Park Hayne Cho, Lee Sang-Ho, Kim Juhee, Kim Do Hyoung, Cho AJin, Jeon Hee Jung, Oh Jieun, Noh Jung-Woo, Jeong Da-Wun, Kim Yang-Gyun, Lee Chang-Hee, Yoo Kyung Don, Lee Young-Ki
Department of Internal Medicine, Kangnam Sacred Heart Hospital.
Hallym University Kidney Research Institute.
Medicine (Baltimore). 2020 Jan;99(3):e18782. doi: 10.1097/MD.0000000000018782.
Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.
在沙特阿拉伯中东呼吸综合征冠状病毒（MERS-CoV）疫情爆发期间，血液透析（HD）患者的感染传播率和死亡率很高。目前尚无针对暴露的HD患者隔离技术的标准化指南。因此，本研究旨在评估不同隔离策略对预防暴露的HD患者继发病毒传播及临床结局的效果。在2015年韩国MERS-CoV疫情爆发期间，3个血液透析单元的116名患者意外接触了确诊感染MERS-CoV的个体，并接受了不同类型的隔离，具体如下：单间隔离（n = 54，47%）、群组隔离（n = 46，40%）和自行隔离（n = 16，13%）。主要结局是继发病毒传播率。次要结局指标包括隔离期间临床和生化指标的变化、根据隔离方式不同临床和生化指标的差异以及隔离方式对患者生存的影响。在平均15天的隔离期内，HD患者中未检测到进一步的继发传播病例。隔离期间血浆血红蛋白、血清钙和血清白蛋白水平以及单池Kt/V下降，但之后恢复正常。自行隔离的患者比接受单间或群组隔离的患者收缩压和舒张压更高，总胆固醇水平更低，Kt/V更低。在24个月的随访期内，有12名患者死亡。然而，在隔离期间没有死亡病例发生，根据不同隔离策略观察到的患者生存率也没有差异。尽管在2015年韩国疫情爆发期间，3个血液透析单元的116名参与者意外接触了MERS-CoV，但严格的患者监测和适当的隔离措施预防了病毒的继发传播。因此，未来必须制定肾脏灾难预案，包括适当的接触监测和隔离措施，以满足灾难或疫情期间HD患者的需求。
