Nosocomial Outbreak of SARS-CoV-2 in a "Non-COVID-19" Hospital Ward: Virus Genome Sequencing as a Key Tool to Understand Cryptic Transmission.

Dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare institutions affects both patients and health-care workers (HCW), as well as the institutional capacity to provide essential health services. Here, we investigated an outbreak of SARS-CoV-2 in a "non-COVID-19" hospital ward unveiled by massive testing, which challenged the reconstruction of transmission chains. The contacts network during the 15-day period before the screening was investigated, and positive SARS-CoV-2 RNA samples were subjected to virus genome sequencing. Of the 245 tested individuals, 48 (21 patients and 27 HCWs) tested positive for SARS-CoV-2. HCWs were mostly asymptomatic, but the mortality among patients reached 57.1% (12/21). Phylogenetic reconstruction revealed that all cases were part of the same transmission chain. By combining contact tracing and genomic data, including analysis of emerging minor variants, we unveiled a scenario of silent SARS-CoV-2 dissemination, mostly driven by the close contact within the HCWs group and between HCWs and patients. This investigation triggered enhanced prevention and control measures, leading to more timely detection and containment of novel outbreaks. This study shows the benefit of combining genomic and epidemiological data for disclosing complex nosocomial outbreaks, and provides valuable data to prevent transmission of COVID-19 in healthcare facilities.

Acute coronary syndromes and other forms of coronary heart disease in the National Health Service, 1997-2001.

AIMS: 1) To study the frequency and distribution of acute coronary syndromes and other forms of ischemic heart disease (IHD) as the cause of hospitalization in the Portuguese National Health Service (NHS); 2) To compare mortality from the various forms of IHD by gender in NHS hospitals in the period 1997-2001. MATERIAL AND METHODS: Annual in-patient data based on Diagnosis Related Groups (DRGs) sent by each NHS hospital to the Informatics and Financial Management Institute (IGIF) using ICD-9-CM codes. After quality control of the data by IGIF, the Statistics Department of the Directorate-General of Health (GDS) studied the distribution of codes 410-414 by age group and gender. Measures of central tendency were studied and the Student's t test was used to evaluate the significance of differences between men and women in the distribution of IHD in-patients. RESULTS: Acute myocardial infarction (AMI) (410) caused 7618 hospitalizations (5271 male, 2347 female) in 1997. In 2001 the number was 10,047 (6693 male, 3354 female). Other acute and subacute forms of IHD (411) were 4005 (2522 male, 1483 female) and 4100 (2618 male, 1482 female) respectively during 1997 and 2001. Angina pectoris (413) and other forms of chronic ischemic heart disease (414) were 2479 (1543 male, 936 female) and 11,293 (7951 male, 3342 female) during 1997, and 1993 (1212 male, 781 female) and 12,029 (8277 male, 3752 female) during 2001. The age (meanSD) of in-patients coded as 410 was 63.1+/-12.9/63.9+/-17.0 years in men and 72.4+/-11.6/73.1+/-11.1 years in women over the period 1997-2001. Age differences by gender were statistically significant (p < 0.001). Age for code 411 was similar to AMI in men (62.9+/-11.1 years and 63.8+/-11.7 years respectively in 1997 and 2001), but was lower in AMI cases in women (68.4+/-10.6 years and 69.3+/-10.7 years respectively in 1997 and 2001). AMI mortality was higher in 1997 (11.6% male, 22.1% female) than in 2001 (9.9% male, 19.8% female). CONCLUSIONS: Acute coronary events are the cause of approximately half of the hospitalizations for IHD, in both sexes. The frequency of every form of IHD in men is higher than in women, and hospitalization occurs nine years earlier on average. Between 1997 and 2001, hospitalizations for IHD increased by over 10%, mainly for AMI (32%), although with no significant increase in age. Nevertheless, the prognosis for AMI in in-patients has improved in both sexes.

[Reported cases of tetanus in the North of Portugal (1993-2002). Missed opportunities for vaccination]. / Caracterização epidemiológica dos casos declarados de tétano. Oportunidades perdidas de vacinação.

The aim of this study was to motivate health professionals to avoid missed opportunities of vaccination against tetanus. In the North of Portugal, 210 cases of tetanus were reported between 1993 and 2002. Data for this study was collected from the computerised records of statutory reportable diseases (1993-2002) and written reports from local health authorities (2000-2002). Most cases occurred between 55 and 84 years of age. Above the age of 65, females were the most affected (73.7%). All 17 cases (2000-2002) received hospital care. Two deaths were reported. Type and site of injuries were analogous to those already described in the literature. None of the patients had been adequately vaccinated. Almost all cases had attended health services in the 10 previous years. In order to eliminate tetanus, all contacts with health professionals should be an opportunity to check vaccination status and immunise against tetanus as recommended.