Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences (The First Department of Internal Medicine), 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Japan Physicians Association, Tokyo, Japan.
BMC Infect Dis. 2021 Mar 15;21(1):263. doi: 10.1186/s12879-021-05972-5.
The Pandemic of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has critically impacted the spread of infection within nursing facilities. We evaluated the usefulness of genetic and serological tests conducted during a COVID-19 outbreak in a nursing facility in Japan.
After the first identification of SARS-CoV-2 infection, a comprehensive, facility- and/or unit-wide PCR testing from nasopharyngeal swabs was repeatedly performed in a three-unit facility including 99 residents with dementia and 53 healthcare personnel. Additionally, PCR testing was conducted separately for residents and staff with fever of ≥37.5 °C. Facility-wide serological testing, including rapid kit testing and quantitative assay, was conducted twice over 1 month apart.
A total of 322 PCR and 257 antibody tests were performed. 37 (24.3%) of the 152 individuals (25/99 residents, 25.3%; 12/53 staff, 22.6%) were identified as PCR-positive. Seven residents died with a mortality of 7.1% (7/99). Among the 37 individuals, 10 (27.0%) were asymptomatic at the time of testing. PCR positivity was concentrated on one unit (Unit 1) (20/30 residents, 66.7%; 9/14 staff, 64.3%). The other units showed a limited spread of infection. In unit-wide and separate tests, PCR positivity detection was highly prevalent (22.9 and 44.4%, respectively) in Unit 1, compared with that in the other units. Serological testing identified two additional infected residents with a negative PCR result and showed that no staff was newly identified as infected.
Thorough PCR testing, in combination with comprehensive and separate tests, is critical for managing COVID-19 outbreaks in nursing facilities, particularly, in units considered an epicenter. Serological testing is also beneficial for tracing contacts, confirming the number of infected individuals, and authorizing the termination of the outbreak.
由严重急性呼吸系统综合症冠状病毒 2 型（SARS-CoV-2）引起的冠状病毒病（COVID-19）大流行，严重影响了护理机构内感染的传播。我们评估了在日本一家护理机构 COVID-19 爆发期间进行的基因和血清学检测的有用性。
在首次发现 SARS-CoV-2 感染后，对包括 99 名痴呆症患者和 53 名医护人员在内的三个单元设施进行了全面的、设施内和/或单元内的鼻咽拭子 PCR 重复检测。此外，对发热≥37.5°C 的居民和工作人员进行了单独的 PCR 检测。在相隔 1 个月的两次检测中，对设施内进行了血清学检测，包括快速试剂盒检测和定量检测。
共进行了 322 次 PCR 和 257 次抗体检测。在 152 名个体（25/99 名居民，25.3%；12/53 名工作人员，22.6%）中，有 37 名（24.3%）被确定为 PCR 阳性。7 名居民死亡，死亡率为 7.1%（7/99）。在这 37 名个体中，10 名（27.0%）在检测时无症状。PCR 阳性集中在一个单元（1 单元）（20/30 名居民，66.7%；9/14 名工作人员，64.3%）。其他单元显示感染的传播有限。在单元内和单独的检测中，1 单元的 PCR 阳性检出率较高（分别为 22.9%和 44.4%），而其他单元则较低。血清学检测还发现了另外两名 PCR 结果阴性的感染居民，并显示没有工作人员被新确定为感染。
彻底的 PCR 检测，结合全面和单独的检测，对于管理护理机构的 COVID-19 爆发至关重要，特别是在被认为是疫情中心的单元。血清学检测也有助于追踪接触者，确认感染人数，并授权结束疫情。
