Imborek Katherine L, Krasowski Matthew D, Natvig Paul, Merrill Anna E, Diekema Daniel J, Ford Bradley A
Department of Family Medicine, University of Iowa Hospitals and Clinics, IA, USA.
Department of Pathology, University of Iowa Hospitals and Clinics, IA, USA.
Acad Pathol. 2021 Apr 28;8:23742895211010247. doi: 10.1177/23742895211010247. eCollection 2021 Jan-Dec.
International travel has been a significant factor in the coronavirus disease 2019 pandemic. Many countries and airlines have implemented travel restrictions to limit the spread of the causative agent, severe acute respiratory syndrome coronavirus-2. A common requirement has been a negative reverse-transcriptase polymerase chain reaction performed by a clinical laboratory within 48 to 72 hours of departure. A more recent travel mandate for severe acute respiratory syndrome coronavirus-2 immunoglobulin M serology testing was instituted by the Chinese government on October 29, 2020. Pretravel testing for severe acute respiratory syndrome coronavirus-2 raises complications in terms of cost, turnaround time, and follow-up of positive results. In this report, we describe the experience of a multidisciplinary collaboration to develop a workflow for pretravel severe acute respiratory syndrome coronavirus-2 reverse-transcriptase polymerase chain reaction and immunoglobulin M serology testing at an academic medical center. The workflow primarily involved self-payment by patients and preferred retrieval of results by the patient through the electronic health record patient portal (Epic MyChart). A total of 556 unique patients underwent pretravel reverse-transcriptase polymerase chain reaction testing, with 13 (2.4%) having one or more positive results, a rate similar to that for reverse-transcriptase polymerase chain reaction testing performed for other protocol-driven asymptomatic screening (eg, inpatient admissions, preprocedural) at our medical center. For 5 of 13 reverse-transcriptase polymerase chain reaction positive samples, the traveler had clinical history, prior reverse-transcriptase polymerase chain reaction positive, and high cycle thresholds values on pretravel testing consistent with remote infection and minimal transmission risk. Severe acute respiratory syndrome coronavirus-2 immunoglobulin M was performed on only 24 patients but resulted in 2 likely false positives. Overall, our experience at an academic medical center shows the challenge with pretravel severe acute respiratory syndrome coronavirus-2 testing.
国际旅行一直是2019冠状病毒病大流行的一个重要因素。许多国家和航空公司已实施旅行限制，以限制病原体严重急性呼吸综合征冠状病毒2的传播。一个常见的要求是在出发前48至72小时内由临床实验室进行逆转录聚合酶链反应检测结果为阴性。2020年10月29日，中国政府发布了一项关于严重急性呼吸综合征冠状病毒2免疫球蛋白M血清学检测的最新旅行要求。出发前对严重急性呼吸综合征冠状病毒2进行检测在成本、周转时间和阳性结果随访方面引发了一些问题。在本报告中，我们描述了一个多学科合作的经验，即在一家学术医疗中心开发一种用于出发前严重急性呼吸综合征冠状病毒2逆转录聚合酶链反应和免疫球蛋白M血清学检测的工作流程。该工作流程主要涉及患者自费，并优先让患者通过电子健康记录患者门户（Epic MyChart）获取检测结果。共有556名不同患者接受了出发前逆转录聚合酶链反应检测，其中13人（2.4%）有一个或多个阳性结果，这一比例与我们医疗中心为其他方案驱动的无症状筛查（如住院入院、术前检查）进行的逆转录聚合酶链反应检测的比例相似。在13份逆转录聚合酶链反应阳性样本中的5份中，旅行者有临床病史，之前逆转录聚合酶链反应呈阳性，且出发前检测的循环阈值较高，符合既往感染且传播风险极小。仅对24名患者进行了严重急性呼吸综合征冠状病毒2免疫球蛋白M检测，但出现了2例假阳性结果。总体而言，我们在一家学术医疗中心的经验显示了出发前对严重急性呼吸综合征冠状病毒2进行检测面临的挑战。
