Infection Control Programme, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Antimicrob Resist Infect Control. 2022 Mar 18;11(1):51. doi: 10.1186/s13756-022-01092-0.
We investigated the contribution of both occupational and community exposure for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among employees of a university-affiliated long-term care facility (LTCF), during the 1 pandemic wave in Switzerland (March-June 2020).
We performed a nested analysis of a seroprevalence study among all volunteering LTCF staff to determine community and nosocomial risk factors for SARS-CoV-2 seropositivity using modified Poison regression. We also combined epidemiological and genetic sequencing data from a coronavirus disease 2019 (COVID-19) outbreak investigation in a LTCF ward to infer transmission dynamics and acquisition routes of SARS-CoV-2, and evaluated strain relatedness using a maximum likelihood phylogenetic tree.
Among 285 LTCF employees, 176 participated in the seroprevalence study, of whom 30 (17%) were seropositive for SARS-CoV-2. Most (141/176, 80%) were healthcare workers (HCWs). Risk factors for seropositivity included exposure to a COVID-19 inpatient (adjusted prevalence ratio [aPR] 2.6; 95% CI 0.9-8.1) and community contact with a COVID-19 case (aPR 1.7; 95% CI 0.8-3.5). Among 18 employees included in the outbreak investigation, the outbreak reconstruction suggests 4 likely importation events by HCWs with secondary transmissions to other HCWs and patients.
These two complementary epidemiologic and molecular approaches suggest a substantial contribution of both occupational and community exposures to COVID-19 risk among HCWs in LTCFs. These data may help to better assess the importance of occupational health hazards and related legal implications during the COVID-19 pandemic.
我们研究了在瑞士第一波大流行期间（2020 年 3 月至 6 月），一所大学附属长期护理机构（LTCF）员工中，职业和社区暴露对严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的贡献。
我们对所有志愿 LTCF 工作人员进行了一项血清流行率研究的嵌套分析，以使用修正后的泊松回归法确定 SARS-CoV-2 血清阳性的社区和医院感染危险因素。我们还结合了 LTCF 病房的 2019 年冠状病毒病（COVID-19）暴发调查的流行病学和遗传测序数据，以推断 SARS-CoV-2 的传播动态和获得途径，并使用最大似然系统发育树评估菌株相关性。
在 285 名 LTCF 员工中，有 176 名参与了血清流行率研究，其中 30 名（17%）对 SARS-CoV-2 呈血清阳性。大多数（141/176，80%）为医护人员（HCWs）。血清阳性的危险因素包括接触 COVID-19 住院患者（调整后的患病率比[aPR]2.6；95%可信区间[CI]0.9-8.1）和与 COVID-19 病例的社区接触（aPR 1.7；95%CI 0.8-3.5）。在包括在暴发调查中的 18 名员工中，暴发重建表明，4 名 HCWs 可能发生了 4 次输入事件，随后 HCWs 和患者发生了二次传播。
这两种互补的流行病学和分子方法表明，职业和社区暴露对 LTCF 中 HCWs 的 COVID-19 风险有很大贡献。这些数据可能有助于更好地评估 COVID-19 大流行期间职业健康危害的重要性和相关法律影响。
