英国卫生保健工作者中SARS-CoV-2大流行的特征：连续四波感染的危险因素

IF 14.3 1区医学 Q1 INFECTIOUS DISEASES

Journal of Infection Pub Date : 2025-02-01 DOI:10.1016/j.jinf.2024.106393

Edward J.M. Monk , Sarah Foulkes , Katie Munro , Ana Atti , Jasmin Islam , Susan Hopkins , Jacqui S. Reilly , Colin S. Brown , Victoria J. Hall , SIREN Study Group

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引用次数: 0

摘要

背景：在SARS-CoV-2大流行早期，医护人员处于感染的高危状态。目前还不确定职业、家庭和社区因素在多大程度上起了作用，以及这些因素如何随时间变化。我们的目的是在英国大型医疗工作者队列（SIREN）中描述连续四波大流行中感染的危险因素。方法：每两周对参与者进行SARS-CoV-2 PCR检测和症状/暴露调查。根据参与者特征和2020年10月1日至2022年8月30日期间每波感染的暴露情况，计算发病率和调整后的感染OR。研究结果：第二波19,427名参与者，第三波20,260名，第四波11,937名，第五波6,503名。感染发生率分别为9.1% （alpha）、6.6% （delta）、36.6% （omicron BA.1/2）和15.9% （omicron BA.4/5）。职业风险因素仅在第二次浪潮中显现出来，在此期间采取了重要的社会距离措施。这些人被确定为医疗保健助理、护士或床边治疗师，以及在住院病房工作。需要个人防护装备的职业接触也是一种风险。在随后的浪潮中，没有社会限制，职业特征不再是危险因素。相反，与他人住在一起比独自生活更有风险，尤其是儿童。在第三波（2021-2022年冬季）期间，首次将患有COVID-19的同事确定为一种风险。解释：我们的研究结果突出了临床领域和职业群体，其中可能存在预防医疗保健相关感染的范围，特别是在冬季压力下。针对这些问题的前瞻性研究对于确定哪种干预措施最有效至关重要。该研究还强调了在考虑医护人员保护时社区流通和暴露的重要性。

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Characterisation of the SARS-CoV-2 pandemic in healthcare workers within the United Kingdom: Risk factors for infection during four successive waves

Background

Healthcare workers were at a high risk of infection early in the SARS-CoV-2 pandemic. It is uncertain to what extent occupational, household and community factors contributed, and how this changed over time. We aimed to characterise the risk factors for infection over four successive waves of the pandemic in a large, UK healthcare worker cohort (SIREN).

Methods

Participants underwent fortnightly SARS-CoV-2 PCR testing and symptom/exposure questionnaire. Attack rates and adjusted OR of infection were calculated according to participant characteristics and exposures for each wave between 1st October 2020 and 30th August 2022.

Findings

19,427 participants were included in the second wave, 20,260 in the third, 11,937 in the fourth, and 6503 in the fifth. The attack rates of infection were 9.1% (alpha), 6.6% (delta), 36.6% (omicron BA.1/2) and 15.9% (omicron BA.4/5), respectively.

Occupational risk factors were only apparent in the second wave, during which significant social distancing measures were in place. These were identified as working as a healthcare assistant, nurse or bedside therapist, and working on an inpatient ward. Occupational exposure requiring personal protective equipment was also a risk.

In subsequent waves, without social restrictions, occupational characteristics were not risk factors. Instead, living with others compared to living alone was a risk, particularly children. During the third wave (winter 2021–2022), having a colleague with COVID-19 was identified as a risk for the first time.

Interpretation

Our findings highlight clinical areas and occupational groups in which there may be scope to prevent healthcare-associated infections, particularly during winter pressures. Prospective studies targeting these are essential to establish which interventions are most effective. This study also underscores the importance of community circulation and exposures when considering healthcare workforce protection.

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来源期刊

Journal of Infection 医学-传染病学

CiteScore

45.90

自引率

3.20%

发文量

475

审稿时长

16 days

期刊介绍： The Journal of Infection publishes original papers on all aspects of infection - clinical, microbiological and epidemiological. The Journal seeks to bring together knowledge from all specialties involved in infection research and clinical practice, and present the best work in the ever-changing field of infection. Each issue brings you Editorials that describe current or controversial topics of interest, high quality Reviews to keep you in touch with the latest developments in specific fields of interest, an Epidemiology section reporting studies in the hospital and the general community, and a lively correspondence section.