Nakwa Firdose Lambey, Thomas Reenu, van Kwawegen Alison, Ntuli Nandi, Seake Karabo, Kesting Samantha Jane, Kamanga Noela Holo Bertha, Kgwadi Dikeledi Maureen, Chami Neema, Mogajane Tshiamo, Ondongo-Ezhet Claude, Maphosa Thulisile Nelly, Jones Stephanie, Baillie Vicky Lynne, Madhi Shabir Ahmed, Velaphi Sithembiso
Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Front Pediatr. 2022 Jul 28;10:933982. doi: 10.3389/fped.2022.933982. eCollection 2022.
The provision of kangaroo mother care (KMC) involving continuous skin-to-skin care (SSC) is an important intervention in neonatal care, which is recommended even when women are infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2). We report on a nosocomial outbreak of SARS-CoV-2 infections in a KMC ward.
Contact tracing was conducted following the diagnosis of SARS-CoV-2 in a mother lodging in the KMC ward. All mother-newborn dyads in the KMC and healthcare workers (HCW) were tested for SARS-CoV-2 within 24-72 h of diagnosing the index case. Nasopharyngeal swab samples were obtained and tested from contacts, with a nucleic acid amplification test (NAAT) assay. Next-generation sequencing was done on positive samples. The secondary attack rate (SAR) was calculated assuming that the mother who presented with symptoms was the source of infection.
Twelve (70.6%) of 17 mothers and 8 (42.1%) of 19 neonates who were in the KMC ward with the index case were found to be positive with SARS-CoV-2. Seven (87.5%) of the 8 neonates who tested positive had mothers who also tested positive. Seventy-five percent (9/12) of the mothers and 62.5% (5/8) of the neonates who tested positive were asymptomatic. Eight (27.6%) of 29 HCW were found to be positive and were all asymptomatic. One neonate died from sepsis, and his post-mortem lung histopathology showed features compatible with SARS-CoV-2 pneumonia. The sequencing of 13 specimens, which included 1 mother-newborn dyad, indicated clustering to the same phylogenetic lineage with identical mutations. In assessing for factors contributing to this outbreak, it was found that spaces between beds were less than 1 m and mothers had their meals around the same table at the same time.
We report on a nosocomial outbreak of SARS-CoV-2 in a KMC ward, affecting a high number of mothers and neonates, and to a lesser extent HCWs. Although it is difficult to point to the index case as the source of this outbreak, as asymptomatic individuals can spread infection, the inadequate adherence to non-pharmaceutical interventions was assessed to have contributed to the spread of infection. This highlights the need for awareness and adherence to mitigation strategies to avoid SARS-CoV-2 outbreaks.
提供包括持续皮肤接触护理（SSC）在内的袋鼠式护理（KMC）是新生儿护理中的一项重要干预措施，即使女性感染了严重急性呼吸综合征冠状病毒（SARS-CoV-2），也建议采用该措施。我们报告了在一个袋鼠式护理病房发生的SARS-CoV-2医院感染暴发事件。
在一名入住袋鼠式护理病房的母亲被诊断出感染SARS-CoV-2后，进行了接触者追踪。在确诊首例病例后的24至72小时内，对袋鼠式护理病房中的所有母婴二元组和医护人员（HCW）进行了SARS-CoV-2检测。从接触者那里采集鼻咽拭子样本并进行检测，采用核酸扩增试验（NAAT）分析。对阳性样本进行了下一代测序。假设出现症状的母亲是感染源，计算了二代发病率（SAR）。
在与首例病例同处袋鼠式护理病房的17名母亲中，有12名（70.6%）以及19名新生儿中的8名（42.1%）被检测出SARS-CoV-2呈阳性。检测呈阳性的8名新生儿中有7名（87.5%）的母亲检测结果也呈阳性。检测呈阳性的母亲中有75%（9/12）以及新生儿中有62.5%（5/8）没有症状。29名医护人员中有8名（27.6%）检测呈阳性，且均无症状。一名新生儿死于败血症，其死后肺部组织病理学检查显示出与SARS-CoV-2肺炎相符的特征。对13份标本（包括1个母婴二元组）进行的测序表明，它们聚类到同一系统发育谱系，具有相同的突变。在评估导致此次暴发的因素时，发现床位之间的间距小于1米，且母亲们同时在同一张桌子旁用餐。
我们报告了在一个袋鼠式护理病房发生的SARS-CoV-2医院感染暴发事件，该事件影响了大量母亲和新生儿，对医护人员的影响较小。尽管很难将首例病例确定为此次暴发的源头，因为无症状个体也可传播感染，但评估认为对非药物干预措施的依从性不足促成了感染的传播。这凸显了提高认识并遵守缓解策略以避免SARS-CoV-2暴发的必要性。
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