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

Chong, Diane Woei-Quan and Jayaraj, Vivek Jason and Ng, Chiu Wan and Sam, Jamal I-Ching and Said, Mas Ayu and Ahmad Zaki, Rafdzah and Mohd Hairi, Noran Naqiah and Nik Farid, Nik Daliana and Hoe, Victor Chee-Wai and Isahak, Marzuki and Ponnampalavanar, Sasheela and Syed Omar, Sharifah Faridah and Kamaruzzaman, Shahrul Bahyah and Ong, Hang-Cheng and Hasmukharay, Kejal and Hasnan, Nazirah and Kamarulzaman, Adeeba and Chan, Yoke Fun and Chong, Yoong Min and Rampal, Sanjay (2021) Propagation of a hospital-associated cluster of COVID-19 in Malaysia. BMC Infectious Diseases, 21 (1). ISSN 1471-2334, DOI

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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.

Item Type: Article
Funders: United States Department of Defense Defense Threat Reduction Agency [HDTRA1-17-1-0027]
Uncontrolled Keywords: SARS-CoV-2; Epidemiological investigation; Whole genome sequencing; Hospital; Infection control; Multidisciplinary
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Medicine Department
Faculty of Medicine > Rehabilitation Medicine Department
Faculty of Medicine > Social & Preventive Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 14 Sep 2022 00:04
Last Modified: 14 Sep 2022 00:04

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