Outbreak Investigation in a COVID-19 Designated Hospital: The Combination of Phylogenetic Analysis and Field Epidemiology Study Suggesting Airborne Transmission

Overview

Journal J Microbiol Immunol Infect

Specialties Allergy & Immunology
Microbiology

Date 2023 Jan 23

PMID 36690516

Authors

Yi-Chia Huang

Hsiao-Chen Tu

Han-Yueh Kuo

Pei-Lan Shao

Yu-Nong Gong

Hui-Ying Weng

Hung-Yu Shu

Chiung-Hui Kuo

Po-Hsien Kuo

Chien-Hui Chien

Chen-Chi Wu

Ding-Cheng Derrick Chan

Meng-Kun Tsai

Shih-Feng Tsai

Chong-Jen Yu

Affiliations

Soon will be listed here.

Abstract

Background: Healthcare-associated COVID-19 infections caused by SARS-CoV-2 have increased morbidity and mortality. Hospitals and skilled nursing facilities (SNFs) have been challenged by infection control and management.

Methods: This case study presents an outbreak investigation in a COVID-19-designated hospital and a hospital-based SNF. Real-time polymerase chain reaction (PCR) and other studies were performed on samples obtained from SNF residents, hospital patients, and healthcare workers (HCWs). The results of the laboratory tests and field epidemiological data were analyzed. Genome sequencing and phylogenetic analysis of SARS-CoV-2 were performed to identify the associations between cases. The tracer gas was released and recorded by a thermal imaging camera to investigate the spatial relations within clusters.

Results: During the outbreak, 29 COVID-19 infections in 3 clusters were identified through hospital-wide, risk-guided, and symptom-driven PCR tests. This included 12 HCWs, 5 patients, and 12 SNF residents who had been hospitalized for at least 14 days. Serology tests did not identify any cases among the PCR-negative individuals. The phylogenetic analysis revealed that viral strains from the 3 clusters shared a common mutation of G3994T and were phylogenetically related, which suggested that this outbreak had a common source rather than multiple introductions from the community. Linked cases exhibited vertical spatial distribution, and the sulfur hexafluoride release test confirmed a potential airborne transmission.

Conclusions: This report addressed the advantage of a multi-disciplinary team in outbreak investigation. Identifying an airborne transmission within an outbreak highlighted the importance of regular maintenance of ventilation systems.

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