Getting to the Heart of In-hospital Transmission of SARS-CoV-2 with the Help of Whole Genome Sequencing

Source avec lien : Journal of Hospital Infection, 131. 10.1016/j.jhin.2022.09.023

Nous présentons une épidémie de 56 cas de COVID-19 chez le personnel et les patients sur une période de 31 jours dans un service de référence tertiaire, avec au moins 29 autres cas identifiés en dehors du service et de l’hôpital par séquençage du génome entier. Nous documentons la transmission du personnel au personnel, du personnel aux patients et des patients au personnel et montrons la perturbation d’un service de référence tertiaire, malgré la mise en œuvre des mesures de contrôle recommandées au niveau national, une ventilation supérieure et l’utilisation d’EPI.

We present an outbreak of 56 staff and patient cases of COVID-19 over a 31 day period in a tertiary referral unit, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). We document transmission from staff-to-staff, staff-to-patients and patients-to-staff and show disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation and use of PPE. We demonstrate extensive spread from the index case, despite them spending only 10 hours bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT=32) PCR test. This investigation highlights critical issues including how effectively and explosively SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.

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