Outbreak or pseudo-outbreak? Integrating SARS-CoV-2 sequencing to validate infection control practices in a dialysis facility - 24/09/21
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Abstract |
Background |
The COVID-19 pandemic poses a particularly high risk for End Stage Renal Disease (ESRD) patients so rapid identification of case clusters in ESRD facilities is essential. Nevertheless, with high community prevalence, a series of ESRD patients may test positive contemporaneously for reasons unrelated to their shared ESRD facility. Here we describe a series of 5 cases detected within 11 days in November 2020 in a hospital-based 32-station ESRD facility in Southwest Wisconsin, the subsequent facility-wide testing, and the use of genetic sequence analysis to evaluate links between cases.
Methods |
Four patient cases and one staff case were identified in symptomatic individuals by RT-PCR. Facility-wide screening was conducted using rapid SARS-CoV-2 antigen tests. SARS-CoV-2 genome sequences were obtained from residual diagnostic specimens.
Results |
Facility-wide screening of 47 staff and 107 patients identified no additional cases. Residual specimens from 4 of 5 cases were available for genetic sequencing. Clear genetic differences proved that these contemporaneous cases were not linked.
Conclusions |
With high community prevalence, epidemiological data alone is insufficient to deem a case cluster an outbreak. Cluster evaluation with genomic data, when available with a short turn-around time, can play an important role in infection prevention and control response programs.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Dialysis patient care poses infection control challenges due to high COVID19 risk. |
• | High community case loads can create “pseudo-outbreaks” of unlinked cases. |
• | Rapid sequencing can refute presumed COVID19 outbreaks in congregate settings. |
Key Words : COVID-19, End stage renal disease, Infection prevention, Genome sequencing, Epidemiology
Plan
| Funding: This work was supported by the Gundersen Medical Foundation and by a grant from Fast Grants (#2243) to PAK. The funders had no role in the study design. |
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| Conflict of interest: The authors declare that they have no conflicts of interest. |
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| Author contributions: Conception and Design: PAK, CSR, BLP, APS. Acquisition and analysis of data: DMA, JCA, MEM, KU, SAS, BJS, AJB, CSR, BLP, PAK. Drafting and revision of manuscript: BLP, APS, PAK. Approval of final manuscript: All authors. |
Vol 49 - N° 10
P. 1232-1236 - octobre 2021 Retour au numéro
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