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...
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-021-06894-y |
| _version_ | 1818338085705875456 |
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| author | Diane Woei-Quan Chong Vivek Jason Jayaraj Chiu-Wan Ng I-Ching Sam Mas Ayu Said Rafdzah Ahmad Zaki Noran Naqiah Hairi Nik Daliana Nik Farid Victor Chee-Wai Hoe Marzuki Isahak Sasheela Ponnampalavanar Sharifah Faridah Syed Omar Shahrul Bahyah Kamaruzzaman Hang-Cheng Ong Kejal Hasmukharay Nazirah Hasnan Adeeba Kamarulzaman Yoke Fun Chan Yoong Min Chong Sanjay Rampal |
| author_facet | Diane Woei-Quan Chong Vivek Jason Jayaraj Chiu-Wan Ng I-Ching Sam Mas Ayu Said Rafdzah Ahmad Zaki Noran Naqiah Hairi Nik Daliana Nik Farid Victor Chee-Wai Hoe Marzuki Isahak Sasheela Ponnampalavanar Sharifah Faridah Syed Omar Shahrul Bahyah Kamaruzzaman Hang-Cheng Ong Kejal Hasmukharay Nazirah Hasnan Adeeba Kamarulzaman Yoke Fun Chan Yoong Min Chong Sanjay Rampal |
| author_sort | Diane Woei-Quan Chong |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T15:05:30Z |
| format | Article |
| id | doaj.art-12ba245fcc5d4a20915c49ebd60707de |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-13T15:05:30Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-12ba245fcc5d4a20915c49ebd60707de2022-12-21T23:41:00ZengBMCBMC Infectious Diseases1471-23342021-12-0121111210.1186/s12879-021-06894-yPropagation of a hospital-associated cluster of COVID-19 in MalaysiaDiane Woei-Quan Chong0Vivek Jason Jayaraj1Chiu-Wan Ng2I-Ching Sam3Mas Ayu Said4Rafdzah Ahmad Zaki5Noran Naqiah Hairi6Nik Daliana Nik Farid7Victor Chee-Wai Hoe8Marzuki Isahak9Sasheela Ponnampalavanar10Sharifah Faridah Syed Omar11Shahrul Bahyah Kamaruzzaman12Hang-Cheng Ong13Kejal Hasmukharay14Nazirah Hasnan15Adeeba Kamarulzaman16Yoke Fun Chan17Yoong Min Chong18Sanjay Rampal19Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaDepartment of Medical Microbiology, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaDepartment of Medicine, Faculty of Medicine, University of MalayaDepartment of Medicine, Faculty of Medicine, University of MalayaDepartment of Medicine, Faculty of Medicine, University of MalayaMinistry of Health MalaysiaDepartment of Medicine, Faculty of Medicine, University of MalayaDepartment of Rehabilitation Medicine, Faculty of Medicine, University of MalayaDepartment of Medicine, Faculty of Medicine, University of MalayaDepartment of Medical Microbiology, Faculty of Medicine, University of MalayaDepartment of Medical Microbiology, Faculty of Medicine, University of MalayaCentre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of MalayaAbstract 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.https://doi.org/10.1186/s12879-021-06894-ySARS-CoV-2Epidemiological investigationWhole genome sequencingHospitalInfection controlMultidisciplinary |
| spellingShingle | Diane Woei-Quan Chong Vivek Jason Jayaraj Chiu-Wan Ng I-Ching Sam Mas Ayu Said Rafdzah Ahmad Zaki Noran Naqiah Hairi Nik Daliana Nik Farid Victor Chee-Wai Hoe Marzuki Isahak Sasheela Ponnampalavanar Sharifah Faridah Syed Omar Shahrul Bahyah Kamaruzzaman Hang-Cheng Ong Kejal Hasmukharay Nazirah Hasnan Adeeba Kamarulzaman Yoke Fun Chan Yoong Min Chong Sanjay Rampal Propagation of a hospital-associated cluster of COVID-19 in Malaysia BMC Infectious Diseases SARS-CoV-2 Epidemiological investigation Whole genome sequencing Hospital Infection control Multidisciplinary |
| title | Propagation of a hospital-associated cluster of COVID-19 in Malaysia |
| title_full | Propagation of a hospital-associated cluster of COVID-19 in Malaysia |
| title_fullStr | Propagation of a hospital-associated cluster of COVID-19 in Malaysia |
| title_full_unstemmed | Propagation of a hospital-associated cluster of COVID-19 in Malaysia |
| title_short | Propagation of a hospital-associated cluster of COVID-19 in Malaysia |
| title_sort | propagation of a hospital associated cluster of covid 19 in malaysia |
| topic | SARS-CoV-2 Epidemiological investigation Whole genome sequencing Hospital Infection control Multidisciplinary |
| url | https://doi.org/10.1186/s12879-021-06894-y |
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