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中东呼吸综合征冠状病毒在医护人员中的传播:对感染控制的启示。

Middle East respiratory syndrome coronavirus transmission among health care workers: Implication for infection control.

机构信息

Corona Center, Infectious Diseases Division, Department of Pediatric, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; University of British Columbia, Vancouver, BC, Canada.

Indiana University School of Medicine, Indianapolis, IN; Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.

出版信息

Am J Infect Control. 2018 Feb;46(2):165-168. doi: 10.1016/j.ajic.2017.08.010. Epub 2017 Sep 25.

Abstract

BACKGROUND

Many outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) have occurred in health care settings and involved health care workers (HCWs). We describe the occurrence of an outbreak among HCWs and attempt to characterize at-risk exposures to improve future infection control interventions.

METHODS

This study included an index case and all HCW contacts. All contacts were screened for MERS-CoV using polymerase chain reaction.

RESULTS

During the study period in 2015, the index case was a 30-year-old Filipino nurse who had a history of unprotected exposure to a MERS-CoV-positive case on May 15, 2015, and had multiple negative tests for MERS-CoV. Weeks later, she was diagnosed with pulmonary tuberculosis and MERS-CoV infection. A total of 73 staff were quarantined for 14 days, and nasopharyngeal swabs were taken on days 2, 5, and 12 postexposure. Of those contacts, 3 (4%) were confirmed positive for MERS-CoV. An additional 18 staff were quarantined and had MERS-CoV swabs. A fourth case was confirmed positive on day 12. Subsequent contact investigations revealed a fourth-generation transmission. Only 7 (4.5%) of the total 153 contacts were positive for MERS-CoV.

CONCLUSIONS

The role of HCWs in MERS-CoV transmission is complex. Although most MERS-CoV-infected HCWs are asymptomatic or have mild disease, fatal infections can occur and HCWs can play a major role in propagating health care facility outbreaks. This investigation highlights the need to continuously review infection control guidance relating to the role of HCWs in MERS-CoV transmission in health care outbreaks, especially as it relates to the complex questions on definition of risky exposures, who to test, and the frequency of MERS-CoV testing; criteria for who to quarantine and for how long; and clearance and return to active duty criteria.

摘要

背景

中东呼吸综合征冠状病毒(MERS-CoV)已在多个医疗机构暴发,涉及医护人员(HCWs)。我们描述了一起发生在 HCWs 中的暴发事件,并尝试对高危接触进行特征描述,以改进未来的感染控制干预措施。

方法

本研究包括一名索引病例和所有 HCW 接触者。所有接触者均采用聚合酶链反应(PCR)进行 MERS-CoV 筛查。

结果

在 2015 年的研究期间,索引病例是一名 30 岁的菲律宾护士,她曾于 2015 年 5 月 15 日有过一次对 MERS-CoV 阳性病例的无保护接触史,且多次检测 MERS-CoV 均为阴性。数周后,她被诊断为肺结核和 MERS-CoV 感染。共有 73 名员工被隔离 14 天,在接触后第 2、5 和 12 天采集鼻咽拭子。其中 3 名(4%)接触者被确诊为 MERS-CoV 阳性。另有 18 名员工被隔离并进行了 MERS-CoV 拭子检测。第 12 天确诊第 4 例阳性病例。随后的接触者调查显示发生了四代传播。在总共 153 名接触者中,只有 7 名(4.5%)检测出 MERS-CoV 阳性。

结论

医护人员在 MERS-CoV 传播中的作用很复杂。虽然大多数感染 MERS-CoV 的 HCWs 无症状或仅有轻症,但也可能发生致命感染,且 HCWs 可能在传播医疗机构暴发中发挥重要作用。本研究强调需要不断审查与 HCWs 在医疗机构暴发中的 MERS-CoV 传播作用相关的感染控制指南,特别是在涉及高危接触的定义、检测对象、MERS-CoV 检测频率、隔离对象和隔离时长、解除隔离和重返工作岗位的标准等复杂问题上。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d709/7115310/523dd33d2bc7/ymic4557-fig-0001_lrg.jpg

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