#Prevalence and #Clinical #Presentation of #HCWs With Symptoms of #Coronavirus Disease 2019 in 2 #Dutch #Hospitals During an Early Phase of the Pandemic (JAMA Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic

Marjolein F. Q. Kluytmans-van den Bergh, PhD1,2,3; Anton G. M. Buiting, PhD4,5; Suzan D. Pas, PhD6; et alRobbert G. Bentvelsen, MD7,8; Wouter van den Bijllaardt, MD7; Anne J. G. van Oudheusden, MSc5; Miranda M. L. van Rijen, PhD1; Jaco J. Verweij, PhD4; Marion P. G. Koopmans, PhD9; Jan A. J. W. Kluytmans, PhD1,3,7

Author Affiliations: 1 Department of Infection Control, Amphia Hospital, Breda, the Netherlands; 2 Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, the Netherlands; 3 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; 4 Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; 5 Department of Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; 6 Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands; 7 Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands; 8 Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands; 9 Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands

JAMA Netw Open. 2020;3(5):e209673. doi:10.1001/jamanetworkopen.2020.9673

 

Key Points

  • Question  – What was the prevalence and clinical presentation of coronavirus disease 2019 among health care workers with self-reported fever or respiratory symptoms in 2 Dutch hospitals within 2 weeks after the first patient with coronavirus disease 2019 was detected in the Netherlands?
  • Findings  – In this cross-sectional study that included 1353 health care workers with self-reported fever or respiratory symptoms, 6% were infected with severe acute respiratory syndrome coronavirus 2. Most health care workers with coronavirus disease 2019 experienced mild disease, and only 53% reported fever.
  • Meaning  – The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected coronavirus disease 2019 should be used less stringently.

 

Abstract

Importance  

On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring.

Objective  

To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms.

Design, Setting, and Participants  

This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020.

Main Outcomes and Measures  

The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase–polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19.

Results  

Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms.

Conclusions and Relevance  

Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently.

Keywords: SARS-CoV-2; COVID-19; HCWs; The Netherlands.

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Strong associations and moderate #predictive #value of early #symptoms for #SARS-CoV-2 #test positivity among #HCWs, the #Netherlands, March 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Strong associations and moderate predictive value of early symptoms for SARS-CoV-2 test positivity among healthcare workers, the Netherlands, March 2020

Alma Tostmann1, John Bradley2, Teun Bousema1,3, Wing-Kee Yiek1, Minke Holwerda1, Chantal Bleeker-Rovers4, Jaap ten Oever4, Corianne Meijer1, Janette Rahamat-Langendoen1, Joost Hopman1, Nannet van der Geest-Blankert5, Heiman Wertheim1

Affiliations: 1 Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands; 2 MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; 3 Department of Infection and Immunity, London School of Hygiene and Tropical Medicine, London, United Kingdom; 4 Department of Internal Medicine, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands; 5 Department of Occupational Health, Radboud university medical centre, Nijmegen, The Netherlands

Correspondence:  Alma Tostmann

Citation style for this article: Tostmann Alma, Bradley John, Bousema Teun, Yiek Wing-Kee, Holwerda Minke, Bleeker-Rovers Chantal, ten Oever Jaap, Meijer Corianne, Rahamat-Langendoen Janette, Hopman Joost, van der Geest-Blankert Nannet, Wertheim Heiman. Strong associations and moderate predictive value of early symptoms for SARS-CoV-2 test positivity among healthcare workers, the Netherlands, March 2020. Euro Surveill. 2020;25(16):pii=2000508. https://doi.org/10.2807/1560-7917.ES.2020.25.16.2000508

Received: 03 Apr 2020;   Accepted: 21 Apr 2020

 

Abstract

Healthcare workers (n = 803) with mild symptoms were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 90 positive) and asked to complete a symptom questionnaire. Anosmia, muscle ache, ocular pain, general malaise, headache, extreme tiredness and fever were associated with positivity. A predictive model based on these symptoms showed moderate discriminative value (sensitivity: 91.2%; specificity: 55.6%). While our models would not justify presumptive SARS-CoV-2 diagnosis without molecular confirmation, it can contribute to targeted screening strategies.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; HCWs; The Netherlands.

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#SARS-CoV-2 in #wastewater: potential #health #risk, but also data source (Lancet Gastroenterol Hepatol., summary)

[Source: The Lancet Gastroenterology & Hepatology, full page: (LINK). Summary, edited.]

SARS-CoV-2 in wastewater: potential health risk, but also data source

Willemijn Lodder, Ana Maria de Roda Husman

Published: April 01, 2020 | DOI: https://doi.org/10.1016/S2468-1253(20)30087-X

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Since the first publications reporting the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in faeces,1 it became clear that human wastewater might contain the novel coronavirus. From Feb 17, 2020, onwards, we took 24-h 10 L samples once a week from human wastewater collected at Amsterdam Airport Schiphol (Haarlemmermeer, Netherlands) for virus analyses. Samples tested positive for virus RNA by quantitative RT-PCR methodology 4 days after the first cases of coronavirus disease 2019 (COVID-19) were identified in the Netherlands on Feb 27, 2020 (unpublished data). This could be explained by virus excretion from potentially symptomatic, asymptomatic, or presymptomatic individuals passing through the airport. Furthermore, human wastewater sampled near the first Dutch cases in Tilburg, Netherlands, also tested positive for the presence of viral RNA within a week of the first day of disease onset (unpublished data).2 These findings indicate that wastewater could be a sensitive surveillance system and early warning tool, as was previously shown for poliovirus.3
To our knowledge, this detection in the Netherlands is the first report of SARS-CoV-2 in wastewater.

(…)

Keywords: SARS-CoV-2; COVID-19; Netherlands.

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Rapid #assessment of #regional #SARS-CoV-2 #community #transmission through a convenience sample of healthcare workers, the #Netherlands, March 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020

Chantal B Reusken1,2,7, Anton Buiting3, Chantal Bleeker-Rovers4, Bram Diederen5, Mariëtte Hooiveld6, Ingrid Friesema1, Marion Koopmans7, Titia Kortbeek1, Suzanne PM Lutgens8, Adam Meijer1, Jean-Luc Murk3, Ilse Overdevest9, Thera Trienekens10, Aura Timen1, Wouter Van den Bijllaardt11, Jaap Van Dissel1, Arianne Van Gageldonk-Lafeber1, Dewi Van der Vegt12, Peter C Wever13, Wim Van der Hoek1,2, Jan Kluytmans11

Affiliations: 1 Centre for Infectious Disease Control-National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 2 These authors contributed equally to this work; 3 Elisabeth-Tweesteden hospital, Tilburg and Waalwijk, the Netherlands; 4 Radboudumc, Nijmegen, the Netherlands; 5 Bravis hospital, Roosendaal and Bergen-op-Zoom, the Netherlands. 6 Nivel, Netherlands institute for health services research, Utrecht, the Netherlands; 7 Erasmus MC, Rotterdam, the Netherlands; 8 Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; 9 Catharina hospital, Eindhoven, the Netherlands; 10 VieCuri hospital, Venlo, the Netherlands; 11 Amphia hospital, Breda, the Netherlands; 12 Elkerliek hospital, Helmond, the Netherlands; 13 Bernhoven hospital, Uden, the Netherlands

Correspondence:  Chantal Reusken

Citation style for this article: Reusken Chantal B, Buiting Anton, Bleeker-Rovers Chantal, Diederen Bram, Hooiveld Mariëtte, Friesema Ingrid, Koopmans Marion, Kortbeek Titia, Lutgens Suzanne PM, Meijer Adam, Murk Jean-Luc, Overdevest Ilse, Trienekens Thera, Timen Aura, Van den Bijllaardt Wouter, Van Dissel Jaap, Van Gageldonk-Lafeber Arianne, Van der Vegt Dewi, Wever Peter C, Van der Hoek Wim, Kluytmans Jan. Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020. Euro Surveill. 2020;25(12):pii=2000334. https://doi.org/10.2807/1560-7917.ES.2020.25.12.2000334

Received: 16 Mar 2020;   Accepted: 25 Mar 2020

 

Abstract

To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active circulation) were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within 2 days, 1,097 HCW in nine hospitals were tested; 45 (4.1%) were positive. Of six hospitals with positive HCW, two accounted for 38 positive HCW. The results informed local and national risk management.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; HCWs; Nosocomial Outbreaks; Netherlands.

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#Emergence and #Selection of a Highly Pathogenic #Avian #Influenza #H7N3 Virus (J Virol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Virol  2020 Jan 22 [Online ahead of print]

Emergence and Selection of a Highly Pathogenic Avian Influenza H7N3 Virus

Nancy Beerens 1, Rene Heutink 2, Frank Harders 2, Alex Bossers 2, Guus Koch 2, Ben Peeters 2

Affiliations: 1 Wageningen Bioveterinary Research, Lelystad, The Netherlands. nancy.beerens@wur.nl. 2 Wageningen Bioveterinary Research, Lelystad, The Netherlands.

PMID: 31969434  DOI: 10.1128/JVI.01818-19

 

Abstract

Low pathogenic avian influenza (LPAI) viruses of subtypes H5 and H7 have the ability to spontaneously mutate to highly pathogenic (HPAI) variants, causing high mortality in poultry. The highly pathogenic phenotype is caused by mutation of the hemagglutinin (HA) cleavage site, but additional mutations may play a role. Evidence from the field for the switch to high pathogenicity remains scarce. This study provides direct evidence for LPAI to HPAI mutation during H7N3 infection of a turkey farm in the Netherlands. No severe clinical symptoms were reported at the farm, but deep-sequencing revealed a minority of HPAI sequences (0.06%) in the virus population isolated from infected turkeys. The HPAI virus contained a 12-nucleotide insertion in the HA cleavage site, that was likely introduced by a single event, as no intermediates with shorter inserts were identified. This suggests non-homologous recombination as the mechanism of insertion. Analysis of different organs of the infected turkeys showed the highest amount of HPAI virus in the lung (4.4%). The HPAI virus was rapidly selected in experimentally infected chickens, after both intravenous and intranasal/intratracheal inoculation with the mixed virus preparation. Full-genome sequencing revealed that both pathotypes contained a deletion in the stalk region of the neuraminidase protein. We identified additional mutations in HA and polymerase basic protein 1 (PB1) in the HPAI virus, which were already present as minority variants in the LPAI virus population. Our findings provide more insight in the molecular changes and mechanisms involved in the emergence and selection of HPAI viruses.

 

IMPORTANCE

Low pathogenic avian influenza (LPAI) viruses circulate in wild birds, and can be transmitted to poultry. LPAI viruses can mutate to become highly pathogenic avian influenza (HPAI) viruses causing severe disease and death in poultry. Little is known about this switch to high pathogenicity. We isolated a LPAI H7N3 virus from an infected turkey farm, and showed that this contains small amounts of HPAI virus. The HPAI virus rapidly outcompeted the LPAI virus in chickens that were experimentally infected with this mixture of viruses. We analysed the genome sequences of the LPAI and HPAI viruses, and identified several changes that may be important for a virus to become highly pathogenic. This knowledge may be used for timely identification of LPAI viruses that pose a risk of becoming highly pathogenic in the field.

Copyright © 2020 American Society for Microbiology.

Keywords: Avian Influenza; H7N3; Poultry; Netherlands.

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#Comparison of #infection #control practices in a #Dutch and #US #hospital using the infection #risk scan (#IRIS) method (Am J Infect Control, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Infect Control. 2019 Nov 5. pii: S0196-6553(19)30856-9. doi: 10.1016/j.ajic.2019.09.020. [Epub ahead of print]

Comparison of infection control practices in a Dutch and US hospital using the infection risk scan (IRIS) method.

Willemsen I1, Jefferson J2, Mermel L3, Kluytmans J4.

Author information: 1 Department of Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands. Electronic address: iwillemsen@amphia.nl. 2 Department of Epidemiology & Infection Control, Rhode Island Hospital, Providence, RI, USA. 3 Department of Epidemiology & Infection Control, Rhode Island Hospital, Providence, RI, USA; Department of Medicine, Warren Alpert Medial School of Brown University, Providence, RI, USA. 4 Department of Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, the Netherlands.

 

Abstract

BACKGROUND:

The infection risk scan (IRIS) is a tool to measure the quality of infection control (IC) and antimicrobial use in a standardized way. We describe the feasilibility of the IRIS in a Dutch hospital (the Netherlands, NL) and a hospital in the United States (US).

METHODS:

Cross-sectional measurements were performed. Variables included a hand hygiene indicator, environmental contamination, IC preconditions, personal hygiene of health care workers, use of indwelling medical devices, and use of antimicrobials.

RESULTS:

IRIS was performed in 2 wards in a US hospital and 4 wards in a Dutch hospital. Unjustified use of medical devices: none in the US hospital, 2.2% in the Dutch hospital; inappropriate use of antibiotics: 11.7% (US), 19% (NL); items considered not clean: 10% (US); 36% (NL); shortcomings preconditions: 6 of 20 (US), 6 of 40 (NL); health care workers with rings, watches, or long sleeves: 34 of 43 (US), none in the NL hospital; and hand hygiene actions per patient/day: 41 (US) and 10 (NL). US data judged against the Dutch guidelines and vice versa revealed remarkable differences.

CONCLUSIONS:

We showed the feasibility of using the IRIS in a US hospital. The method provided insight in IC local performance. This method could be the first step to standardize the measurement of the quality of IC and antimicrobial use. However, if the IRIS is used for benchmarking between hospitals in different regions, this should be done in the context of regional guidelines and policies.

Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Antimicrobial resistance; Benchmarking; Guidelines; Infection prevention

PMID: 31703820 DOI: 10.1016/j.ajic.2019.09.020

Keywords: Antibiotics; Drugs Resistance; IPC; HCWs; Nosocomial Outbreaks; USA; Netherlands.

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#Risk of #pneumonia among #residents living near #goat and #poultry #farms during 2014-2016 (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Risk of pneumonia among residents living near goat and poultry farms during 2014-2016

Pim M. Post , Lenny Hogerwerf, Anke Huss, Ronald Petie, Gert Jan Boender, Christos Baliatsas, Erik Lebret, Dick Heederik, Thomas J. Hagenaars, C. Joris IJzermans, Lidwien A. M. Smit

Published: October 14, 2019 / DOI: https://doi.org/10.1371/journal.pone.0223601

 

Abstract

In the Netherlands, an association was found between the prevalence of pneumonia and living near goat and poultry farms in 2007–2013. This association then led to regulatory decisions to restrict the building of new goat farms and to reduce emissions of poultry farms. Confirmation of these results, however, is required because the period of previous analyses overlapped a Q-fever epidemic in 2007–2010. To confirm the association, we performed a population-based study during 2014–2016 based on general practitioner (GP) data. Electronic medical records of 90,183 persons were used to analyze the association between pneumonia and the population living in the proximity (within 500–2000 m distance) of goat and poultry farms. Data were analyzed with three types of logistic regression (with and without GP practice as a random intercept and with stratified analyses per GP practice) and a kernel model to discern the influence of different statistical methods on the outcomes. In all regression analyses involving adults, a statistically significant association between pneumonia and residence within 500 meters of goat farms was found (odds ratio [OR] range over all analyses types: 1.33–1.60), with a decreasing OR for increasing distances. In kernel analyses (including all ages), a population-attributable risk between 6.0 and 7.8% was found for a distance of 2000 meters in 2014–2016. The associations were consistent across all years and robust for mutual adjustment for proximity to other animals and for several other sensitivity analyses. However, associations with proximity to poultry farms are not supported by the present study. As the causes of the elevated pneumonia incidence in persons living close to goat farms remain unknown, further research into potential mechanisms is required for adequate prevention.

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Citation: Post PM, Hogerwerf L, Huss A, Petie R, Boender GJ, Baliatsas C, et al. (2019) Risk of pneumonia among residents living near goat and poultry farms during 2014-2016. PLoS ONE 14(10): e0223601. https://doi.org/10.1371/journal.pone.0223601

Editor: Eric HY Lau, The University of Hong Kong, CHINA

Received: May 22, 2019; Accepted: September 24, 2019; Published: October 14, 2019

Copyright: © 2019 Post et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: In consultation with the Medical Ethical Committee of the University Medical Centre of Utrecht that approved the study protocol (number 13/533), data are not publicly available due to privacy protection of participants. Sharing an anonymized and de-identified dataset is not possible as it would still contain Electronic Health Records and address data of GP patients, which could potentially lead to the identification of subjects. The data for this study are derived from the NIVEL Primary Care Database. More information about the NIVEL Primary Care Database can be found at https://www.nivel.nl/en/nivel-primary-care-database. Requests for data can be sent to zorgregistraties@nivel.nl. Because of the granularity of the data and the requirements for data protection according to the Dutch Data Protection Act and the General Data Protection Regulation, access to the data is limited. The governance structure (data access committee) of the NIVEL Primary Care Database assesses data requests on data protection, scientific soundness of the request and public interest. Part of the governance structure is the privacy committee of the NIVEL Primary Care Database. For questions on data access, R. Coppen, member of this privacy committee and Data Protection Officer of NIVEL, may be contacted. He is registered as Data Protection Officer at the Dutch Data Protection Authority, see https://autoriteitpersoonsgegevens.nl/nl/onderwerpen/algemene-informatie-avg/functionaris-gegevensbescherming-fg

Funding: The work in this paper was commissioned to the Netherlands Institute for Health Services Research (NIVEL), in collaboration with the Institute for Risk Assessment Sciences (IRAS), Utrecht University, and Wageningen University and Research, The Netherlands. It was funded by the Ministry of Health, Welfare and Sport and the Ministry of Agriculture, Nature and Food Quality of The Netherlands [through grant number BO-43-013.01-007]. PMP analyzed the data as part of his PhD-project, which is supervised by Lenny Hogerwerf and funded by the Strategic Programme (SPR) of the National Institute for Public Health and the Environment (RIVM), The Netherlands. The funding sources had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Goat; Poultry; Pneumonia; Human; Netherlands.

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