可能经空气传播导致 2019 年冠状病毒病医院感染暴发，并引发超级传播事件。
Nosocomial Outbreak of Coronavirus Disease 2019 by Possible Airborne Transmission Leading to a Superspreading Event.
机构信息
Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China.
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
出版信息
Clin Infect Dis. 2021 Sep 15;73(6):e1356-e1364. doi: 10.1093/cid/ciab313.
BACKGROUND
Nosocomial outbreaks with superspreading of coronavirus disease 2019 due to a possible airborne transmission have not been reported.
METHODS
Epidemiological analysis, environmental samplings, and whole-genome sequencing (WGS) were performed for a hospital outbreak.
RESULTS
A superspreading event that involved 12 patients and 9 healthcare workers (HCWs) occurred within 9 days in 3 of 6 cubicles at an old-fashioned general ward with no air exhaust built within the cubicles. The environmental contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was significantly higher in air grilles (>2 m from patients' heads and not within reach) than on high-touch clinical surfaces (36.4%, 8 of 22 vs 3.4%, 1 of 29, P = .003). Six (66.7%) of 9 contaminated air exhaust grilles were located outside patient cubicles. The clinical attack rate of patients was significantly higher than of HCWs (15.4%, 12 of 78 exposed patients vs 4.6%, 9 of 195 exposed HCWs, P = .005). Moreover, the clinical attack rate of ward-based HCWs was significantly higher than of nonward-based HCWs (8.1%, 7 of 68 vs 1.8%, 2 of 109, P = .045). The episodes (mean ± standard deviation) of patient-care duty assignment in the cubicles was significantly higher among infected ward-based HCWs than among noninfected ward-based HCWs (6.0 ± 2.4 vs 3.0 ± 2.9, P = .012) during the outbreak period. The outbreak strains belong to SARS-CoV-2 lineage B.1.36.27 (GISAID clade GH) with the unique S-T470N mutation on WGS.
CONCLUSIONS
This nosocomial point source superspreading event due to possible airborne transmission demonstrates the need for stringent SARS-CoV-2 screening at admission to healthcare facilities and better architectural design of ventilation systems to prevent such outbreaks. Portable high-efficiency particulate filters were installed in each cubicle to improve ventilation before resumption of clinical service.
背景
由于可能的空气传播，导致 2019 年冠状病毒病的医院暴发超级传播事件尚未有报道。
方法
对医院暴发事件进行了流行病学分析、环境采样和全基因组测序（WGS）。
结果
在一个老式的普通病房内的 6 个小隔间中的 3 个小隔间中，在 9 天内发生了涉及 12 名患者和 9 名医护人员（HCWs）的超级传播事件。严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）RNA 的环境污染在空气格栅（距患者头部>2 m 且不可及）上明显高于高接触临床表面（36.4%，22 个中的 8 个与 3.4%，29 个中的 1 个，P=0.003）。6（66.7%）个受污染的空气排气格栅位于患者隔间外。患者的临床发病率明显高于 HCWs（15.4%，12/78 名暴露患者与 4.6%，195/195 名暴露 HCWs，P=0.005）。此外，基于病房的 HCWs 的临床发病率明显高于非基于病房的 HCWs（8.1%，7/68 与 1.8%，109/109，P=0.045）。在暴发期间，受感染的基于病房的 HCWs 比未感染的基于病房的 HCWs 分配在小隔间中执行的患者护理任务次数明显更高（6.0±2.4 与 3.0±2.9，P=0.012）。暴发株属于 SARS-CoV-2 谱系 B.1.36.27（GISAID 谱系 GH），在 WGS 上具有独特的 S-T470N 突变。
结论
由于可能的空气传播而导致的这种医院点状源超级传播事件表明，需要在进入医疗机构时对 SARS-CoV-2 进行严格筛查，并改善通风系统的建筑设计以防止此类暴发。在恢复临床服务之前，在每个小隔间中安装了便携式高效微粒过滤器以改善通风。
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