在资源有限的情况下对 4040 名医护人员进行通用的 COVID-19 筛查：埃及在拥有 12 所公立医院和医疗中心的大学中的试点模式。
Universal COVID-19 screening of 4040 health care workers in a resource-limited setting: an Egyptian pilot model in a university with 12 public hospitals and medical centers.
机构信息
Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
出版信息
Int J Epidemiol. 2021 Mar 3;50(1):50-61. doi: 10.1093/ije/dyaa173.
BACKGROUND
The scale of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs), particularly in resource-limited settings, remains unclear. To address this concern, universal (non-symptom-based) screening of HCWs was piloted to determine the proportion of SARS-CoV-2 infection and the associated epidemiological and clinical risk factors at a large public health care facility in Egypt.
METHODS
Baseline voluntary screening of 4040 HCWs took place between 22 April and 14 May 2020 at 12 hospitals and medical centres in Cairo. Epidemiological and clinical data were collected using an online survey. All participants were tested for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) and rapid IgM and IgG serological tests.
RESULTS
Of the 4040 HCWs screened, 170 [4.2%; 95% confidence interval (CI): 3.6-4.9] tested positive for SARS-CoV-2 by either of the three tests (i.e. infected); 125/170 (73.5%) tested PCR-positive. Most infected HCWs were nurses (97/170, 57.5%). Median age of infected HCWs was 31.5 [interquartile range (IQR): 27.0-41.3] years. Of infected HCWs, 78 (45.9%) reported contact with a suspected case and 47 (27.6%) reported face-to-face contact within 2 m with a confirmed case. The proportion of infection among symptomatic HCWs (n = 54/616) was 8.8% (95% CI: 6.7-11.3); 6/54 (11.1%) had fever ≥38°C and 7/54 (13.0%) reported severe symptoms. Most infected HCWs were asymptomatic (116/170, 68.2%). The proportion of infection among asymptomatic HCWs (n = 116/3424) was 3.4% (95% CI: 2.8-4.0).
CONCLUSIONS
The high rate of asymptomatic infections among HCWs reinforces the need for expanding universal regular testing. The infection rate among symptomatic HCWs in this study is comparable with the national rate detected through symptom-based testing. This suggests that infections among HCWs may reflect community rather than nosocomial transmission during the early phase of the COVID-19 epidemic in Egypt.
背景
在卫生保健工作者（HCWs）中，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的规模，特别是在资源有限的环境中，仍不清楚。为了解决这一问题，在埃及的一家大型公共医疗保健机构中，对 HCWs 进行了普遍（非基于症状）筛查，以确定 SARS-CoV-2 感染的比例，以及相关的流行病学和临床危险因素。
方法
在 2020 年 4 月 22 日至 5 月 14 日期间，在开罗的 12 家医院和医疗中心对 4040 名 HCWs 进行了基线自愿筛查。使用在线调查收集流行病学和临床数据。对所有参与者均采用逆转录聚合酶链反应（RT-PCR）和快速 IgM 和 IgG 血清学检测进行 SARS-CoV-2 检测。
结果
在筛查的 4040 名 HCWs 中，通过三种检测中的任何一种（即感染）检测到 SARS-CoV-2 呈阳性的有 170 名（4.2%；95%置信区间（CI）：3.6-4.9）；125/170（73.5%）的检测结果为 PCR 阳性。大多数感染的 HCWs 是护士（97/170，57.5%）。感染的 HCWs 中位年龄为 31.5 岁（四分位距（IQR）：27.0-41.3）。在感染的 HCWs 中，78 名（45.9%）报告与疑似病例接触，47 名（27.6%）报告与确诊病例面对面接触距离在 2 米以内。有症状的 HCWs 中感染的比例为 8.8%（95%CI：6.7-11.3）（n=54/616）；6/54（11.1%）有体温≥38°C，7/54（13.0%）有严重症状。大多数感染的 HCWs 无症状（116/170，68.2%）。无症状的 HCWs 中感染的比例为 3.4%（95%CI：2.8-4.0）（n=116/3424）。
结论
HCWs 中无症状感染的高比例，强调了扩大普遍定期检测的必要性。本研究中，有症状的 HCWs 的感染率与通过基于症状的检测在全国范围内检测到的感染率相当。这表明，在埃及 COVID-19 疫情的早期阶段，HCWs 的感染可能反映了社区而非医院内的传播。
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