Objectives: To describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a large rheumatology department, early in the pandemic. Methods: Symptomatic and asymptomatic healthcare workers (HCWs) had a naso-oropharyngeal swab for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were followed clinically. Reverse transcription polymerase-chain reaction (RT-PCR) was repeated to document cure, and serological response was assessed. Patients with risk contacts within the department in the 14 days preceding the outbreak were screened for COVID-19 symptoms. Results: 14/34 HCWs (41%; 40±14 years, 71% female) tested positive for SARS-CoV-2, and 11/34 (32%) developed symptoms but were RT-PCR-negative. Half of RT-PCR-positive HCWs did not report fever, cough, or dyspnoea before testing, which were absent in 3/14 cases (21%). Mild disease prevailed (79%), but 3 HCWs had moderate disease requiring further assessment, which excluded severe complications. Nevertheless, symptom duration (28±18 days), viral shedding (31±10 days post-symptom onset, range 15-51) and work absence (29±28 days) were prolonged. 13/14 (93%) of RT-PCR-positive and none of the RT-PCR-negative HCWs had a positive humoral response, with higher IgG-index in individuals over 50 years (14.5±7.7 vs 5.0±4.4, p=0.012). Of 617 rheumatic patients, 8 (1.3%) developed COVID-19 symptoms (1/8 hospitalisation, 8/8 complete recovery), following a consultation/procedure with an asymptomatic (7/8) or mildly-symptomatic (1/8) HCW. Conclusions: A COVID-19 outbreak can occur among HCWs and rheumatic patients, swiftly spreading over the presymptomatic stage. Mild disease without typical symptoms should be recognised, and may evolve with delayed viral shedding, prolonged recovery, and adequate immune response in most individuals.

Infections are among the most important occupational risks for healthcare workers. Some infections can be prevented through vaccination but, in other cases, there are no vaccines to prevent them, as happens with infections from antimicrobial-resistant organisms. Precautions related with transmission route and contact isolation or respiratory isolation are very important in order to protect healthcare workers and other patients. In this paper, the authors reviewed biological hazards for healthcare workers and described the procedures undertaken by an occupational health department (OHD) of a Portuguese hospital where vancomycin-resistant Staphylococcus aureus (VRSA) was isolated from a patient, for the first time in Europe. After the VRSA strain isolation, healthcare workers were instructed to adopt contact preventive measures. Nasal swabs were cultured weekly in 33 healthcare workers for several weeks until the patients' culture changed to negative. In the meantime, OHD prepared actions to adopt in case of VRSA colonization or infection in healthcare workers.

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As with the SARS-CoV-1 outbreak in 2003–2004 and the MERS outbreak in 2012, there were early reports of frequent transmission to healthcare workers (HCW) in the SARS-CoV-2 pandemic. Our hospital center identified its first COVID-19 confirmed case on March 9, 2020, in a 6-day hospitalized patient. The first confirmed COVID-19 case in a HCW happened 3 days later, in a nurse with a probable epidemiological link related to the first confirmed patient. Our study’s first objective is to describe and characterize the impact of the first 3 months of the SARS-CoV-2 pandemic on the Centro Hospitalar Universitário Lisboa Norte (CHULN). Our second objective is to report the performance of the CHULN Occupational Health Department (OHD) and the impact of the pandemic on CHULN HCW and its adaptation across national, regional, and institutional epidemiological evolution. Over the first 3 months, 2,152 HCW were screened (which represent 29.8% of the total HCW population), grouped in 100 separate identifiable clusters, each one ranging from 2 to 98 HCW. The most prevalent profession screened were nurses (<i>n</i> = 800; 37.2%) followed by doctors (<i>n</i> = 634; 29.5%). The main source of potential infection and cluster generating screening procedures was co-worker related (<i>n</i> = 1,216; 56.5%). A patient source or a combined patient co-worker source was only accountable for 559 (26%) and 43 (2%) of cases, respectively. Our preliminary results demonstrate a lower infection rate among HCW than the ones commonly found in the literature. The main source of infection seemed to be co-worker related rather than patient related. New preventive strategies would have to be implemented in order to control SARS-CoV-2 spread.

Aim: Implementation of a web-form based pharmacovigilance plan for the spontaneous notification of adverse events to the Comirnaty® COVID-19 vaccine during its administration to hospital healthcare professionals. Methods: An electronic pharmacovigilance form was developed containing 8 pre-defined event options, an open answer option for the description of other events and/or symptoms, and a question about the overall intensity of symptoms. The adverse events reports were standardized according to physiological and pathological condition. Results: A total of 4119 adverse events notifications were obtained with a 45% rate of electronic notification. The most clinically relevant events reported were:tachycardia (n = 19), dyspnea (n = 7), chest pain (n = 6), facial/labial edema (n = 6), lipothymia (n = 5), bronchospasm (n = 2), herpetic infection (n = 2), vasculitis (n = 2), arrhythmia (n = 1), difficult to control arterial hypertension (n = 1), gastritis (n = 1), and spontaneous abortion (n = 1). Regarding the intensity of symptoms (n = 2928), 70.0% were reported as mild, 25.8% as moderate, and 4.27% as severe, with higher intensity in the second dose compared to first dose. The highest frequency of severe events were reported in the groups from 40 to 59 years in both vaccination periods. During the vaccination process, no hospitalizations and no deaths were notified and/or recorded. Conclusion: In this real world study, comparing with Comirnaty clinical trials program, it was observed a higher frequency of adenomegaly and gastrointestinal disorders. Noteworthy, the notification of a case of miscarriage. The use of hospital pharmacy pharmacovigilance electronic forms, seemed to be relevant to notification adherence and to obtain a greater and faster knowledge of COVID-19 vaccine safety profile

Introduction Healthcare professionals are among the main risk groups for novel coronavirus disease (COVID 19). The identification of respiratory symptoms is important in the clinical assumption of infection, but it may be asymptomatic or paucisymptomatic. Objectives To compare the proportion of professionals with symptoms suggestive of COVID-19 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with the proportion of positive asymptomatic professionals with high-risk contact; and to identify respiratory and non-respiratory symptoms of professionals with suspected COVID-19 and the proportion of those who tested positive for SARS CoV-2. Methods This is a cross-sectional study that retrospectively analyzed clinical records of health professionals who spontaneously sought the occupational health service of a university hospital center from March to August 2020 for presenting with symptoms and/or for having had high risk contact with a confirmed case of COVID-19 and who, in this context, underwent the reverse transcription polymerase chain reaction test for SARS-CoV-2. Results COVID-19 was confirmed in 27 of the 420 symptomatic professionals vs. three of the 193 asymptomatic professionals (p = 0.009). Of the 371 professionals with respiratory symptoms, 19 were positive for COVID-19 vs. 11 among the 242 with no respiratory symptoms (p = 0.750). Nasal congestion and rhinorrhea were the respiratory symptoms with the highest proportion of positive cases (11.43 and 8.97%, respectively). Conclusions : Although COVID-19 is typically associated with respiratory symptoms, not all these symptoms were predictive of disease. It becomes crucial to value mild symptoms among healthcare professionals.

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