Risk factors for reduction in adherence to protective measures following coronavirus disease 2019 (COVID-19) vaccination and vaccine perceptions among healthcare workers, in São Paulo, Brazil.

A survey evaluated 2,300 healthcare workers following the first dose of a coronavirus disease 2019 (COVID-19) vaccine in a tertiary-quaternary hospital in São Paulo, Brazil. Adherence to protective measures following vaccination was compared to previous non-work-related behaviors. Younger age, previous COVID-19, and burnout symptoms were associated with reduced adherence to mitigation measures.

Impact of COVID-19 RT-PCR testing of asymptomatic health care workers on absenteeism and hospital transmission during the pandemic.

Reducing the transmission of SARS-CoV-2 from asymptomatic and pre-symptomatic patients is critical in controlling the circulation of the virus. This study evaluated the prevalence of RT-PCR positivity in serial tests (every 20 days) in 429 asymptomatic health care workers (HCW) and its impact on absenteeism from May to August 2020. Asymptomatic HCW from a COVID-19 reference hospital in Campinas (1.2 million inhabitants), Brazil, were tested, screened, and placed on leave. A time-series segmented regression of weekly absenteeism rates was used, and cases of infection among hospitalized patients were analyzed. Viral gene sequencing and phylogenetic analysis were performed on samples gathered from professionals who had a positive result. A significant decrease in absenteeism was detected 3-4 weeks after the intervention at a time of increased transmission within the city. The prevalence of RT-PCR positivity among asymptomatic professionals was 17.3%. Phylogenetic analyses of 59 samples detected nine clusters, two of them strongly suggestive of intra-hospital transmission with strains (75% B.1.1.28) circulating in the region during this period. Testing and placing asymptomatic professionals on leave contributed to control strategy for COVID-19 transmission in the hospital environment, and in reducing positivity and absenteeism, which directly influences the quality of care and exposes professionals to an extra load of stress. BACKGROUND: Reducing the transmission of SARS-CoV-2 from asymptomatic and pre-symptomatic patients is critical in controlling the circulation of the virus. METHODS: This study evaluated the prevalence of RT-PCR positivity in serial tests (every 20 days) in 429 asymptomatic health care workers (HCW) and its impact on absenteeism from May to August 2020. Asymptomatic HCW from a COVID-19 reference hospital in Campinas (1.2 million inhabitants), Brazil, were tested, screened, and placed on leave. A time-series segmented regression of weekly absenteeism rates was used, and cases of infection among hospitalized patients were analyzed. Viral gene sequencing and phylogenetic analysis were performed on samples gathered from professionals who had a positive result. RESULTS: A significant decrease in absenteeism was detected 3-4 weeks after the intervention at a time of increased transmission within the city. The prevalence of RT-PCR positivity among asymptomatic professionals was 17.3%. Phylogenetic analyses of 59 samples detected nine clusters, two of them strongly suggestive of intra-hospital transmission with strains (75% B.1.1.28) circulating in the region during this period. CONCLUSIONS: Testing and placing asymptomatic professionals on leave contributed to control strategy for COVID-19 transmission in the hospital environment, and in reducing positivity and absenteeism, which directly influences the quality of care and exposes professionals to an extra load of stress.

Reinfection rate in a cohort of healthcare workers over 2 years of the COVID-19 pandemic.

In this large cohort of healthcare workers, we aimed to estimate the rate of reinfections by SARS-CoV-2 over 2 years of the COVID-19 pandemic. We investigated the proportion of reinfections among all the cases of SARS-CoV-2 infection from March 10, 2020 until March 10, 2022. Reinfection was defined as the appearance of new symptoms that on medical evaluation were suggestive of COVID-19 and confirmed by a positive RT-PCR. Symptoms had to occur more than 90 days after the previous infection. These 2 years were divided into time periods based on the different variants of concern (VOC) in the city of São Paulo. There were 37,729 medical consultations due to COVID-19 at the hospital's Health Workers Services; and 25,750 RT-PCR assays were performed, of which 23% (n = 5865) were positive. Reinfection by SARS-CoV-2 was identified in 5% (n = 284) of symptomatic cases. Most cases of reinfection occurred during the Omicron period (n = 251; 88%), representing a significant increase on the SARS-CoV-2 reinfection rate before and during the Omicron variant period (0.8% vs. 4.3%; p < 0.001). The mean interval between SARS-CoV-2 infections was 429 days (ranged from 122 to 674). The Omicron variant spread faster than Gamma and Delta variant. All SARS-CoV-2 reinfections were mild cases.

Evaluation of eleven immunochromatographic assays for SARS-CoV-2 detection: investigating the dengue cross-reaction.

COVID-19 disease is spread worldwide and diagnostic techniques have been studied in order to contain the pandemic. Immunochromatographic (IC) assays are feasible and a low-cost alternative especially in low and middle-income countries, which lack structure to perform certain diagnostic techniques. Here we evaluate the sensitivity and specificity of eleven different IC tests in 145 serum samples from confirmed cases of COVID-19 using RT-PCR and 100 negative serum samples from blood donors collected in February 2019. We also evaluated the cross-reactivity with dengue using 20 serum samples from patients with confirmed diagnosis for dengue collected in early 2019 through four different tests. We found high sensitivity (92%), specificity (100%) and an almost perfect agreement (Kappa 0.92) of IC assay, especially when we evaluated IgG and IgM combined after 10 days from the onset of symptoms with RT-PCR. However, we detected cross-reactivity between dengue and COVID-19 mainly with IgM antibodies (5 to 20% of cross-reaction) and demonstrated the need for better studies about diagnostic techniques for these diseases.

AGENTES ETIOLÓGICOS DE MENINGOENCEFALITE CIRCULANTES DURANTE O PERÍODO DE PANDEMIA DA COVID-19

Introdução A pandemia pelo novo coronavírus trouxe mudanças no comportamento da população. O impacto do efeito do uso de máscaras, do distanciamento social e das mudanças de comportamento da população sobre a circulação dos agentes etiológicos das meningites é desconhecido. Objetivo Descrever os agentes etiológicos em pacientes com meningite da comunidade durante o período de pandemia pelo COVID-19. Método Estudo de coorte retrospectiva, de janeiro de 2019 a dezembro de 2021, composta por pacientes com suspeita de meningite, em hospital terciário de ensino, conveniado ao SUS, em Fortaleza, Ceará. A identificação do microrganismo foi por cultura para germes piogênicos, micobactérias, fungos, sorologia e RT-PCR para arbovírus, RT-PCR para SARS-CoV-2, FilmArrayR Meningitis/Encephalitis Panel (Biomérieux) e GeneXpert MTB/RIF (Cepheid). Resultados Foram atendidos no hospital 721 casos suspeitos de meningite durante o período, e analisados 201 pacientes (28% do total). Em 143 (68%) houve confirmação de meningite. Cultura para germes piogênicos foi realizada em 92 (64%) pacientes, e os microrganismos encontrados foram: Cryptococcus sp. (n = 3;3%), S. pneumoniae (n = 3;3%), S. aureus (n = 1;1%), S. suis sorotipo I (n = 1;1%), S. agalactiae (n = 1;1%), N. meningitidis grupo C (n = 1;1%), K. pneumoniae (n = 1;1%), L. monocytogenes (n = 1;1%) e Corynebacterium jeikeium (n = 1;1%). A cultura para fungos (Cryptococcus) foi positiva em 10 pacientes. A cultura para micobactérias foi realizada em 34 (24%) pacientes, com 2 (6%) positivas. O PCR Multiplex foi realizado em 105 (73%) pacientes, com identificação de S. pneumoniae (n = 16;15%), N. meningitidis (n = 13;12%), Vírus Varicela-Zoster (n = 8;8%), Cryptococcus sp. (n = 7;7%), Citomegalovírus (n = 6;6%), Enterovírus (n = -5;5%), HSV-1 (n = 3;3%), HSV-2 (n = 2;2%), S. agalactiae (n = 2;2%), Haemophilus influenzae (n = 1;1%), Herpesvírus 6 (n = 1;1%) e Listeria monocytogenes (n = 1;1%). Houve coinfecção em 3 pacientes. O RT-PCR para M. tuberculosis (MTB) foi realizado em 51 (36%) pacientes, com detecção em 13 pacientes (25%). No período estudado, houve dois casos de meningite por SARS-CoV-2 (2%). Conclusão Identificaram-se uma ampla variedade de agentes etiológicos em circulação durante a pandemia. Apesar de S. pneumoniae e N. meningitidis terem sido os agentes mais frequentes, destacou-se a variedade de vírus. Foi relevante o incremento no diagnóstico das meningites pelos métodos moleculares em comparação com as culturas. Casos de meningoencefalite por COVID-19 foram identificados.

SURTO DE ACINETOBACTER BAUMANNII RESISTENTE A CARBAPENÊMICOS EM UMA UTI DE PACIENTES COM COVID-19: CONTROLE COM MEDIDAS BÁSICAS É POSSÍVEL

Introdução Surtos relacionados a Acinetobacter baumannii resistente a carbapenêmicos (CRAB) em unidades de terapia intensiva são eventos relatados na literatura durante a pandemia de COVID-19 e já observados em serviços do Brasil. Objetivo Descrever um surto de CRAB numa UTI adulto destinada a COVID, as medidas de prevenção aplicadas e os resultados após os planos de ação. Método Os dados clínicos e epidemiológicos relacionados ao surto foram registrados durante o período do evento pela equipe da UTI e pela equipe da Subcomissão do Controle de Infecção Hospitalar para fins de vigilância epidemiológica do hospital e para notificação. Os materiais para culturas foram coletados com propósito diagnóstico no momento da suspeita clínica e analisados pelo laboratório de referência do serviço (Laboratório Maricondi) e algumas cepas foram encaminhadas para o laboratório externo (Laboratorio de Investigação Médica do Instituto de Medicina Tropical) para análise de linhagem bacteriana com o objetivo de avaliar fonte comum do surto, sensibilidade antimicrobiana e mecanismos de resistência. Resultados O surto ocorreu em junho a setembro de 2021 no HU-UFSCAR, em pacientes internados na UTI adulto/ Leitos de suporte ventilatório para pacientes COVID 19 (total de 14 leitos). Neste período, 21 pacientes apresentaram swab de colonização ou cultura clínica positiva para o agente. Destes, 6 evoluíram a óbito (28%). A maioria (85%) apresentou o agente em trato respiratório, sendo um fator comum entre eles a necessidade de suporte respiratório (95%). No período, 2 pacientes tiveram cultura positiva para CRAB, mas encontravam-se internados em área diferente da área do surto (enfermaria não-COVID). Após envio das cepas para laboratório de pesquisa foram identificados 3 clones que eram comuns a todas as áreas do hospital. Foram identificados problemas como má adesão a prática de higiene de mãos, uso de avental e luvas fora do atendimento ao paciente e ausência de rotinas de limpeza dos equipamentos e leitos. Após treinamento de toda a equipe hospitalar, adequação do uso de EPIs, avaliação da qualidade de limpeza tivemos como resultado 4 semanas sem novos isolados e redução da densidade de incidência de infecções por CRAB de 14,4/1000 paciente.dia em julho para 0 em agosto. Conclusão Surtos de bactérias multirresistentes estão relacionadas a más práticas de higiene de mãos e limpeza de ambiente. A readequação dessas práticas é eficaz para o controle de surto e consequentemente redução das IRAS dentro de um serviço.

CARACTERIZAÇÃO DA INFECTIVIDADE DA VARIANTE ÔMICRON E PREDITORES DE POSITIVIDADE DE CULTURA VIRAL EM PROFISSIONAIS DE SAÚDE COM COVID-19 LEVE

Introdução A variante Ômicron do vírus SARS-CoV-2 (B.1.1.529) foi designada uma variante preocupante (VOC) devido à alta transmissibilidade e capacidade de escapar da imunidade natural e induzida por vacina. Objetivo Caracterizar a duração da infectividade da variante Ômicron em indivíduos vacinados com sintomas leves de COVID-19. Método Estudo transversal com 30 indivíduos vacinados com COVID-19 para avaliar a duração da infectividade da Ômicron comparando o isolamento viral com o teste rápido de antígeno (RAT) e os valores de Ct da reação em cadeia da polimerase em tempo real (RT-PCR) de amostras respiratórias nos dias 5, 7, 10 e 14 a partir do início dos sintomas. Resultados O crescimento viral foi observado em 46% (11/24) das amostras dos indivíduos vacinados no dia 5 dos sintomas e 20% (6/30) no dia 7, nenhuma amostra teve isolamento viral no dia 10. A carga de RNA viral permaneceu detectável em 97% (29/30) e 57% (17/30) dos participantes nos dias 10 e 14, respectivamente. Entre as amostras com isolamento viral, todas (n = 17) foram RAT e RT-PCR positivas. Por outro lado, amostras sem isolamento viral (n = 97) foram RAT e RT-PCR positivas em 36 (37%) e 83 (86%), respectivamente. RAT e RT-PCR evidenciaram sensibilidade global e valores preditivos negativos de 100%, porém, RAT apresentou 63% de especificidade global e 32% de valor preditivo positivo (VPP), enquanto RT-PCR evidenciou menor especificidade (14%) e VPP (17%) para predizer a infectividade. Conclusão Indivíduos vacinados imunocompetentes com infecção por Ômicron ainda podem transmitir o vírus no 7° dia de sintomas, portanto, é altamente improvável que estejam transmitindo o vírus infeccioso no dia 10. Testes rápidos de antígeno podem ser usados para estimar a duração da infectividade dos casos de Ômicron. Ag. Financiadora Instituto todos pela saúde do Banco Itaú.

COVID-19 and isolation: Risks and implications in the scenario of new variants.

With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.

Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites.

Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs' and cats' mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski's sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.

Adherence to non-pharmacological preventive measures among healthcare workers in a middle-income country during the first year of the COVID-19 pandemic: Hospital and community setting.

This study assessed, using a self-reported questionnaire, the adherence to PPE (mask, gowns, and gloves) at the workplace, as well as to non-pharmacological preventive measures (NPPM) (physical distance defined as hardly ever and/or never approaches other people within 1.5 meters, social isolation as leaving home less than once a week, hand hygiene was defined as performing hand hygiene ≥ 6 times per period, and adherence to the use of a mask outside of the workplace was defined as on all outings and hardly ever and/or never removes the mask) outside of the workplace among 1,296 health care workers (HCWs), including if NPPM adherence was associated with COVID-19 in HCWs. High adherence to PPE was independently associated with younger age, professional category, work in an area of direct patient assistance; use of public transportation, or adherence to NPPM outside of the workplace.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seroprevalence and Risk Factors Among Oligo/Asymptomatic Healthcare Workers: Estimating the Impact of Community Transmission.

We evaluated the seroprevalence of SARS-CoV-2 and risk factors among 4987 oligo/asymptomatic healthcare workers; seroprevalence was 14% and factors associated with SARS-CoV-2 infection were lower educational level (aOR, 1.93; 95% CI, 1.03-3.60), using public transport to work (aOR, 1.65; 95% CI, 1.07-2.62), and working in cleaning or security (aOR, 2.05; 95% CI, 1.04-4.03).

SARS-CoV-2 in a stream running through an underprivileged, underserved, urban settlement in São Paulo, Brazil: A 7-month follow-up.

COVID-19 pandemic has led to concerns on the circulation of SARS-CoV-2 in the environment, its infectivity from the environment and, the relevance of transmission via environmental compartments. During 31 weeks, water samples were collected from a heavily contaminated stream going through an urban, underprivileged community without sewage collection. Our results showed a statistically significant correlation between cases of COVID-19 and SARS in the community, and SARS-CoV-2 concentrations in the water. Based on the model, if the concentrations of SARS-CoV-RNA (N1 and N2 target regions) increase 10 times, there is an expected increase of 104% [95%CI: (62-157%)] and 92% [95%CI: (51-143%)], respectively, in the number of cases of COVID-19 and SARS. We believe that differences in concentration of the virus in the environment reflect the epidemiological status in the community, which may be important information for surveillance and controlling dissemination in areas with vulnerable populations and poor sanitation. None of the samples were found infectious based cultures. Our results may be applicable globally as similar communities exist worldwide.

A Novel Saliva RT-LAMP Workflow for Rapid Identification of COVID-19 Cases and Restraining Viral Spread.

Rapid diagnostics is pivotal to curb SARS-CoV-2 transmission, and saliva has emerged as a practical alternative to naso/oropharyngeal (NOP) specimens. We aimed to develop a direct RT-LAMP (reverse transcription loop-mediated isothermal amplification) workflow for viral detection in saliva, and to provide more information regarding its potential in curbing COVID-19 transmission. Clinical and contrived specimens were used to optimize formulations and sample processing protocols. Salivary viral load was determined in symptomatic patients to evaluate the clinical performance of the test and to characterize saliva based on age, gender and time from onset of symptoms. Our workflow achieved an overall sensitivity of 77.2% (n = 90), with 93.2% sensitivity, 97% specificity, and 0.895 Kappa for specimens containing >102 copies/µL (n = 77). Further analyses in saliva showed that viral load peaks in the first days of symptoms and decreases afterwards, and that viral load is ~10 times lower in females compared to males, and declines following symptom onset. NOP RT-PCR data did not yield relevant associations. This work suggests that saliva reflects the transmission dynamics better than NOP specimens, and reveals gender differences that may reflect higher transmission by males. This saliva RT-LAMP workflow can be applied to track viral spread and, to maximize detection, testing should be performed immediately after symptoms are presented, especially in females.

Procalcitonin as a biomarker for ventilator associated pneumonia in COVID-19 patients: Is it an useful stewardship tool?

Ventilator associated pneumonia(VAP) is a severe complication that can lead to high mortality when not early identified or when therapy is delayed. The aim of this study was to evaluate procalcitonin(PCT) as a biomarker for VAP development. In total, 73 hospitalized patients with COVID-19 were analyzed. PCT levels greater than 0.975ng/mL were more related to VAP. No association was found for C-reactive protein (CRP). The results show that procalcitonin may be a pertinent biomarker for VAP diagnosis and can be a helpful tool for antibiotic withdrawal.

SARS-Cov-2 seroprevalence and risk factors among health care workers: Estimating the risk of COVID-19 dedicated units.

We evaluated the seroprevalence of SARS-CoV-2 and risk factors among 1,996 oligo/asymptomatic health care workers. The seroprevalence was 5.5% and risk factors associated with being infected with SARS-CoV-2 was professional category of cleaning (adj odds ratio 2.22, 95% confidence interval: 1.12-4.44, P: .023) and male gender (adj odds ratio: 1.54, 95% confidence interval: 1.03-2.32, P: .035).Working at dedicated COVID-19 units (high-risk group) was not an independent risk factor for seropositivity.

Decontamination and re-use of surgical masks and respirators during the COVID-19 pandemic.

OBJECTIVES: The coronavirus disease 2019 pandemic increased global demand for personal protective equipment (PPE) and resulted in shortages. The study evaluated the re-use of surgical masks and respirators by analysing their performance and safety before and after reprocessing using the following methods: oven, thermal drying, autoclave, and hydrogen peroxide plasma vapour. METHODS: In total, 45 surgical masks and 69 respirators were decontaminated. Visual integrity, air permeability, burst resistance, pressure differential and particulate filtration efficiency of new and decontaminated surgical masks and respirators were evaluated. In addition, 14 used respirators were analysed after work shifts before and after decontamination using reverse transcription polymerase chain reaction (RT-PCR) and viral culturing. Finally, reprocessed respirators were evaluated by users in terms of functionality and comfort. RESULTS: Oven decontamination (75 °C for 45 min) was found to be the simplest decontamination method. Physical and filtration assays indicated that all reprocessing methods were safe after one cycle. Oven decontamination maintained the characteristics of surgical masks and respirators for at least five reprocessing cycles. Viral RNA was detected by RT-PCR in two of the 14 used respirators. Four respirators submitted to viral culture were PCR-negative and culture-negative. Reprocessed respirators used in work shifts were evaluated positively by users, even after three decontamination cycles. CONCLUSION: Oven decontamination is a safe method for reprocessing surgical masks and respirators for at least five cycles, and is feasible in the hospital setting.