COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021.

OBJECTIVES: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.

Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel - United States, 2021-22.

The Advisory Committee on Immunization Practices (ACIP) and CDC recommend that all health care personnel (HCP) receive annual influenza vaccination to reduce influenza-related morbidity and mortality among these personnel and their patients (1). ACIP also recommends that all persons aged ≥6 months, including HCP, be vaccinated with COVID-19 vaccines and remain up to date (2,3). During March 29-April 19, 2022, CDC conducted an opt-in Internet panel survey of 3,618 U.S. HCP to estimate influenza vaccination coverage during the 2021-22 influenza season as well as receipt of the primary COVID-19 vaccination series and a booster dose. Influenza vaccination coverage was 79.9% during the 2021-22 season, and 87.3% of HCP reported having completed the primary COVID-19 vaccination series; among these HCP, 67.1% reported receiving a COVID-19 booster dose. Among HCP, influenza, COVID-19 primary series, and COVID-19 booster dose vaccination coverage were lowest among assistants and aides, those working in long-term care (LTC) or home health care settings, and those whose employer neither required nor recommended the vaccines. Overall, employer requirements for influenza and COVID-19 primary series vaccines were reported by 43.9% and 59.9% of HCP, respectively; among HCP who completed the primary series of COVID-19 vaccines, 23.5% reported employer requirements for COVID-19 booster vaccines. Vaccination coverage for all three vaccine measures was higher among HCP who reported employer vaccination requirements and ranged from 95.8% to 97.3% for influenza, 90.2% to 95.1% for COVID-19 primary series, and 76.4% to 87.8% for COVID-19 booster vaccinations among HCP who completed the primary series of COVID-19 vaccines, by work setting. Implementing workplace strategies demonstrated to improve vaccination coverage among HCP, including vaccination requirements or active promotion of vaccination, can increase influenza and COVID-19 vaccination coverage among HCP and reduce influenza and COVID-19-related morbidity and mortality among HCP and their patients (4).

Employer requirements and COVID-19 vaccination and attitudes among healthcare personnel in the U.S.: Findings from National Immunization Survey Adult COVID Module, August - September 2021.

INTRODUCTION: Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP's COVID-19 vaccination status and attitudes about the vaccine. METHODS: Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August-September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. RESULTS: Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements-a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18-29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine's safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). CONCLUSION: In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines.

Reported exposure trends among healthcare personnel COVID-19 cases, USA, March 2020-March 2021.

BACKGROUND: Health care personnel (HCP) have experienced significant SARS-CoV-2 risk, but exposure settings among HCP COVID-19 cases are poorly characterized. METHODS: We assessed exposure settings among HCP COVID-19 cases in the United States from March 2020 to March 2021 with reported exposures (n = 83,775) using national COVID-19 surveillance data. Exposure setting and reported community incidence temporal trends were described using breakpoint estimation. Among cases identified before initiation of COVID-19 vaccination programs (n = 65,650), we used separate multivariable regression models to estimate adjusted prevalence ratios (aPR) for associations of community incidence with health care and household and/or community exposures. RESULTS: Health care exposures were the most reported (52.0%), followed by household (30.8%) and community exposures (25.6%). Health care exposures and community COVID-19 incidence showed similar temporal trends. In adjusted analyses, HCP cases were more likely to report health care exposures (aPR = 1.31; 95% CI:1.26-1.36) and less likely to report household and/or community exposures (aPR = 0.73; 95% CI:0.70-0.76) under the highest vs lowest community incidence levels. DISCUSSION: These findings highlight HCP exposure setting temporal trends and workplace exposure hazards under high community incidence. Findings also underscore the need for robust collection of work-related data in infectious disease surveillance. CONCLUSIONS: Many reported HCP cases experienced occupational COVID-19 exposures, particularly during periods of higher community COVID-19 incidence.

COVID-19 Vaccination and Intent Among Healthcare Personnel, U.S.

INTRODUCTION: Healthcare personnel are at increased risk for COVID-19 from workplace exposure. National estimates on COVID-19 vaccination coverage among healthcare personnel are limited. METHODS: Data from an opt-in Internet panel survey of 2,434 healthcare personnel, conducted on March 30, 2021-April 15, 2021, were analyzed to assess the receipt of ≥1 dose of a COVID-19 vaccine and vaccination intent. Multivariable logistic regression was used to assess the factors associated with COVID-19 vaccination and intent for vaccination. RESULTS: Overall, 68.2% of healthcare personnel reported a receipt of ≥1 dose of a COVID-19 vaccine, 9.8% would probably/definitely get vaccinated, 7.1% were unsure, and 14.9% would probably/definitely not get vaccinated. COVID-19 vaccination coverage was highest among physicians (89.0%), healthcare personnel working in hospitals (75.0%), and healthcare personnel of non-Hispanic White or other race (75.7%-77.4%). Healthcare personnel who received influenza vaccine in 2020-2021 (adjusted prevalence ratio=1.92) and those aged ≥60 years (adjusted prevalence ratio=1.37) were more likely to report a receipt of ≥1 dose of a COVID-19 vaccine. Non-Hispanic Black healthcare personnel (adjusted prevalence ratio=0.74), nurse practitioners/physician assistants (adjusted prevalence ratio=0.55), assistants/aides (adjusted prevalence ratio=0.73), and nonclinical healthcare personnel (adjusted prevalence ratio=0.79) were less likely to have received a COVID-19 vaccine. The common reasons for vaccination included protecting self (88.1%), family and friends (86.3%), and patients (69.2%) from COVID-19. The most common reason for nonvaccination was concern about side effects and safety of COVID-19 vaccine (59.7%). CONCLUSIONS: Understanding vaccination status and intent among healthcare personnel is important for addressing barriers to vaccination. Addressing concerns on side effects, safety, and effectiveness of COVID-19 vaccines as well as their fast development and approval may help improve vaccination coverage among healthcare personnel.

Proposed Framework for Considering SARS-CoV-2 Antigen Testing of Unexposed Asymptomatic Workers in Selected Workplaces.

OBJECTIVES: To propose a framework for considering SARS-CoV-2 antigen testing of unexposed asymptomatic workers in selected workplaces. METHODS: This is a commentary based on established occupational safety and health principles, published articles, and other pertinent literature, including non-peer-reviewed preprints in medrixiv.org prior to April 16, 2021. RESULTS: Not applicable to this commentary/viewpoint article. CONCLUSION: Antigen testing is a rapidly evolving and useful public health tool that can be used to guide measures to reduce spread of SARS-CoV-2 in the community and in selected workplaces. This commentary provides a proposed framework for occupational safety and health practitioners and employers for considering antigen testing as a method to screen asymptomatic workers in selected non-healthcare settings. When applied selectively, antigen testing can be a useful, effective part of a comprehensive workplace program for COVID-19 prevention and control.

Occupational Respiratory Infections.

Occupational respiratory infections can be caused by bacterial, viral, and fungal pathogens. Transmission in occupational settings can occur from other humans, animals, or the environment, and occur in various occupations and industries. In this article, we describe 4 occupationally acquired respiratory infections at the focus of NIOSH investigations over the last decade: tuberculosis (TB), influenza, psittacosis, and coccidioidomycosis. We highlight the epidemiology, clinical manifestations, occupational risk factors, and prevention measures.

Media Reports as a Tool for Timely Monitoring of COVID-19-Related Deaths Among First Responders-United States, April 2020.

We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19-related deaths among first responders during March 30-April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19-related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19-related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers.

Candida auris Outbreak in a COVID-19 Specialty Care Unit - Florida, July-August 2020.

In July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A). C. auris is a multidrug-resistant yeast that can cause invasive infection. Its ability to colonize patients asymptomatically and persist on surfaces has contributed to previous C. auris outbreaks in health care settings (1-7). Since the first C. auris case was identified in Florida in 2017, aggressive measures have been implemented to limit spread, including contact tracing and screening upon detection of a new case. Before the COVID-19 pandemic, hospital A conducted admission screening for C. auris and admitted colonized patients to a separate dedicated ward.

Considerations for Pooled Testing of Employees for SARS-CoV-2.

OBJECTIVES: To identify important background information on pooled tested of employees that employers workers, and health authorities should consider. METHODS: This paper is a commentary based on the review by the authors of pertinent literature generally from preprints in medrixiv.org prior to August 2020. RESULTS/CONCLUSIONS: Pooled testing may be particularly useful to employers in communities with low prevalence of COVID-19. It can be used to reduce the number of tests and associated financial costs. For effective and efficient pooled testing employers should consider it as part of a broader, more comprehensive workplace COVID-19 prevention and control program. Pooled testing of asymptomatic employees can prevent transmission of SARS-CoV-2 and help assure employers and customers that employees are not infectious.

Respiratory Protection Resources in Long Term Care [video]

This is a "[w]ebinar presenting information about respiratory protection resources in long term care during the COVID-19 [coronavirus disease 2019] pandemic." The duration of this video is 1 hour, 18 minutes, and 54 seconds.

Strategies for Optimizing the Supply of N95 Filtering Facepiece Respirators During the Coronavirus Disease 2019 (COVID-19)Pandemic

N95 respirators are the personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in healthcare settings while maximizing the level of protection offered to healthcare personnel when there is limited supply in the United States during the Coronavirus Disease 2019 (COVID-19) pandemic. The strategies are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in healthcare facilities to protect healthcare personnel from job-related risks of exposure to infectious respiratory illnesses. Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss specific engineering control, administrative control, and personal protective equipment measures that may help in optimizing N95 respirator supplies.