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Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain

Limiting outbreaks in long-term care facilities (LTCFs) is a cornerstone strategy to avoid an excess of COVID-19-related morbidity and mortality and to reduce its burden on the health system. We studied a large outbreak that occurred at an LTCF, combining methods of classical and genomic epidemiolog...

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Autores principales: Bordoy, Antoni E., Vallès, Xavier, Not, Anna, Chiner-Oms, Álvaro, Saludes, Verónica, Torres Cervós, Judit, Roset Roig, Anna, Juan-Andres, Concha, Sureda, Helena, Pardo-Amil, Vanessa, García, Irene, Guitart Rossell, Gemma, Cambra Cibeira, Laura, Casañ, Cristina, Giménez, Montserrat, Blanco, Ignacio, Torres-Puente, Manuela, Cancino-Muñoz, Irving, González-Candelas, Fernando, Comas, Iñaki, Martró, Elisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society for Microbiology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769531/
https://www.ncbi.nlm.nih.gov/pubmed/36448779
http://dx.doi.org/10.1128/msphere.00346-22
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author Bordoy, Antoni E.
Vallès, Xavier
Not, Anna
Chiner-Oms, Álvaro
Saludes, Verónica
Torres Cervós, Judit
Roset Roig, Anna
Juan-Andres, Concha
Sureda, Helena
Pardo-Amil, Vanessa
García, Irene
Guitart Rossell, Gemma
Cambra Cibeira, Laura
Casañ, Cristina
Giménez, Montserrat
Blanco, Ignacio
Torres-Puente, Manuela
Cancino-Muñoz, Irving
González-Candelas, Fernando
Comas, Iñaki
Martró, Elisa
author_facet Bordoy, Antoni E.
Vallès, Xavier
Not, Anna
Chiner-Oms, Álvaro
Saludes, Verónica
Torres Cervós, Judit
Roset Roig, Anna
Juan-Andres, Concha
Sureda, Helena
Pardo-Amil, Vanessa
García, Irene
Guitart Rossell, Gemma
Cambra Cibeira, Laura
Casañ, Cristina
Giménez, Montserrat
Blanco, Ignacio
Torres-Puente, Manuela
Cancino-Muñoz, Irving
González-Candelas, Fernando
Comas, Iñaki
Martró, Elisa
author_sort Bordoy, Antoni E.
collection PubMed
description Limiting outbreaks in long-term care facilities (LTCFs) is a cornerstone strategy to avoid an excess of COVID-19-related morbidity and mortality and to reduce its burden on the health system. We studied a large outbreak that occurred at an LTCF, combining methods of classical and genomic epidemiology analysis. The outbreak lasted for 31 days among residents, with an attack rate of 98% and 57% among residents and staff, respectively. The case fatality rate among residents was 16% (n = 15). Phylogenetic analysis of 59 SARS-CoV-2 isolates revealed the presence of two closely related viral variants in all cases (B.1.177 lineage), revealing a far more complex outbreak than initially thought and suggesting an initial spread driven by staff members. In turn, our results suggest that resident relocations to mitigate viral spread might have increased the risk of infection for staff members, creating secondary chains of transmission that were responsible for prolonging the outbreak. Our results highlight the importance of considering unnoticed chains of transmission early during an outbreak and making an adequate use and interpretation of diagnostic tests. Outbreak containment measures should be carefully tailored to each LTCF. IMPORTANCE The impact of COVID-19 on long-term care facilities (LTCFs) has been disproportionately large due to the high frailty of the residents. Here, we report epidemiological and genomic findings of a large outbreak that occurred at an LTCF, which ultimately affected almost all residents and nearly half of staff members. We found that the outbreak was initially driven by staff members; however, later resident relocation to limit the outbreak resulted in transmission from residents to staff members, evidencing the complexity and different phases of the outbreak. The phylogenetic analysis of SARS-CoV-2 isolates indicated that two closely related variants were responsible for the large outbreak. Our study highlights the importance of combining methods of classical and genomic epidemiology to take appropriate outbreak containment measures in LTCFs.
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spelling pubmed-97695312022-12-22 Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain Bordoy, Antoni E. Vallès, Xavier Not, Anna Chiner-Oms, Álvaro Saludes, Verónica Torres Cervós, Judit Roset Roig, Anna Juan-Andres, Concha Sureda, Helena Pardo-Amil, Vanessa García, Irene Guitart Rossell, Gemma Cambra Cibeira, Laura Casañ, Cristina Giménez, Montserrat Blanco, Ignacio Torres-Puente, Manuela Cancino-Muñoz, Irving González-Candelas, Fernando Comas, Iñaki Martró, Elisa mSphere Research Article Limiting outbreaks in long-term care facilities (LTCFs) is a cornerstone strategy to avoid an excess of COVID-19-related morbidity and mortality and to reduce its burden on the health system. We studied a large outbreak that occurred at an LTCF, combining methods of classical and genomic epidemiology analysis. The outbreak lasted for 31 days among residents, with an attack rate of 98% and 57% among residents and staff, respectively. The case fatality rate among residents was 16% (n = 15). Phylogenetic analysis of 59 SARS-CoV-2 isolates revealed the presence of two closely related viral variants in all cases (B.1.177 lineage), revealing a far more complex outbreak than initially thought and suggesting an initial spread driven by staff members. In turn, our results suggest that resident relocations to mitigate viral spread might have increased the risk of infection for staff members, creating secondary chains of transmission that were responsible for prolonging the outbreak. Our results highlight the importance of considering unnoticed chains of transmission early during an outbreak and making an adequate use and interpretation of diagnostic tests. Outbreak containment measures should be carefully tailored to each LTCF. IMPORTANCE The impact of COVID-19 on long-term care facilities (LTCFs) has been disproportionately large due to the high frailty of the residents. Here, we report epidemiological and genomic findings of a large outbreak that occurred at an LTCF, which ultimately affected almost all residents and nearly half of staff members. We found that the outbreak was initially driven by staff members; however, later resident relocation to limit the outbreak resulted in transmission from residents to staff members, evidencing the complexity and different phases of the outbreak. The phylogenetic analysis of SARS-CoV-2 isolates indicated that two closely related variants were responsible for the large outbreak. Our study highlights the importance of combining methods of classical and genomic epidemiology to take appropriate outbreak containment measures in LTCFs. American Society for Microbiology 2022-11-30 /pmc/articles/PMC9769531/ /pubmed/36448779 http://dx.doi.org/10.1128/msphere.00346-22 Text en Copyright © 2022 Bordoy et al. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Article
Bordoy, Antoni E.
Vallès, Xavier
Not, Anna
Chiner-Oms, Álvaro
Saludes, Verónica
Torres Cervós, Judit
Roset Roig, Anna
Juan-Andres, Concha
Sureda, Helena
Pardo-Amil, Vanessa
García, Irene
Guitart Rossell, Gemma
Cambra Cibeira, Laura
Casañ, Cristina
Giménez, Montserrat
Blanco, Ignacio
Torres-Puente, Manuela
Cancino-Muñoz, Irving
González-Candelas, Fernando
Comas, Iñaki
Martró, Elisa
Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain
title Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain
title_full Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain
title_fullStr Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain
title_full_unstemmed Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain
title_short Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain
title_sort epidemiological and genomic analysis of a large sars-cov-2 outbreak in a long-term care facility in catalonia, spain
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769531/
https://www.ncbi.nlm.nih.gov/pubmed/36448779
http://dx.doi.org/10.1128/msphere.00346-22
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