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Duverger C, Monteil C, Souyri V, Fournier S. Factors associated with extent of COVID-19 outbreaks: A prospective study in a large hospital network. Am J Infect Control 2024; 52:696-700. [PMID: 38224818 DOI: 10.1016/j.ajic.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND The COVID-19 pandemic has generated numerous hospital outbreaks. This study aimed to identify factors related to the extent of nosocomial COVID-19 outbreaks in the largest French public health institution. METHODS An observational study was conducted from July 2020 to September 2021. Outbreaks were defined as at least 2 cases, patients and/or health care workers (HCWs), linked by time and geographic location. Logistic regression was performed to identify risk factors for large outbreaks among nine variables: variant, medical ward, COVID-19 vaccination rate and incidence among HCWs and Paris population, number of weekly COVID-19 tests among HCWs and the positivity rate, epidemic waves. RESULTS Within 14 months, 799 outbreaks were identified: 450 small ones (≤6 cases) and 349 large ones (≥7 cases), involving 3,260 patients and 3,850 HCWs. In univariate analysis, large outbreaks were positively correlated to geriatrics wards, COVID-19 incidence, and rate of weekly positive tests among HCWs; and negatively correlated to intensive care units, variant Delta, fourth wave, vaccination rates of the Paris region's population and that of the HCWs. In multivariate analysis, factors that remained significant were the type of medical ward and the vaccination rate among HCWs. CONCLUSIONS Intensive care unit and high vaccination rates among HCWs were associated with a lower risk of large COVID-19 outbreaks, as opposed to geriatric wards, which are associated with a higher risk.
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Affiliation(s)
- Clarisse Duverger
- Central Infection Prevention and Control Team, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Catherine Monteil
- Central Infection Prevention and Control Team, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Valérie Souyri
- Central Infection Prevention and Control Team, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sandra Fournier
- Central Infection Prevention and Control Team, Assistance Publique-Hôpitaux de Paris, Paris, France
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Siraj F, Mir MH, Mehfooz N, Happa K, Sofi MA, Syed NA, Guru F, Banday SZ, Dar NA, Jan RA. Nosocomial SARS-COVID-19 Outbreak During the Third Wave of COVID-19 in an Oncology Facility at a Tertiary Care Hospital in Kashmir, India. Cureus 2023; 15:e43459. [PMID: 37711953 PMCID: PMC10499056 DOI: 10.7759/cureus.43459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) emerged as a life-threatening respiratory condition, especially in immunocompromised patients, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially detected in China in December 2019, the first case in India was diagnosed on January 30, 2020. Here we report a nosocomial COVID-19 outbreak among cancer patients and healthcare workers (HCWs) in a medical oncology unit of a tertiary care hospital from our region. MATERIALS AND METHODS This was a descriptive study of the nosocomial COVID-19 outbreak and was conducted in the month of January 2022 at the medical oncology unit of a tertiary care hospital in Srinagar, Jammu and Kashmir (J&K), India. The study included 25 COVID-19 cases, including patients and HC/non-HCWs (NHCWs). The confirmation of diagnosis was done through real-time polymerase chain reaction (RT-PCR) using nasopharyngeal/oropharyngeal swabs as the test sample. RESULTS Twenty-five COVID-19 cases, including 14 admitted patients, nine HCWs, and two NHCWs were confirmed by COVID-19 RT-PCR in a span of 11 days. The first case was a positive HCW. The patients were admitted for management of various hematological as well as solid organ malignancies. Of the 14 patients, eight were in the pediatric age group with a mean age of 6.9 years, and six were adults with a mean age of 55.2 years. Thirteen patients were on different chemotherapy protocols, and one was undergoing an autologous stem cell transplant. Of the 14 patients, four were asymptomatic for COVID-19 symptoms, eight had mild disease, and two had severe disease with respiratory failure. Two patients with severe diseases needed COVID-19-designated high-dependency unit (HDU) admission. There was one COVID-19-related death. Among the healthcare workers, the mean age was 33.8 years, of which six were males and three were females. All the HCWs and NHCWs had mild disease, and all of them recovered completely. CONCLUSION Nosocomial COVID-19 illness is a new entity and is preventable. COVID-19 illness will remain in society after the pandemic is over, like the influenza B viral illness, and there can be seasonal flares in the future. Proper measures should be taken to prevent its clustering in hospital settings.
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Affiliation(s)
- Farhana Siraj
- Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Mohmad Hussain Mir
- Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Nazia Mehfooz
- Pulmonology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Karan Happa
- Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Mushtaq Ahmad Sofi
- Radiation Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Nisar Ahmad Syed
- Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Faisal Guru
- Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Saquib Z Banday
- Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Nazir Ahmad Dar
- Radiation Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Rafi A Jan
- Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Mardiko AA, Bludau A, Heinemann S, Kaba HEJ, Fenz D, Leha A, von Maltzahn N, Mutters NT, Leistner R, Mattner F, Scheithauer S. Infection control strategies for healthcare workers during COVID-19 pandemic in German hospitals: A cross-sectional study in march-april 2021. Heliyon 2023; 9:e14658. [PMID: 36945349 PMCID: PMC10022461 DOI: 10.1016/j.heliyon.2023.e14658] [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: 10/18/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Background Healthcare workers (HCW) are at risk of getting infected with COVID-19 at work. To prevent such incidents and provide a safe environment in hospitals, comprehensive infection control strategies are necessary. We aimed to collect information on COVID-19 infection control strategies regarding personal protective equipment (PPE), regulations during breaks for HCW and dissemination of pandemic-related information. Methods We invited infection control practitioners from 987 randomly selected German hospitals in March-April 2021 to participate in our cross-sectional online survey. We categorized the hospital based on bed capacity (≤499 beds = small; ≥500 beds = large). Fisher's exact test was performed and p < 0.05 defined as statistically significant. Findings 100 participants completed the questionnaire. Small hospitals were more directive about requiring FFP2 respirators (63%), whereas larger hospitals more often gave their HCW a choice between these and medical masks (67%). For the care of COVID-19 and suspected COVID-19 cases, >90% of the participants recommended the use of gloves. Notably, gloves were recommended beyond COVID-19 in 30% of the hospitals. During meal breaks various strategies were followed. Conclusion Recommendations for PPE varied across hospital sizes, which could be due to different assessments of necessity and safety. Regulations during breaks varied strongly which illustrates the need for clear official guidelines.
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Affiliation(s)
- Amelia A Mardiko
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University, Göttingen, Germany
| | - Anna Bludau
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University, Göttingen, Germany
| | - Stephanie Heinemann
- Local Task Force of the Network University Medicine (NUM), University Medical Center Göttingen (UMG), Göttingen, Germany
- Department of General Practice, University Medical Center Göttingen (UMG), Göttingen, Germany
- Department of Geriatrics, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Hani E J Kaba
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University, Göttingen, Germany
| | - Diana Fenz
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University, Göttingen, Germany
| | - Andreas Leha
- Department of Medical Statistic, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Nicole von Maltzahn
- Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany
| | - Nico T Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Rasmus Leistner
- Institute for Hygiene and Environmental Medicine, Charité University Hospital Berlin, Berlin, Germany
- Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité University Hospital Berlin, Berlin, Germany
| | - Frauke Mattner
- Institute for Hygiene, Cologne Merheim Medical Centre, University Witten-Herdecke, Cologne, Germany
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University, Göttingen, Germany
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Lu TL, Chuang Y, Huang C. Nosocomial Omicron Outbreak in a Medical Ward During the Coronavirus Disease 2019 Pandemic. Risk Manag Healthc Policy 2023; 16:309-315. [PMID: 36879826 PMCID: PMC9985400 DOI: 10.2147/rmhp.s398668] [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: 12/07/2022] [Accepted: 02/18/2023] [Indexed: 03/04/2023] Open
Abstract
Background The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is 2 to 3 times more contagious than the Delta variant and poses a new challenge in containing transmission in community and health care settings. Transmission in hospitals can cause nosocomial outbreak infections and affect patients and health care workers. This study describes a coronavirus disease 2019 (COVID-19) outbreak in a medical ward. The purpose of the investigation was to determine the transmission source of the outbreak, as well as the measures implemented to prevent and control it. Methods A cluster of SARS-CoV-2 infections that affected health care workers, inpatients, and caregivers was thoroughly researched in a medical ward. There were several strict outbreak measures implemented in our hospital, and these measures controlled the nosocomial COVID-19 outbreak in this study. Results Seven cases of SARS-CoV-2 infection were diagnosed within 2 days in the medical ward. The infection control team declared a nosocomial outbreak of the COVID-19 Omicron variant. Several strict outbreak measures were implemented as follows: 1. The medical ward was closed and cleaning and disinfection were performed. 2. All patients and caregivers with negative test results were transferred to a spare COVID-19 isolation ward. 3. Relatives' visits were not allowed, and no new patient was admitted during the outbreak period. 4. Health care workers were retrained on wearing personal protective equipment and enhanced techniques and practices of hand hygiene, social distancing, and self-monitoring of fever and respiratory symptoms. Conclusion This outbreak occurred in a non-COVID-19 ward during the COVID-19 Omicron variant phase of the pandemic. Our strict outbreak measures halted and contained the nosocomial COVID-19 outbreak in 10 days. Future studies are needed to establish a standard policy of COVID-19 outbreak measure implementation.
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Affiliation(s)
- Tsung-Lung Lu
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Yiling Chuang
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Chienhsiu Huang
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
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Wu HH, Su CH, Chien LJ, Tseng SH, Chang SC. Healthcare-associated COVID-19 outbreaks: a nationwide population-based cohort study. J Hosp Infect 2022; 124:29-36. [PMID: 35283225 PMCID: PMC8907114 DOI: 10.1016/j.jhin.2022.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 10/31/2022]
Abstract
Background Aim Methods Findings Conclusion
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Ngandu NK, Mmotsa TM, Dassaye R, Thabetha A, Odendaal W, Langdown N, Ndwandwe D. Hospital acquired COVID-19 infections amongst patients before the rollout of COVID-19 vaccinations, a scoping review. BMC Infect Dis 2022; 22:140. [PMID: 35144556 PMCID: PMC8830001 DOI: 10.1186/s12879-022-07128-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 01/16/2023] Open
Abstract
Background Hospital settings are at increased risk of spreading Coronavirus Disease 2019 (COVID-19) infections, hence non-pharmaceutical prevention interventions (NPPIs) and prioritized vaccination of healthcare workers and resident patients are critical. The status of COVID-19 hospital acquired infections (HAIs) in low-income settings is unclear. We aimed to identify and summarize the existing evidence on COVID-19 HAIs amongst patients, prior to the rollout of vaccines in countries worldwide. Methods We conducted a scoping review of English peer-reviewed literature in PubMed, Web of Science and Scopus using a combination of selected search terms. Full texts articles presenting results on COVID-19 HAIs in hospitalised patients before the rollout of vaccines in countries worldwide were eligible. Data extracted from eligible articles included estimates of COVID-19 HAIs, country, and type of hospital setting, and was summarized narratively. Quality assessment of included articles was not possible. Results Literature searches generated a total of 5920 articles, and 45 were eligible for analysis. Eligible articles were from Europe, North America, Asia, and Brazil and none were from low-income countries. The proportion of COVID-19 HAIs ranged from 0% when strict NPPIs were applied, to 65% otherwise. The estimates of COVID-19 HAIs did not differ by country but were lower in studies conducted after implementation of NPPIs and in specialized hospital settings for operative surgery. Studies conducted before the implementation of NPPIs or in long-term care and psychiatric wards often reported high estimates of HAI. Although there was no clear trend in general wards, those situated in academic hospitals managed to reduce HAI rates under strict NPPI protocols. Operative surgery settings, unlike psychiatric settings, effectively prevented COVID-19 HAI using tailored NPPIs. Conclusion The available evidence shows a high risk of COVID-19 HAIs, the feasibility of preventing HAIs in different healthcare settings and the importance of appropriately tailored NPPIs. There were no data from low-income settings, therefore, it is unclear whether the reported NPPI approaches could be equally effective elsewhere. We recommend routine monitoring of COVID-19 HAIs in countries with low vaccination coverage, to identify and close gaps in NPPIs and understand gains made from vaccinating healthcare workers and hospitalized patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07128-5.
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Affiliation(s)
- Nobubelo K Ngandu
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Tshiamo M Mmotsa
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Reshmi Dassaye
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Alice Thabetha
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willem Odendaal
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Natasha Langdown
- Knowledge and Information Management Services, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane, South African Medical Research Council, Cape Town, South Africa
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Kates OS, Stock PG, Ison MG, Allen RD, Burra P, Jeong JC, Kute V, Muller E, Nino-Murcia A, Wang H, Wall A. Ethical review of COVID-19 vaccination requirements for transplant center staff and patients. Am J Transplant 2022; 22:371-380. [PMID: 34706165 PMCID: PMC8653143 DOI: 10.1111/ajt.16878] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/03/2021] [Accepted: 10/24/2021] [Indexed: 01/25/2023]
Abstract
Transplant centers seeking to increase coronavirus disease 2019 (COVID-19) vaccine coverage may consider requiring vaccination for healthcare workers or for candidates. The authors summarize current data to inform an ethical analysis of the harms, benefits, and individual and societal impact of mandatory vaccination, concluding that vaccine requirements for healthcare workers and transplant candidates are ethically justified by beneficence, net utility, and fiduciary duty to patients and public health. Implementation strategies should mitigate concerns about respect for autonomy and transparency for both groups. We clarify how the same arguments might be applied to related questions of caregiver vaccination, allocation of other healthcare resources, and mandates for non-COVID-19 vaccines. Finally, we call for effort to achieve global equity in vaccination as soon as possible.
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Affiliation(s)
- Olivia S. Kates
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Peter G. Stock
- Department of Surgery, University of California, San Francisco, San Francisco, California,Correspondence Peter G. Stock, Department of Surgery, University of California, San Francisco, San Francisco, CA.
| | - Michael G. Ison
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard D.M. Allen
- Bosch Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Jong Cheol Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Vivek Kute
- Department of Nephrology and Transplantation Science, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Haibo Wang
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Anji Wall
- Baylor University Medical Center, Annette C. and Harold C. Simmons Transplant Institute, Dallas, Texas
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Abdolsalehi MR, Mahmoudi S, Badv RS, Pourakbari B, Mirnia K, Mahmoudieh Y, Mamishi S. SARS-CoV-2 transmission among health care workers in Iran: an urgent need for early identification and management. Infect Disord Drug Targets 2021; 22:e100821195494. [PMID: 35135466 DOI: 10.2174/1871526521666210810124359] [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: 12/30/2020] [Revised: 04/15/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION By increasing the rate of COVID-19, particularly in developing countries such as Iran, high numbers of frontline service providers, including doctors and nurses, die and makes frontline healthcare workers (HCWs) more vulnerable to the psychological disorders, fear and anxiety of secondary transmission to others, especially their family members. In this study, we aimed to report the incidence of COVID-19 infection among HCWs in an Iranian referral pediatrics hospital between April 2020 and July 2020. MATERIAL AND METHODS In this retrospective cross-sectional study, HCWs and hospital staff working at Children's Medical Center, Tehran, Iran with positive SARS-CoV-2 RT-PCR test results were evaluated between April 2020 and July 2020. RESULTS Sixty-one out of the 1085 personnel (5.6%) including 14 pediatricians (23%), 24 nurses (39%), 9 paramedics (15%), and 14 HCWs without direct patient contact (23%) had a nasopharyngeal specimen positive SARS-CoV-2 RT-PCR test. The mean age was 39.8±10.6 years. Eleven cases (18%) had underlying diseases such as hypertension and asthma. The most common symptoms were fatigue (67%, n=41), dry cough (61%, n=37), fever (52%, n=32), headache (46%, n=28), dyspnea (43%, n=24), anosmia (28%, n=17), chills (26%, n=16), sore throat (26%, n=16), gastrointestinal symptoms (23%, n=14), and productive cough (3%, n=2). Eleven cases (18%) showed lung involvement in their chest X-rays and/or CT scans. Eighteen cases (29.5%) had lymphopenia, and 20 individuals (33%) had a high level of C-reactive protein. CONCLUSION In conclusion, in the early phase of the COVID-19 outbreak, a substantial proportion of HCWs with fever, respiratory, and other prevalent symptoms including fatigue and headache were infected with SARS-CoV-2. Therefore, implementation of infection prevention measures, isolation of confirmed HCWs, disinfection of the environment, and regular COVID-19 prevention training for HCWs are strongly recommended for the wellbeing of health workers and minimizing the spread of infection.
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Affiliation(s)
- Mohammad Reza Abdolsalehi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Reza Shervin Badv
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Keyvan Mirnia
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Yasmine Mahmoudieh
- Department of Molecular and Cell Biology, University of California, Berkeley. United States
| | - Setareh Mamishi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
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