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Chea N, Eure T, Alkis Ramirez R, Zlotorzynska M, Blazek GT, Nadle J, Lee J, Czaja CA, Johnston H, Barter D, Kellogg M, Emanuel C, Meek J, Brackney M, Carswell S, Thomas S, Fridkin SK, Wilson LE, Perlmutter R, Marceaux-Galli K, Fell A, Lovett S, Lim S, Lynfield R, Shrum Davis S, Phipps EC, Sievers M, Dumyati G, Myers C, Hurley C, Licherdell E, Pierce R, Ocampo VLS, Hall EW, Wilson C, Adre C, Kirtz E, Markus TM, Billings K, Plumb ID, Abedi GR, James-Gist J, Magill SS, Grigg CT. Characteristics of healthcare personnel with SARS-CoV-2 infection: 10 emerging infections program sites in the United States, April 2020-December 2021. Infect Control Hosp Epidemiol 2024:1-9. [PMID: 38770586 DOI: 10.1017/ice.2024.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021. METHODS CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively. RESULTS Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles. CONCLUSIONS To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
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Affiliation(s)
- Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Taniece Eure
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Alkis Ramirez
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Zlotorzynska
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gregory T Blazek
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Chenega Enterprise Systems and Solutions, LLC, Chesapeake, VA, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA, USA
| | - Jane Lee
- California Emerging Infections Program, Oakland, CA, USA
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Melissa Kellogg
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Catherine Emanuel
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Monica Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Stacy Carswell
- Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Atlanta, GA, USA
| | - Stepy Thomas
- Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Foundation for Atlanta Veterans Education and Research, Atlanta, GA, USA
| | - Scott K Fridkin
- Georgia Emerging Infections Program, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Ashley Fell
- Minnesota Department of Health, St. Paul, MN, USA
| | - Sara Lovett
- Minnesota Department of Health, St. Paul, MN, USA
| | - Sarah Lim
- Minnesota Department of Health, St. Paul, MN, USA
| | | | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA
- New Mexico Department of Health, Santa Fe, NM, USA
| | | | - Ghinwa Dumyati
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher Myers
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Christine Hurley
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Erin Licherdell
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | - Eric W Hall
- Oregon Health and Science University and Portland State University School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | | | - Cullen Adre
- Tennessee Department of Health, Nashville, TN, USA
| | - Erika Kirtz
- Tennessee Department of Health, Nashville, TN, USA
| | | | | | - Ian D Plumb
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Glen R Abedi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jade James-Gist
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cheri T Grigg
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zlotorzynska M, Chea N, Eure T, Alkis Ramirez R, Blazek GT, Czaja CA, Johnston H, Barter D, Kellogg M, Emanuel C, Lynfield R, Fell A, Lim S, Lovett S, Phipps EC, Shrum Davis S, Sievers M, Dumyati G, Concannon C, Myers C, McCullough K, Woods A, Hurley C, Licherdell E, Pierce R, Ocampo VL, Hall E, Magill SS, Grigg CT. Residential social vulnerability among healthcare personnel with and without severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in Five US states, May-December 2020. Infect Control Hosp Epidemiol 2024; 45:82-88. [PMID: 37462106 PMCID: PMC10782193 DOI: 10.1017/ice.2023.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection. DESIGN Case-control study. SETTING This study analyzed data collected in May-December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon. PARTICIPANTS Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed. METHODS HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase- polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression. RESULTS Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37-2.26). CONCLUSIONS These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.
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Affiliation(s)
- Maria Zlotorzynska
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taniece Eure
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Alkis Ramirez
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory T. Blazek
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Chenega Enterprise Systems & Solutions, LLC, Chesapeake, Virginia
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Melissa Kellogg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Catherine Emanuel
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Ashley Fell
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Sarah Lim
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Sara Lovett
- Minnesota Department of Health, St. Paul, Minnestoa
| | - Erin C. Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico
| | - Marla Sievers
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Ghinwa Dumyati
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Cathleen Concannon
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Christopher Myers
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Kathryn McCullough
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Amy Woods
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Christine Hurley
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Erin Licherdell
- New York Emerging Infections Program, University of Rochester Medical Center, Rochester, New York
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | | | - Eric Hall
- School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Shelley S. Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheri T. Grigg
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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3
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Zhang MX, Lilien TA, van Etten-Jamaludin FS, Fraenkel CJ, Bonn D, Vlaar APJ, Löndahl J, Klompas M, Bem RA. Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337258. [PMID: 37819660 PMCID: PMC10568354 DOI: 10.1001/jamanetworkopen.2023.37258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. Objective To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. Data Sources A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. Study Selection Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. Data Extraction and Synthesis Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. Main Outcomes and Measures The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. Results Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. Conclusions and Relevance This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.
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Affiliation(s)
- Madeline X. Zhang
- Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs A. Lilien
- Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Carl-Johan Fraenkel
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Daniel Bonn
- Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander P. J. Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jakob Löndahl
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Reinout A. Bem
- Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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4
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van der Feltz S, Schlünssen V, Basinas I, Begtrup LM, Burdorf A, Bonde JPE, Flachs EM, Peters S, Pronk A, Stokholm ZA, van Tongeren M, van Veldhoven K, Oude Hengel KM, Kolstad HA. Associations between an international COVID-19 job exposure matrix and SARS-CoV-2 infection among 2 million workers in Denmark. Scand J Work Environ Health 2023; 49:375-385. [PMID: 37167299 PMCID: PMC10790132 DOI: 10.5271/sjweh.4099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES This study investigates the associations between the Danish version of a job exposure matrix for COVID-19 (COVID-19-JEM) and Danish register-based SARS-CoV-2 infection information across three waves of the pandemic. The COVID-19-JEM consists of four dimensions on transmission: two on mitigation measures, and two on precarious work characteristics. METHODS The study comprised 2 021 309 persons from the Danish working population between 26 February 2020 and 15 December 2021. Logistic regression models were applied to assess the associations between the JEM dimensions and overall score and SARS-CoV-2 infection across three infection waves, with peaks in March-April 2020, December-January 2021, and February-March 2022. Sex, age, household income, country of birth, wave, residential region and during wave 3 vaccination status were accounted for. RESULTS Higher risk scores within the transmission and mitigation dimensions and the overall JEM score resulted in higher odds ratios (OR) of a SARS-CoV-2 infection. OR attenuated across the three waves with ranges of 1.08-5.09 in wave 1, 1.06-1.60 in wave 2, and 1.05-1.45 in those not (fully) vaccinated in wave 3. In wave 3, no associations were found for those fully vaccinated. In all waves, the two precarious work dimensions showed weaker or inversed associations. CONCLUSIONS The COVID-19-JEM is a promising tool for assessing occupational exposure to SARS-CoV-2 and other airborne infectious agents that mainly spread between people who are in close contact with each other. However, its usefulness depends on applied restrictions and the vaccination status in the population of interest.
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Affiliation(s)
- Sophie van der Feltz
- Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus N, Denmark.
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5
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Chen P, Wu M, He Y, Jiang B, He ML. Metabolic alterations upon SARS-CoV-2 infection and potential therapeutic targets against coronavirus infection. Signal Transduct Target Ther 2023; 8:237. [PMID: 37286535 DOI: 10.1038/s41392-023-01510-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/18/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by coronavirus SARS-CoV-2 infection has become a global pandemic due to the high viral transmissibility and pathogenesis, bringing enormous burden to our society. Most patients infected by SARS-CoV-2 are asymptomatic or have mild symptoms. Although only a small proportion of patients progressed to severe COVID-19 with symptoms including acute respiratory distress syndrome (ARDS), disseminated coagulopathy, and cardiovascular disorders, severe COVID-19 is accompanied by high mortality rates with near 7 million deaths. Nowadays, effective therapeutic patterns for severe COVID-19 are still lacking. It has been extensively reported that host metabolism plays essential roles in various physiological processes during virus infection. Many viruses manipulate host metabolism to avoid immunity, facilitate their own replication, or to initiate pathological response. Targeting the interaction between SARS-CoV-2 and host metabolism holds promise for developing therapeutic strategies. In this review, we summarize and discuss recent studies dedicated to uncovering the role of host metabolism during the life cycle of SARS-CoV-2 in aspects of entry, replication, assembly, and pathogenesis with an emphasis on glucose metabolism and lipid metabolism. Microbiota and long COVID-19 are also discussed. Ultimately, we recapitulate metabolism-modulating drugs repurposed for COVID-19 including statins, ASM inhibitors, NSAIDs, Montelukast, omega-3 fatty acids, 2-DG, and metformin.
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Affiliation(s)
- Peiran Chen
- Department of Biomedical Sciences, City University of Hong Kong, HKSAR, Hong Kong, China
| | - Mandi Wu
- Department of Biomedical Sciences, City University of Hong Kong, HKSAR, Hong Kong, China
| | - Yaqing He
- Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, Guangdong, China
| | - Binghua Jiang
- Cell Signaling and Proteomic Center, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Ming-Liang He
- Department of Biomedical Sciences, City University of Hong Kong, HKSAR, Hong Kong, China.
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6
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Bonde JPE, Begtrup LM, Jensen JH, Flachs EM, Schlünssen V, Kolstad HA, Jakobsson K, Nielsen C, Nilsson K, Rylander L, Vilhelmsson A, Petersen KKU, Soegaard Toettenborg S. Occupational risk of SARS-CoV-2 infection: a nationwide register-based study of the Danish workforce during the COVID-19 pandemic, 2020-2021. Occup Environ Med 2023; 80:202-208. [PMID: 36813540 PMCID: PMC10086477 DOI: 10.1136/oemed-2022-108713] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Most earlier studies on occupational risk of COVID-19 covering the entire workforce are based on relatively rare outcomes such as hospital admission and mortality. This study examines the incidence of SARS-CoV-2 infection by occupational group based on real-time PCR (RT-PCR) tests. METHODS The cohort includes 2.4 million Danish employees, 20-69 years of age. All data were retrieved from public registries. The incidence rate ratios (IRRs) of first-occurring positive RT-PCR test from week 8 of 2020 to week 50 of 2021 were computed by Poisson regression for each four-digit Danish Version of the International Standard Classification of Occupations job code with more than 100 male and 100 female employees (n=205). Occupational groups with low risk of workplace infection according to a job exposure matrix constituted the reference group. Risk estimates were adjusted by demographic, social and health characteristics including household size, completed COVID-19 vaccination, pandemic wave and occupation-specific frequency of testing. RESULTS IRRs of SARS-CoV-2 infection were elevated in seven healthcare occupations and 42 occupations in other sectors, mainly social work activities, residential care, education, defence and security, accommodation and transportation. No IRRs exceeded 2.0. The relative risk in healthcare, residential care and defence/security declined across pandemic waves. Decreased IRRs were observed in 12 occupations. DISCUSSION We observed a modestly increased risk of SARS-CoV-2 infection among employees in numerous occupations, indicating a large potential for preventive actions. Cautious interpretation of observed risk in specific occupations is needed because of methodological issues inherent in analyses of RT-PCR test results and because of multiple statistical tests.
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Affiliation(s)
- Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark .,Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Luise Moelenberg Begtrup
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Johan Høy Jensen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
| | - Vivi Schlünssen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Jakobsson
- Sahlgrenska Academy, University of Gothenburg, School of Public Health and Community Medicine, Gothenburg, Sweden
| | - Christel Nielsen
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Kerstin Nilsson
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Andreas Vilhelmsson
- Laboratory Medicine, Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Sandra Soegaard Toettenborg
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederikberg Hospital, Copenhagen, Denmark
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7
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Cherry N, Mhonde T, Adisesh A, Burstyn I, Durand-Moreau Q, Labrèche F, Ruzycki S. The evolution of workplace risk for Covid-19 in Canadian healthcare workers and its relation to vaccination: A nested case-referent study. Am J Ind Med 2023; 66:297-306. [PMID: 36734295 DOI: 10.1002/ajim.23466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND During the early months of the Covid-19 pandemic, studies demonstrated that healthcare workers (HCWs) were at increased risk of infection. Few modifiable risks were identified. It is largely unknown how these evolved over time. METHODS A prospective case-referent study was established and nested within a cohort study of Canadian HCWs. Cases of Covid-19, confirmed by polymerase chain reaction, were matched with up to four referents on job, province, gender, and date of first vaccination. Cases and referents completed a questionnaire reporting exposures and experiences in the 21 days before case date. Participants were recruited from October 2020 to March 2022. Workplace factors were examined by mixed-effects logistic regression allowing for competing exposures. A sensitivity analysis was limited to those for whom family/community transmission seemed unlikely. RESULTS 533 cases were matched with 1697 referents. Among unvaccinated HCWs, the risk of infection was increased if they worked hands-on with patients with Covid-19, on a ward designated for care of infected patients, or handled objects used by infected patients. Sensitivity analysis identified work in residential institutions and geriatric wards as high risk for unvaccinated HCWs. Later, with almost universal HCW vaccination, risk from working with infected patients was much reduced but cases were more likely than referents to report being unable to access an N95 mask or that decontaminated N95 masks were reused. CONCLUSIONS These results suggest that, after a rocky start, the risks of Covid-19 infection from work in health care are now largely contained in Canada but with need for continued vigilance.
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Affiliation(s)
- Nicola Cherry
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Trish Mhonde
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Anil Adisesh
- Division of Occupational Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - France Labrèche
- Research Department, Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montreal, Quebec, Canada.,School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Shannon Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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8
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Bonde JPE, Sell L, Flachs EM, Coggon D, Albin M, Oude Hengel KM, Kolstad H, Mehlum IS, Schlünssen V, Solovieva S, Torén K, Jakobsson K, Nielsen C, Nilsson K, Rylander L, Petersen KU, Tøttenborg SS. Occupational risk of COVID-19 related hospital admission in Denmark 2020-2021: a follow-up study. Scand J Work Environ Health 2023; 49:84-94. [PMID: 36228167 PMCID: PMC10549918 DOI: 10.5271/sjweh.4063] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Mounting evidence indicates increased risk of COVID-19 among healthcare personnel, but the evidence on risks in other occupations is limited. In this study, we quantify the occupational risk of COVID-19-related hospital admission in Denmark during 2020-2021. METHODS The source population included 2.4 million employees age 20-69 years. All information was retrieved from public registers. The risk of COVID-19 related hospital admission was examined in 155 occupations with at least 2000 employees (at-risk, N=1 620 231) referenced to a group of mainly office workers defined by a COVID-19 job exposure matrix (N=369 341). Incidence rate ratios (IRR) were computed by Poisson regression. RESULTS During 186 million person-weeks of follow-up, we observed 2944 COVID-19 related hospital admissions in at-risk occupations and 559 in referents. Adjusted risk of such admission was elevated in several occupations within healthcare (including health care assistants, nurses, medical practitioners and laboratory technicians but not physiotherapists or midwives), social care (daycare assistants for children aged 4-7, and nursing aides in institutions and private homes, but not family daycare workers) and transportation (bus drivers, but not lorry drivers). Most IRR in these at-risk occupations were in the range of 1.5-3. Employees in education, retail sales and various service occupations seemed not to be at risk. CONCLUSION Employees in several occupations within and outside healthcare are at substantially increased risk of COVID-19. There is a need to revisit safety measures and precautions to mitigate viral transmission in the workplace during the current and forthcoming pandemics.
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Affiliation(s)
- Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospitals, Bispebjerg Bakke 23, DK-Copenhagen 2400 NV, Denmark.
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lea Sell
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - David Coggon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Maria Albin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Karen Marieke Oude Hengel
- Netherlands Organization for Applied Scientific Research TNO, Department of Work Health Technology, Leiden, The Netherlands
| | - Henrik Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Århus, Denmark
| | - Ingrid Sivesind Mehlum
- National Institute of Occupational Health (STAMI), Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | | | - Kjell Torén
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kristina Jakobsson
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Christel Nielsen
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Kerstin Nilsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Division of Public Health, Kristianstad University, Kristianstad, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Kajsa Ugelvig Petersen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Sertcelik A, Cakir B, Metan G. Evaluation of risk factors for developing COVID-19 in healthcare professionals working at two university hospitals in Turkey. Work 2022; 74:799-809. [PMID: 36442185 DOI: 10.3233/wor-220053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Healthcare workers (HCWs) were seriously affected by the coronavirus disease 2019 (COVID-19). It is a priority to protect HCWs against COVID-19 and ensure the continuity of the health care system. OBJECTIVE: To evaluate the risk factors for COVID-19 in HCWs and the effectiveness of the measures taken on protection. METHODS: A nested case-control study was conducted in two hospitals serving on the same campus which are affiliated with a university from Turkey, between 03.12.2020 and 05.22.2020. We aimed to recruit three controls working in the same unit with the cases diagnosed with COVID-19 by polymerase chain reaction (PCR) and whose SARS-CoV-2 PCR test is negative. Self-reported data were collected from the HCWs by the face-to-face method. Descriptive and analytical methods were used and a logistic regression model was built. Results: The study was completed with 271 HCWs, 72 cases, and 199 controls. Household contact with a COVID-19 patient or a patient with symptoms compatible with COVID-19 was found to be significantly higher in the cases than in the controls (p = 0.02, p < 0.001). When the measures for control the COVID-19 were analyzed, using a medical mask (OR = 0.28, 95% confidence interval = 0.11–0.76, p = 0.01) by COVID-19 patient and using the respiratory mask by HCWs (OR = 0.13, 95% CI = 0.03–0.52, p = 0.004) during close contact was found to be protective against COVID-19 transmission. Conclusion: This study showed an association with using medical masks by the patients as an important protective precaution for the transmission of COVID-19 to HCWs. Respiratory masks should be used by HCWs while in close contact with COVID-19 patients regardless of aerosol-producing procedures.
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Affiliation(s)
- Ahmet Sertcelik
- Department of Public Health, Division of Epidemiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Banu Cakir
- Department of Public Health, Division of Epidemiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Hospitals Infection Control Committee, Hacettepe University, Ankara, Turkey
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