Propagation of a hospital-associated cluster of COVID-19 in Malaysia

Abstract

Background Hospitals are vulnerable to COVID-19 outbreaks. Intrahospital transmission of the disease is a threat to the healthcare systems as it increases morbidity and mortality among patients. It is imperative to deepen our understanding of transmission events in hospital-associated cases of COVID-19 for timely implementation of infection prevention and control measures in the hospital in avoiding future outbreaks. We examined the use of epidemiological case investigation combined with whole genome sequencing of cases to investigate and manage a hospital-associated cluster of COVID-19 cases. Methods An epidemiological investigation was conducted in a University Hospital in Malaysia from 23 March to 22 April 2020. Contact tracing, risk assessment, testing, symptom surveillance, and outbreak management were conducted following the diagnosis of a healthcare worker with SARS-CoV-2 by real-time PCR. These findings were complemented by whole genome sequencing analysis of a subset of positive cases. Results The index case was symptomatic but did not fulfill the initial epidemiological criteria for routine screening. Contact tracing suggested epidemiological linkages of 38 cases with COVID-19. Phylogenetic analysis excluded four of these cases. This cluster included 34 cases comprising ten healthcare worker-cases, nine patient-cases, and 15 community-cases. The epidemic curve demonstrated initial intrahospital transmission that propagated into the community. The estimated median incubation period was 4.7 days (95% CI: 3.5–6.4), and the serial interval was 5.3 days (95% CI: 4.3–6.5). Conclusion The study demonstrated the contribution of integrating epidemiological investigation and whole genome sequencing in understanding disease transmission in the hospital setting. Contact tracing, risk assessment, testing, and symptom surveillance remain imperative in resource-limited settings to identify and isolate cases, thereby controlling COVID-19 outbreaks. The use of whole genome sequencing complements field investigation findings in clarifying transmission networks. The safety of a hospital population during this COVID-19 pandemic may be secured with a multidisciplinary approach, good infection control measures, effective preparedness and response plan, and individual-level compliance among the hospital population.

Combining viral genomics and clinical data to assess risk factors for severe COVID-19 (mortality, ICU admission, or intubation) amongst hospital patients in a large acute UK NHS hospital Trust

“…Large-scale SARS-CoV-2 sequencing programs throughout the pandemic have allowed researchers to explore the role of viral genomics and different variants of the virus. However, whilst genomic epidemiology has been used in a number of studies to understand viral transmission in settings such as hospitals [14][15][16][17], long-term care facilities [18][19][20][21][22], and army barracks [23,24], well-powered studies of patient outcomes with high numbers of cases currently remain limited [25][26][27][28][29][30][31]. One of the largest studies looking at large-scale effects of viral genomics on patient outcomes are papers from the Hospital Onset COVID-19 Infections (HOCI) study in the UK [25,26,28].…”

Factors Associated With Nosocomial COVID-19 Infection Among Health Care Workers in an Urban-Setting Malaysia Hospital

“…1,2 These outbreaks can lead to increase in workload due to reduced number of HCWs and increased number of patients, which put a strain on health care services. 3 Although, in Malaysia, up to 70% of SARS-CoV-2 infections among HCWs were community-acquired, there is still a need to identify SARS-CoV-2 transmitted through patients-HCWs or HCWs-HCWs cross-infections. 4 Therefore, we aimed to explore the factors associated with workplace transmission among HCWs who contracted coronavirus disease (COVID-19).…”

Epidemiological and Clinical Characteristics of COVID-19 Outbreak in a Mental Hospital in Wenzhou, China, December 2022–January 2023

“…The researches showed that the epidemiological characteristics (such as the spatial, temporal and population distributions) and clinical characteristics (such as clinical manifestations, disease severity) of COVID-19 among medical personnel in different regions, periods, and medical institutions were different, [4][5][6][7][8][9] based on the variation of SARS CoV-2 virus, as well as the changes in medical system and prevention and control strategies, population density and mobility, medical resources, COVID-19 vaccination and antibody levels of population etc. 10 Hospitals are vulnerable to COVID-19 outbreaks.…”

“…Since the initial outbreak of the COVID-19 in Wuhan at the end of December 2019, in the past three years, outbreaks of nosocomial COVID-19 infections have occurred in many countries, such as Malaysia, Spain, Switzerland, Germany, Italy, and Vietnam. [4][5][6][7][8][9][10][11] However, the epidemiological and clinical characteristics of these outbreaks are not all the same, their morbidity and case fatality rates and the scale of the outbreaks varies. In China, the government has adopted stringent COVID-19 prevention and control measures until November 2022, with low morbidity and mortality, and few large-scale COVID-19 outbreaks in hospitals.…”