The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia.
Influenza Other Respir Viruses. 2022 May;16(3):429-437. doi: 10.1111/irv.12942. Epub 2021 Dec 5.
Aged-care facilities (ACF's) provide unique challenges when implementing infection control methods for respiratory outbreaks such as COVID-19. Research on this highly vulnerable setting is lacking and there was no national reporting data of COVID-19 cases in ACFs in Australia early in the pandemic. We aimed to estimate the burden of aged-care worker (ACW) infections and outbreaks of COVID-19 in Australian aged-care.
A line list of publicly available aged-care related COVID-19 reported cases from January 25 to June 10, 2020 was created and was enhanced by matching data extracted from media reports of aged-care related COVID-19 relevant outbreaks and reports. Rate ratios (RR) were used to predict risk of infection in ACW and aged-care residents, and were calculated independently, by comparing overall cases to ACW and aged-care residents' cases.
A total of 14 ACFs with COVID-19 cases were recorded by June 2020 nationwide, with a high case fatality rate (CFR) of 50% (n = 34) and 100% (n = 3) seen in two ACFs. Analysis on the resident risk found that the COVID-19 risk is 1.27 times higher (unadjusted RR 1.27 95% confidence interval [CI] 1.00 to1.61; P = 0.047) as compared with the risk of infection in the general population. In over 60% of cases identified in ACFs, the source of infection in the index case was unknown. A total of 28 deaths associated within ACFs were reported, accounting for 54.9% of total deaths in New South Wales and 26.9% of total deaths in Australia.
This high-risk population requires additional prevention and control measures, such as routine testing of all staff and patients regardless of symptoms. Prompt isolation and quarantine as soon as a case is confirmed within a facility is essential.
在实施针对 COVID-19 等呼吸道传染病的感染控制方法时，老年护理设施（ACF）带来了独特的挑战。针对这一高度脆弱环境的研究较为匮乏，在大流行早期，澳大利亚没有关于 ACF 中 COVID-19 病例的全国报告数据。我们旨在估算澳大利亚老年护理中与老年护理工作者（ACW）感染和 COVID-19 疫情相关的负担。
创建了一份公开的、与 COVID-19 相关的、截至 2020 年 1 月 25 日至 6 月 10 日期间报告的老年护理相关病例的清单，并通过匹配从媒体报道中提取的与 COVID-19 相关的老年护理相关疫情和报告中的数据对其进行了增强。使用率比（RR）预测 ACW 和老年护理居民的感染风险，并通过将总病例与 ACW 和老年护理居民的病例进行比较，分别独立计算。
到 2020 年 6 月，全国范围内共记录了 14 家出现 COVID-19 病例的 ACF，病死率高（CFR）达 50%（n=34），两家 ACF 达到 100%（n=3）。对居民风险的分析发现，与普通人群相比，COVID-19 的风险高出 1.27 倍（未调整 RR 1.27，95%置信区间[CI] 1.00 至 1.61；P=0.047）。在识别出的超过 60%的 ACF 病例中，索引病例的感染源未知。共报告了与 ACF 相关的 28 例死亡病例，占新南威尔士州总死亡人数的 54.9%，占澳大利亚总死亡人数的 26.9%。
这一高风险人群需要采取额外的预防和控制措施，例如对所有员工和患者进行常规检测，无论其症状如何。一旦在设施内确诊病例，就必须立即进行隔离和检疫。
