An outbreak of SARS‐CoV‐2 on a transplant unit in the early vaccination era

Abstract

Background: Solid organ transplant recipients are at increased risk of COVID-19associated morbidity and mortality. Aims: We describe a nosocomial outbreak investigation on an immunocompromised inpatient unit. Methods: Patients positive for SARS-CoV-2 were identified. An epidemiologic investigation was assisted with whole genome sequencing of positive samples. Results: Two patients were identified as potential index cases; one presented with diarrhea and was initially not isolated, and the other developed hypoxemia on hospital day 18 before testing positive. Following identification of a SARS-CoV-2 cluster, the unit was closed and all patients and staff received surveillance testing revealing eight additional positive patients and staff members. Whole genome sequencing confirmed an outbreak. Enhanced infection prevention practices mitigated further spread. Asymptomatic patients with COVID-19 were successfully treated with bamlanivimab. Discussion: Preventing SARS-CoV-2 outbreaks in transplant units poses unique challenges as patients may have atypical presentations of COVID-19. Immunocompromised patients who test positive for SARS-CoV-2 while asymptomatic may benefit from monoclonal antibody therapy to prevent disease progression. All hospital staff members working with immunocompromised patients should be promptly encouraged to follow infection prevention behaviors and receive SARS-CoV-2 vaccination. Conclusion: SARS-CoV-2 outbreaks on immunocompromised units can be mitigated through prompt identification of cases and robust infection prevention practices.

Patient and ward related risk factors in a multi-ward nosocomial outbreak of COVID-19: Outbreak investigation and matched case–control study

“…The retrospective nature of our case-control study precludes conclusions There have been many reports on hospital-based outbreaks of COVID-19 [4, 25, 27-29, 31, 39, 52-56], however a strength of our report is that it incorporated a case-control study to explore contributing ward and patient-related factors to the acquisition of COVID-19, occurring in a setting without vaccination for any HCWs or patients. Our outbreak has similarities with other COVID-19 nosocomial outbreaks including unidentified cases on a ward [39,56], positive HCWs who may have sub-optimal adherence to IPC measures [52,54], and the role of multi-bedded rooms in SARS-CoV-2 transmission [27,29,31,34,35] Further, our report included patient symptoms, environmental sampling, whole genome sequencing, viral culture and has identified the novel finding of fluid and electrolyte disorders increasing the likelihood of COVID-19 acquisition.…”

“…stress, fatigue, burnout) resulted in suboptimal point-of-care risk assessment resulting in missed, delayed, or incorrect diagnosis of COVID-19 among these patients leading to preventable exposures and increased transmission [37]. Precise case identification is essential to isolate vulnerable individuals and hence contain transmission [38,39].…”

Nosocomial outbreak of SARS-CoV-2 delta variant among vaccinated healthcare workers and immunocompromised patients on a solid-organ transplant unit: Complexities of an epidemiologic and genomic investigation

“…Other outbreaks in transplant units were reported in the prevaccination era. 3,4 Our transplant-unit outbreak was the first described during SARS-CoV-2 δ (delta) variant circulation. This outbreak was confirmed by WGS and included cases of vaccinated HCWs.…”

Autochthonous Outbreak of SARS-CoV-2 Omicron Variant in Booster-Vaccinated (3 Doses) Healthcare Workers in Southern Italy: Just the Tip of the Iceberg?

“…Non-COVID-19 hospital areas should therefore be considered high-risk environments for SARS-CoV-2 outbreaks. The virus may originate from patients or HCWs who interact with others in environments inside and outside the hospital, and may especially affect vulnerable patients who are hospitalized [32]. Wearing surgical masks, according to protocols adopted in non-COVID-19 wards, may be insufficient to completely avoid SARS-CoV-2 dissemination in hospital wards, especially because the Omicron VOC is highly transmissible.…”