A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment.

BACKGROUND: The arrival of the Delta variant of SARS-CoV-2 was associated with increased transmissibility and illness of greater severity. Reports of nosocomial outbreaks of Delta variant COVID-19 in acute care hospitals have been described but control measures varied widely. AIM: Epidemiological investigation of a linked two-ward COVID-19 Delta variant outbreak was conducted to elucidate its source, risk factors, and control measures. METHODS: Investigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS). FINDINGS: This linked two-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting, suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection. Sudden onset of symptoms, within 72 h, was observed in 79% of all Ward 2 patients, and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point-source outbreak. RT-PCR assays showed low cycle threshold (CT) values, indicating high viral load from environmental swabs including the vital signs cart. WGS results with ≤3 SNP differences between specimens were observed. CONCLUSION: Outbreaks on both wards settled rapidly, within 3 weeks, using a `back-to-basics' approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, co-operation from HCWs, including testing and interviews, and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.

North American and Eurasian strains of Stylonychia lemnae (Ciliophora, Hypotrichida) have a high genetic identity, but differ in the nuclear apparatus and in their mating behavior.

It was investigated whether the closely related species Stylonychia lemnae and Stylonychia mytilus occur in North America. Eigthy-one Stylonychia cells were collected in the surroundings of Ithaca, N.Y., USA. A comparison of their isoenzyme patterns and the number of dorsal cilia with those of Eurasian clones demonstrated that 79 clones belong to S. lemnae and 2 to S. mytilus. The mean genetic identity between the European and the North American populations of S. lemnae is 84% which is characteristic for different populations of one species. Only 33 of the North American clones conjugated. F 1 and F 2 exconjugants (North American × European clones) are as viable as exconjugants from European clones. Crossings of North American × European clones with different isoenzyme alleles demonstrated that the genetic material is exchanged. In contrast, many of the other 46 nonconjugating North American clones can start but do not finish conjugation ("pseudoconjugation" without genetic exchange). Some of these clones have Mi without function, small Mi or no Mi at all. Some clones also show a peculiar DNA banding pattern with several highly overamplified DNA sequences. It is concluded that the American populations of S. lemnae contain clones which diverge in several characteristics from the European/Asian clones.

Characterization of macronuclear DNA in five species of ciliates.

Macronuclear DNA of four hypotrichous and one holotrichous ciliate species was characterized by biochemical techniques. The renaturation kinetics of the macronuclear DNAs of all five species were similar. Repetitive sequences occur only in an amount below 2%. Although the DNA content of the macronuclei of the species differs considerably, the kinetic complexity of the macronuclear DNA is rather uniform (around 3 x 10(10) daltons, i.e., 4-11 x the E. coli genome). Only in the macronuclei of the hypotrichous species the DNA exists as gene-sized fragments.