn.12664] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/18/2018] [Accepted: 03/29/2018] [Indexed: 12/30/2022]
Abstract
Aims To explore working experiences of nurses during Middle East respiratory syndrome outbreak. Background Since the first case of Middle East respiratory syndrome was reported on May 20, 2015 in South Korea, 186 people, including health care workers, were infected, and 36 died. Design A qualitative descriptive study. Methods Seven focus groups and 3 individual in‐depth interviews were conducted from August to December 2015. Content analysis was used. Results The following 4 major themes emerged: “experiencing burnout owing to the heavy workload,” “relying on personal protective equipment for safety,” “being busy with catching up with the new guidelines related to Middle East respiratory syndrome,” and “caring for suspected or infected patients with caution.” Participants experienced burnout because of the high volume of work and expressed safety concerns about being infected. Unclear and frequently changing guidelines were 1 of the common causes of confusion. Participants expressed that they need to be supported while caring for suspected or infected patients. Conclusion This study showed that creating a supportive and safe work environment is essential by ensuring adequate nurse staffing, supplying best‐quality personal protective equipment, and improving communication to provide the quality of care during infection outbreak. What is already known about this topic?
Infectious disease outbreaks cause a significant level of distress and fear among nurses. Nurses are near to patients, even when they have life‐threatening infectious diseases. Little is known about the work experiences of nurses during the Middle East respiratory syndrome coronavirus outbreaks.
What this paper adds?
High volume of work and fear of infection appear to be the main concerns among nurses during the outbreak. Nurses were confused about best practices because of lack of clarity of the guidelines during the outbreak. However, sharing information on the new guidelines and job‐related information via text messages using smartphones was helpful for the nurses. Creating a supportive work environment and providing adequate training for nurses is essential.
The implications of this paper:
Nurse managers and hospital administrators should establish strategies to prevent nurses from burnout and to ensure their safety during the outbreak of infectious diseases. Clear and consistent practice guidelines and effective communication methods among nurses should be developed. Increasing awareness of health care workers about infectious diseases to enhance emergency preparedness is essential.
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Affiliation(s)
- Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Ye Dong Son
- College of Nursing, Woosuk University, Seoul, South Korea
| | - Sun-Mi Chae
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Colleen Corte
- College of Nursing, University of Illinois, Chicago, Illinois, USA
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