CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
Vaccine. 2022 May 20;40(23):3165-3173. doi: 10.1016/j.vaccine.2022.04.040. Epub 2022 Apr 18.
As of 2 September 2021, United States nursing homes have reported >675,000 COVID-19 cases and >134,000 deaths according to the Centers for Medicare & Medicaid Services (CMS). More than 205,000,000 persons in the United States had received at least one dose of a COVID-19 vaccine (62% of total population) as of 2 September 2021. We investigate the role of vaccination in controlling future COVID-19 outbreaks. We developed a stochastic, compartmental model of SARS-CoV-2 transmission in a 100-bed nursing home with a staff of 99 healthcare personnel (HCP) in a community of 20,000 people. We parameterized admission and discharge of residents in the model with CMS data, for a within-facility basic reproduction number (R) of 3.5 and a community R of 2.5. The model also included: importation of COVID-19 from the community, isolation of SARS-CoV-2 positive residents, facility-wide adherence to personal protective equipment (PPE) use by HCP, and testing. We systematically varied coverage of mRNA vaccine among residents, HCP, and the community. Simulations were run for 6 months after the second dose in the facility, with results summarized over 1,000 simulations. Expected resident cases decreased as community vaccination increased, with large reductions at high HCP coverage. The probability of a COVID-19 outbreak was lower as well: at HCP vaccination coverage of 60%, probability of an outbreak was below 20% for community coverage of 50% or above. At high coverage, stopping asymptomatic screening and facility-wide testing yielded similar results. Results suggest that high coverage among HCP and in the community can prevent infections in residents. When vaccination is high in nursing homes, but not in their surrounding communities, asymptomatic and facility-wide testing remains necessary to prevent the spread of COVID-19. High adherence to PPE may increase the likelihood of containing future COVID-19 outbreaks if they occur.
截至 2021 年 9 月 2 日，根据医疗保险和医疗补助服务中心（CMS）的数据，美国养老院报告了超过 67.5 万例 COVID-19 病例和超过 13.4 万例死亡。截至 2021 年 9 月 2 日，美国已有超过 2.05 亿人至少接种了一剂 COVID-19 疫苗（占总人口的 62%）。我们研究了疫苗接种在控制未来 COVID-19 爆发中的作用。我们开发了一种 SARS-CoV-2 在一个有 100 张床位的养老院中的传播的随机、分区模型，该养老院有 99 名医护人员（HCP），位于一个拥有 20000 人的社区中。我们使用 CMS 数据对居民的入院和出院进行了模型参数化，在院内基本繁殖数（R）为 3.5，社区 R 为 2.5。该模型还包括：从社区输入 COVID-19，隔离 SARS-CoV-2 阳性居民，HCP 在整个设施内遵守个人防护设备（PPE）的使用，以及检测。我们系统地改变了居民、HCP 和社区中 mRNA 疫苗的覆盖率。模拟在设施内接种第二剂疫苗后进行了 6 个月，结果在 1000 多次模拟中进行了总结。随着社区接种率的提高，居民预期病例数减少，HCP 覆盖率高的情况下减少幅度更大。COVID-19 爆发的概率也降低了：当 HCP 接种率达到 60%时，社区接种率在 50%或以上时，爆发的概率低于 20%。在高覆盖率的情况下，停止无症状筛查和全设施检测会产生类似的结果。结果表明，HCP 和社区中的高覆盖率可以防止居民感染。当养老院的接种率高，但周围社区的接种率不高时，无症状和全设施检测仍然是防止 COVID-19 传播的必要措施。如果发生 COVID-19 爆发，高遵从不症状和设施内检测可以增加控制未来 COVID-19 爆发的可能性。
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