Effect of an enhanced public health contact tracing intervention on the secondary transmission of SARS-CoV-2 in educational settings: The four-way decomposition analysis

Background

The aim of our study was to test the hypothesis that the community contact tracing strategy of testing contacts in households immediately instead of at the end of quarantine had an impact on the transmission of SARS-CoV-2 in schools in Reggio Emilia Province.

Methods

We analysed surveillance data on notification of COVID-19 cases in schools between 1 September 2020 and 4 April 2021. We have applied a mediation analysis that allows for interaction between the intervention (before/after period) and the mediator.

Results

Median tracing delay decreased from 7 to 3.1 days and the percentage of the known infection source increased from 34-54.8% (incident rate ratio-IRR 1.61 1.40-1.86). Implementation of prompt contact tracing was associated with a 10% decrease in the number of secondary cases (excess relative risk -0.1 95% CI -0.35-0.15). Knowing the source of infection of the index case led to a decrease in secondary transmission (IRR 0.75 95% CI 0.63-0.91) while the decrease in tracing delay was associated with decreased risk of secondary cases (1/IRR 0.97 95% CI 0.94-1.01 per one day of delay). The direct effect of the intervention accounted for the 29% decrease in the number of secondary cases (excess relative risk -0.29 95%-0.61 to 0.03).

Conclusions

Prompt contact testing in the community reduces the time of contact tracing and increases the ability to identify the source of infection in school outbreaks. Although there are strong reasons for thinking it is a causal link, observed differences can be also due to differences in the force of infection and to other control measures put in place.

Funding

This project was carried out with the technical and financial support of the Italian Ministry of Health - CCM 2020 and Ricerca Corrente Annual Program 2023.

Surveillance, contact tracing and characteristics of SARS-CoV-2 transmission in educational settings in Northern Italy, September 2020 to April 2021

BACKGROUND

The role of school contacts in the spread of the virus and the effectiveness of school closures in controlling the epidemic is still debated. We aimed to quantify the risk of transmission of SARS-CoV-2 in the school setting by type of school, characteristics of the index case and calendar period in the Province of Reggio Emilia (RE), Italy. The secondary aim was to estimate the speed of implementation of contact tracing.

METHODS

A population-based analysis of surveillance data on all COVID-19 cases occurring in RE, Italy, from 1 September 2020, to 4 April 2021, for which a school contact and/or exposure was suspected. An indicator of the delay in contact tracing was calculated as the time elapsed since the index case was determined to be positive and the date on which the swab test for classmates was scheduled (or most were scheduled).

RESULTS

Overall, 30,184 and 13,608 contacts among classmates and teachers/staff, respectively, were identified and were recommended for testing, and 43,214 (98.7%) underwent the test. Secondary transmission occurred in about 40% of the investigated classes, and the overall secondary case attack rate was 4%. This rate was slightly higher when the index case was a teacher but with almost no differences by type of school, and was stable during the study period. Speed of implementation of contact tracing increased during the study period, with the time from index case identification to testing of contacts being reduced from seven to three days. The ability to identify the possible source of infection in the index case also increased.

CONCLUSIONS

Despite the spread of the Alpha variant during the study period in RE, the secondary case attack rate remained stable from school reopening in September 2020 until the beginning of April 2021.

Comparative effectiveness of breathing exercises in patients with chronic obstructive pulmonary disease

BACKGROUND AND PURPOSE

This study aims to determine the best choice of breathing exercises (BE) for patients with chronic obstructive pulmonary disease (COPD) via a network meta-analysis.

METHODS

We searched randomized controlled trials (RCTs) of adults with COPD investigating any BEs in MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases. The effects of comparative treatment on the St. George Respiratory Questionnaire as the outcome were analysed and ranked according to a surface under the cumulative classification curve (SUCRA) analysis.

RESULTS

The network meta-analysis included six RCTs involving 280 patients with four intervention groups, comprising control, diaphragmatic breathing training (DBT), yoga, and singing course. Performing SUCRA, we reported that yoga is 75% likely to be the best treatment available as DBT with 66%, instead of 35% for singing and 21% for control.

CONCLUSION

DBT and yoga seem to be the best choices for breathing exercises in people with COPD.

Sharps and needle-stick injuries among medical residents and healthcare professional students: pattern and reporting in Italy-a cross-sectional analytical study

OBJECTIVES

Healthcare workers, in the course of their professional activity, are potentially exposed to chemical, physical and above all biological risks. The aims of our study were to investigate the extent and distribution of needle-stick and sharp injuries (NSIs) in healthcare students, the behaviours and circumstances most frequently associated with NSIs, the frequency of NSI reporting and the adherence to the post-exposure protocols.

METHODS

This study involved, through an interviewer-administered structured questionnaire, undergraduate and postgraduate students attending postgraduate medical schools and healthcare professional schools who underwent occupational health visits between January 2015 and July 2018.

RESULTS

Of the 642 students that participated in the study, 95 (14.8%) sustained an NSI during the traineeship and, of these, 59 (62.1%) reported the NSI to the occupational health service. NSIs were significantly more frequent in older subjects (χ²=9.853, p=0.020) and, among medical residents, in surgical residents (χ²=31.260, p<0.0001); moreover, occurrence of NSIs increased with increasing duration of traineeship (t=-2.051, p=0.041). Reporting of NSIs significantly increased with increasing age (χ²=12.543, p=0.006), with medical residents significantly under-reporting NSIs compared with undergraduate healthcare professional students (χ²=10.718, p=0.001) and among medical residents, those attending critical care units had the highest under-reporting (χ²=7.323, p=0.026).

CONCLUSIONS

The study showed remarkable under-reporting, as well as a lack of preparedness of students for NSI preventive and post-exposure effective measures. Our findings underline that healthcare student education should be reinforced to ensure that safe practices are carried out when needles and sharps are involved, as well as stressing the importance of NSI reporting and adherence to post-exposure prophylaxis protocols.

Spontaneous regression of syringomyelia in a young patient with Chiari type I malformation

Syringomyelia is a disorder in which a cyst or cavity forms within the spinal cord. This cyst, called syrinx, can expand and elongate over time, destroying the spinal cord. We describe the case of a young patient with partial spontaneous regression of syringomyelia in Chiari I malformation, confirmed by magnetic resonance imaging three years after the diagnosis. During this period the patient did not experience any clinical symptoms. Although described in literature, spontaneous regression is an unusual event and very few cases have been reported. This case report supports the belief that conservative management together with both clinical and imaging periodic controls should be preferred in stable mild-symptomatic patients.

Spontaneous Regression of Dilated Virchow-Robin Spaces

We describe a 28-year-old woman with a dilated perivascular spaces in the right prerolandic district. The purpose of this article is to provide an in-depth overview of the MR imaging features of VR spaces and to describe magnetic resonance imaging evidence of complete regression of dilated perivascular spaces 2.

SoC CMOS UWB Pulse Radar Sensor for Contactless Respiratory Rate Monitoring

An ultra wideband (UWB) system-on-chip radar sensor for respiratory rate monitoring has been realized in 90 nm CMOS technology and characterized experimentally. The radar testchip has been applied to the contactless detection of the respiration activity of adult and baby. The field operational tests demonstrate that the UWB radar sensor detects the respiratory rate of person under test (adult and baby) associated with sub-centimeter chest movements, allowing the continuous-time non-invasive monitoring of hospital patients and other people at risk of obstructive apneas such as babies in cot beds, or other respiratory diseases.

Wearable system-on-a-chip UWB radar for contact-less cardiopulmonary monitoring: present status

The present status of the project aimed at the realization of an innovative wearable system-on-chip UWB radar for the cardiopulmonary monitoring is presented. The overall system consists of a wearable wireless interface including a fully integrated UWB radar for the detection of the heart beat and breath rates, and a IEEE 802.15.4 ZigBee low-power radio interface. The principle of operation of the UWB radar for the monitoring of the heart wall is summarized. With respect to the prior art, this paper reports the results of the experimental characterization of the intra-body channel loss, which has been carried out successfully in order to validate the theoretical model employed for the radar system analysis. Moreover, the main building blocks of the radar have been manufactured in 90 nm CMOS technology by ST-Microelectronics and the relevant performance are resulted in excellent agreement with those expected by post-layout simulations.