Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Clin Infect Dis. 2021 Jul 30;73(Suppl 2):S163-S169. doi: 10.1093/cid/ciaa1664.
An outbreak of coronavirus disease 2019 (COVID-19) in a nursing home in the Netherlands, following an on-site church service held on 8 March 2020, triggered an investigation to unravel sources and chain(s) of transmission.
Epidemiological data were collected from registries and through a questionnaire among church attendees. Symptomatic residents and healthcare workers (HCWs) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction and subjected to whole genome sequencing (WGS). Sequences from a selection of people from the same area were included as community reference.
After the church service, 30 of 39 attendees (77%) developed symptoms; 14 (11 residents and 3 nonresidents) were tested and were positive for COVID-19. In the following 5 weeks, 62 of 300 residents (21%) and 30 of 640 HCWs (5%) tested positive for COVID-19; 21 of 62 residents (34%) died. The outbreak was controlled through a cascade of measures. WGS of samples from residents and HCWs identified a diversity of sequence types, grouped into 8 clusters. Seven resident church attendees all were infected with distinct viruses, 4 of which belonged to 2 larger clusters in the nursing home.
Although initial investigation suggested the church service as the source of the outbreak, detailed analysis showed a more complex picture, most consistent with widespread regional circulation of the virus in the weeks before the outbreak, and multiple introductions into the nursing home before the visitor ban. The findings underscore the importance of careful outbreak investigations to understand SARS-CoV-2 transmission to develop evidence-based mitigation measures.
2020 年 3 月 8 日在荷兰的一家养老院举行现场教堂礼拜后，爆发了 2019 年冠状病毒病（COVID-19）疫情，由此展开了一项调查，以揭示传播源和传播链。
从登记处和通过对教堂参加者的问卷调查收集了流行病学数据。对有症状的居民和医护人员（HCWs）进行了严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）的逆转录聚合酶链反应（RT-PCR）检测，并进行了全基因组测序（WGS）。从同一地区选择的一些人的序列被纳入社区参考。
在教堂礼拜之后，39 名参加者中有 30 人（77％）出现症状；对 14 人（11 名居民和 3 名非居民）进行了检测，COVID-19 检测呈阳性。在接下来的 5 周内，300 名居民中有 62 人（21％）和 640 名 HCWs 中有 30 人（5％）COVID-19 检测呈阳性；21 名居民（34％）死亡。通过一系列措施控制了疫情。对居民和 HCWs 的样本进行 WGS 鉴定出了多种序列类型，分为 8 个簇。7 名居民教堂参加者均感染了不同的病毒，其中 4 种属于养老院中的 2 个较大的簇。
尽管初步调查表明教堂礼拜是疫情的源头，但详细分析显示出更为复杂的情况，最符合疫情爆发前数周病毒在该地区广泛传播的情况，以及访客禁令之前病毒多次传入养老院的情况。这些发现强调了仔细进行疫情调查以了解 SARS-CoV-2 传播的重要性，以便制定基于证据的缓解措施。
