Severe acute respiratory syndrome coronavirus 2 infection among healthcare workers in a tertiary public hospital in Curitiba, Brazil

ABSTRACT BACKGROUND: We aimed to describe the clinical characteristics of coronavirus disease 2019 (COVID-19) among healthcare workers (HCWs) in Curitiba, Brazil. METHODS: Upper respiratory samples from 1077 HCWs were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription polymerase chain reaction from June 16, 2020 to December 9, 2020. RESULTS: Overall, 32.7% of HCWs were infected. The positivity rates in symptomatic and asymptomatic HCWs were 39.2% and 15.9%, respectively. Hospital departments categorized as high-risk for exposure had the highest number of infected HCWs. CONCLUSIONS: Early diagnosis and isolation of infected HCWs remain key in controlling SARS-CoV-2 transmission because HCWs in close contact with COVID-19 patients are more likely to be infected than those who are not.

Tiempo de aislamiento y periodo infeccioso en pacientes con covid 19 hospitalizados / Isolation time and infectious period in patients with covid 19 hospitalized

RESUMEN: Se revisan las recomendaciones actuales de aislamiento y los criterios que se deben conocer para considerar a los pacientes que cursan con COVID, como potencialmente contagiosos. Se debe continuar utilizando las tasas de transmisión y seguir las recomendaciones de control y prevención de infecciones de los CDC para entornos de atención médica. El aislamiento ayuda a prevenir la transmisión del virus al separar a las personas infectadas con el virus de las que no lo están. Es básico por lo tanto discriminar esas situaciones clínicas y tener claros los criterios laboratoriales para tomar decisiones respecto al tiempo de aislamiento de los pacientes. Considerando la exposición del personal de salud y los pacientes hospitalizados se concluye que no necesaria la cuarentena para los asintomáticos que están al día con todas las dosis recomendadas de la vacuna contra el COVID-19 o que se han recuperado de la infección por SARS-CoV-2 en los 90 días anteriores, las posibles excepciones y el grupo de pacientes que deben someterse a pruebas, se describen en el desarrollo de este artículo.

ABSTRACT: It reviews the current isolation recommendations and the criteria that must be known to consider patients who are with COVID, as potentially contagious. Transmission rates should continue to be used and CDC infection prevention and control recommendations for health care settings should be followed. Isolation helps prevent transmission of the virus by separating people infected with the virus from those who are not. It is therefore essential to discriminate these clinical situations and to be clear about the laboratory criteria to make decisions regarding the isolation time of patients. Considering the exposure of health personnel and hospitalized patients; it is concluded that quarantine is not necessary for asymptomatic patients who are up to date with all recommended doses of COVID-19 vaccine or who have recovered from SARS-CoV-2 infection in the previous 90 days, possible exceptions and the group of patients to be tested, are described in the development of this article.

Uso de la técnica de vntr-miru para el estudio de transmisión intrahospitalaria de tuberculosis en el Hospital Universitario de Caracas, 2010-2011 / Use the vntr-miru technique for the study of nosocomial transmission of tuberculosis at the Hospital Universitario de Caracas, 2010-2011

La tuberculosis es una enfermedad infecciosa, causada por especies del complejo Mycobacterium tuberculosis. Es una enfermedad de fácil transmisión, lo que puede generar un problema en los sitios de cuidado de salud al incrementarse el riesgo de infección entre las personas que se encuentran hospitalizadas, personal médico y visitante. El objetivo de este estudio fue tipificar mediante VNTR-MIRU 35 aislados de M. tuberculosis, obtenidos de pacientes recluidos en el Hospital Universitario de Caracas (HUC) durante 2010­2011, para establecer si existe estrecha relación genética entre los aislados y detectar si se presentó transmisión intrahospitalaria. En la tipificación por VNTR se observaron 29 patrones genéticos únicos (82,9%) y 3 clústeres, de los cuales sólo uno estuvo conformado por patrones genéticos de aislados provenientes de pacientes con estrecha relación epidemiológica (superposición de períodos de hospitalización). Mediante el análisis comparativo de los patrones genéticos con los depositados en la base de datos de VNTR-plus utilizando el método de Neighbor-joining, se pudo observar que los aislados se agrupaban con patrones LAM (n=25), Haarlem (n=3) y S (n=7). La conformación de un clúster de dos aislados de pacientes con un vínculo epidemiológico sugiere la posible transmisión nosocomial de la TB en el HUC

Tuberculosis (TB) is an infectious disease, caused by species from the Mycobacterium tuberculosis complex (MTBC). It is an easily transmitted disease that it can increase the risk of infection among people who are in hospital, medical staff and visitors The purpose of this study was to molecular typing by VNTR-MIRU 35 isolates of Mycobacterium tuberculosis (M.tb) from hospitalized patients in the "Hospital Universitario de Caracas" during 2010-2011 to establish whether there is a close genetic relationship between isolates and to detect whether the nosocomial transmission was presented. In the analysis of VNTR typing, 29 unique genetic patterns (82,9%) and 3 clusters were observed, of which only one consisted by genetic patterns of isolates from patient with close epidemiologic relation (overlapping of periods of hospitalization). With the comparative analysis of genetic patterns with VNTR-plus database using Neighbor-joining method it was possible to observe the clustering of the isolates with LAM (n=25), Haarlem (n=3), S (n=7). The forming of one cluster with two isolates from patients with epidemiological link suggests a possible nosocomial transmission of TB in HUC

Tuberculosis risk in health care workers.

Risk to health care workers (HCW) is of paramount importance in the global fight against tuberculosis (TB). There is mounting evidence that they are at increased risk of contracting TB infection as well as developing the disease. This occupational risk is at alarming proportions in the low- and middle-income countries (LMIC), because of increased exposure and lack of preventive measures. Although tuberculin skin test has been used for a long time to detect latent TB infection (LTBI), it has significant drawbacks. Interferon-gamma release assays arrived with a lot of promise, but the expected benefit of more specific diagnosis has not yet been proved. The treatment of LTBI is an area, which is not well studied in LMIC. Effective environmental and personal protective measures along with education to the patients and the HCW needs to be carried out expeditiously, to reduce the occupational risk of TB.

Investigation on the risk factors for reported rising of measles incidence during November, 2011 to February, 2012, in some areas of Hubei province / 中华流行病学杂志

Objective To identify the risk factors for reported sudden rise of measles incidence in November,2011,in some areas of Hubei province.Methods We analyzed all measles patients reported in the measles surveillance system from November 2011 to February 2012 in two prefectures with highest attack rates and their vaccination history by reviewing vaccination records.We interviewed patients' parents by telephone to obtain the history of visiting health care within 7 to 21 days before onset.We also used case-crossover study to estimate the relative risk (RR) of hospital acquired infection and to compare the exposure to health care between 7-21 days before onset to 37-51 days before onset among measles patients.Results Totally 140 patients were reported in the two prefectures.Reported measles incidence rates among the population aged ＜8 m (69/100 000) and 8 m to 17 m (72/100 000) were higher than other age groups (rang from 0 to 5.8 per 100 000).Among the population aged 8 m to 17 m,estimated vaccination coverage was lower than 75％,and it was lower than 90％ among those aged 18 m to 3 yrs.During 7-21 days before onset,58％(29/50) of the patients had an exposure to health care settings,compared to 14％ (7/50) of patients during 37 to 51 days before onset (MH RR=5.4,95％ confidence interval=2.1-14.0).Conclusion Under the condition of measles vaccination coverage lower than 95％,iatrogenic infection was a risk factor for measles in Hubei.

A Locally Acquired Falciparum Malaria via Nosocomial Transmission in Korea

A 57-year old man who was admitted to an emergency room of a tertiary hospital with hemoptysis developed malarial fever 19 days later and then died from severe falciparum malaria 2 days later. He had not traveled outside of Korea for over 30 years. Through intensive interviews and epidemiological surveys, we found that a foreign patient with a recent history of travel to Africa was transferred to the same hospital with severe falciparum malaria. We confirmed through molecular genotyping of the MSP-1 gene that Plasmodium falciparum genotypes of the 2 patients were identical. It is suggested that a breach of standard infection control precautions resulted in this P. falciparum transmission between 2 patients in a hospital environment. This is the first report of a nosocomial transmission of falciparum malaria in Korea.

Nosocomial Mycobacterium tuberculosis transmission among healthcare students in a high incidence region, in Vitória, State of Espírito Santo

This open comparative study for evaluating hypersensitivity to tuberculin among medical students (n=441), nursing students (n=178) and economics students (n=230) in Vitória, State of Espírito Santo, had the aim of assessing whether the prevalence of positive tuberculin tests among healthcare students could be used as a sentinel event for nosocomial transmission in localities with high endemicity. There was a significant change in the frequency of purified protein derivative reactivity in the nursing students (20. 3 percent) and medical students (18. 4 percent), in comparison with the economics students (6 percent) (p <0. 001). As expected, the medical and nursing students had more knowledge about tuberculosis than did the economics students (p <0. 001). Our data suggest that the incidence of Mycobacterium tuberculosis infection among nursing and medical students in our region, which has high endemicity of tuberculosis, does not differ from what is found in low-incidence countries. These data reinforce the need for implementing biosafety programs for this target population.

Este estudo aberto, comparativo, para avaliar a hipersensibilidade a tuberculina em estudantes de medicina (n=441), enfermagem (n=178) e economia (n=230) em Vitória, ES, teve por objetivo avaliar se a prevalência de teste tuberculínico positivo em discentes da área da saúde poderia ser utilizada como evento sentinela de transmissão nosocomial em locais de alta endemicidade. Houve mudança significante na freqüência de reatividade purified protein derivative no grupo de estudantes de enfermagem (20,3 por cento) e medicina (18,4 por cento) comparativamente ao grupo dos estudantes de economia (6 por cento) p<0,001. Como esperado os alunos de medicina e enfermagem tem mais conhecimento sobre a tuberculose que os de economia (p <0,001). Nossos dados sugerem que a incidência da infecção pelo Mycobacterium tuberculosis em estudantes de enfermagem e medicina na nossa região com alta endemicidade de tuberculose não difere de países com baixa incidência da doença. Estes dados reforçam a necessidade de implementação de programas de biossegurança para essa população-alvo.