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To date, few report cases of spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema without any cause of trauma have been observed in patients with COVID-19 pneumonia. We present a case of a 66-year-old male patient who developed such complication on day 19 of hospitalization, without requiring non-invasive or invasive ventilator. CT thorax scan revealed widespread bilateral ground glass opacities with pneumothorax, pneumomediastinum, and subcutaneous emphysema, which were resolved totally on the following 29 days. We highlight preexisting mechanisms for pulmonary air-leak syndrome and importance of prompt recognition to establish adequate therapy in patients with COVID-19 pneumonia.

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BackgroundVaccination is one of the most effective ways to prevent the transmission of certain bacterial and viral diseases and it has reduced the associated morbidity and mortality. WHO estimates that all over the world 59 million healthcare workers (HCWs) are exposed every day to multiple occupational hazards.MethodsCross-sectional survey of a sample of HCWs from a hospital in Mexico was conducted through an anonymous, self-administered questionnaire between October 2015 and May 2016.ResultsOf 930 HCWs 76% completed the questionnaire. Among responders 64% declared knowing the required vaccines. Specialties associated with greater knowledge in vaccines were: Internal medicine (70%) (P = 0.04) and Pediatrics (63%) (P = 0.003); however, only 31% and 34% respectively were vaccinated against influenza. The mean number of years since influenza vaccination was 1.5 ± 1.8 and only 30% workers reported having been vaccinated in the period 2015–2016; 61.2% referred at least one dose against hepatitis B with a mean of 4.4 ± 4.4 years since the application, 15% reported knowing their immune status for hepatits B. In total 65% have been vaccinated against Tdap/td with an average of 3.7 ± 3.9 years from application. The reasons for not getting vaccinated included: Not having access to vaccines in 34%, cost in 8%, fear of adverse events 8%, belief of not require to be vaccinated in 5%. A total of 82.5% HCWs have worked while been sick. Reasons: Sense of duty in 57%, perception of poor performance in 21%, not disappointing colleagues in 13% and not letting down patients in 8%. Better compliance in vaccination coverage was observed among laboratory personnel: OR 2.0 (95% CI 1.0–4.7; P = 0.04) and nursing staff: OR 1.5 (95% CI 1.0–2.3; P = 0.01). There was no difference in compliance by medical specialty (P = 0.5). In total 17% HCWS reported having some occupational accident in the last 10 ± 5 years. Working in the emergency room: OR 1.6 (IC95% 1.0–2.4, P = 0.01); Unit of Intensive Care OR: 1.5 (IC 95% 10–2.3; P = 0.3) and operating room OR: 1.5 (IC95% 09–2.5; P = 0.05) were risk factors for occupational accidents.ConclusionHCWs vaccination coverage and knowledge were poor. Considering the important role of HCWs in preventing diseases, it should be mandatory that all HCWs receive proper advice concerning vaccination at their work place.Disclosures All authors: No reported disclosures.

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