Propagation of a hospital-associated cluster of COVID-19 in Malaysia
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...
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my.um.eprints.345952022-09-14T00:04:26Z http://eprints.um.edu.my/34595/ Propagation of a hospital-associated cluster of COVID-19 in Malaysia Chong, Diane Woei-Quan Jayaraj, Vivek Jason Ng, Chiu Wan Sam, Jamal I-Ching Said, Mas Ayu Ahmad Zaki, Rafdzah Mohd Hairi, Noran Naqiah Nik Farid, Nik Daliana Hoe, Victor Chee-Wai Isahak, Marzuki Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Kamaruzzaman, Shahrul Bahyah Ong, Hang-Cheng Hasmukharay, Kejal Hasnan, Nazirah Kamarulzaman, Adeeba Chan, Yoke Fun Chong, Yoong Min Rampal, Sanjay RA0421 Public health. Hygiene. Preventive Medicine RC Internal medicine 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. BMC 2021-12-09 Article PeerReviewed 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 https://doi.org/10.1186/s12879-021-06894-y <https://doi.org/10.1186/s12879-021-06894-y>. 10.1186/s12879-021-06894-y |
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RA0421 Public health. Hygiene. Preventive Medicine RC Internal medicine Chong, Diane Woei-Quan Jayaraj, Vivek Jason Ng, Chiu Wan Sam, Jamal I-Ching Said, Mas Ayu Ahmad Zaki, Rafdzah Mohd Hairi, Noran Naqiah Nik Farid, Nik Daliana Hoe, Victor Chee-Wai Isahak, Marzuki Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Kamaruzzaman, Shahrul Bahyah Ong, Hang-Cheng Hasmukharay, Kejal Hasnan, Nazirah Kamarulzaman, Adeeba Chan, Yoke Fun Chong, Yoong Min Rampal, Sanjay Propagation of a hospital-associated cluster of COVID-19 in Malaysia |
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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. |
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Article |
author |
Chong, Diane Woei-Quan Jayaraj, Vivek Jason Ng, Chiu Wan Sam, Jamal I-Ching Said, Mas Ayu Ahmad Zaki, Rafdzah Mohd Hairi, Noran Naqiah Nik Farid, Nik Daliana Hoe, Victor Chee-Wai Isahak, Marzuki Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Kamaruzzaman, Shahrul Bahyah Ong, Hang-Cheng Hasmukharay, Kejal Hasnan, Nazirah Kamarulzaman, Adeeba Chan, Yoke Fun Chong, Yoong Min Rampal, Sanjay |
author_facet |
Chong, Diane Woei-Quan Jayaraj, Vivek Jason Ng, Chiu Wan Sam, Jamal I-Ching Said, Mas Ayu Ahmad Zaki, Rafdzah Mohd Hairi, Noran Naqiah Nik Farid, Nik Daliana Hoe, Victor Chee-Wai Isahak, Marzuki Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Kamaruzzaman, Shahrul Bahyah Ong, Hang-Cheng Hasmukharay, Kejal Hasnan, Nazirah Kamarulzaman, Adeeba Chan, Yoke Fun Chong, Yoong Min Rampal, Sanjay |
author_sort |
Chong, Diane Woei-Quan |
title |
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_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_sort |
propagation of a hospital-associated cluster of covid-19 in malaysia |
publisher |
BMC |
publishDate |
2021 |
url |
http://eprints.um.edu.my/34595/ |
_version_ |
1744649189187387392 |
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13.160551 |