Covid-19 outbreak in a properly vaccinated nursing home. Influence of hybrid immunity on viral load, risk of infection and risk of disease progression
e202405036
Keywords:
pandemic, outbreak, nursing home, covid-19, hybrid immunityAbstract
Introduction: This study addressed a COVID-19 outbreak in a nursing home, where the residents were vaccinated with two doses of Comirnaty® and thirty of them had previously had the infection. Outbreaks in closed communities are opportunities to study the entire clinical spectrum of the disease and, as in this case, the effect of hybrid immunity on transmission, infection progression and viral load.
Method: descriptive and retrospective cohort study in the resident population.
Results: The attack rate was 59% (56/95). The clinical spectrum was the same in both sexes. There was a notable protective effect of hybrid immunity against transmission (67%). In terms of progression, those with hybrid immunity had a lower risk of symptomatic infection. Nasopharyngeal viral load was significantly lower in individuals with hybrid immunity and asymptomatic individuals, supporting the idea of lower transmissibility in this group. Age was identified as a risk factor for disease progression. Molecular analysis identified the Delta B.1.617.2 variant in the patients and an air sample, supporting aerosol transmission in closed, poorly ventilated environments.
Conclusion: This study provides a comprehensive view of an outbreak in a vaccinated nursing home, highlighting the importance of hybrid immunity. The results support the individual consideration of previous infection history when assessing the risk of COVID-19, contributing to the understanding of the evolution of the pandemic in the future.
Downloads
References
American Geriatrics Society. American Geriatrics Society Policy Brief: COVID-19 and Nursing Homes. J Am Geriatr Soc. mayo de 2020;68(5):908-911.
Gardner W, States D, Bagley N. The Coronavirus and the Risks to the Elderly in Long-Term Care. J Aging Soc Policy. 3 de julio de 2020;32(4-5):310-315.
García Gómez M, Gherasim AM, Roldán Romero JM, Zimmermann Verdejo M, Monge Corella S, Sierra Moros MJ et al. [The impact of COVID-19 on sick leave of the persons working in nursing homes in Spain. Usefulness of sick leave for the surveillance of the pandemic evolution]. Rev Esp Salud Publica. 4 de abril de 2022;96:e202204038.
https://ojs.sanidad.gob.es/index.php/resp/article/view/294
Eltaybani S, Igarashi A, Cal A, Lai CKY, Carrasco C, Sari DW et al. Long-term care facilities’ response to the COVID-19 pandemic: An international, cross-sectional survey. J Adv Nurs. 14 de julio de 2023;jan.15785.
Wilson WW, Keaton AA, Ochoa LG, Hatfield KM, Gable P, Walblay KA et al. Outbreaks of SARS-CoV-2 Infections in Nursing Homes during Periods of Delta and Omicron Predominance, United States, July 2021-March 2022. Emerg Infect Dis. abril de 2023;29(4):761-770.
Centers for Disease Control. CDC Covid Data Tracker. Monitoring Variant Proportions [Internet]. 2023 [consultado 12 de agosto de 2023]. Disponible en:
https://covid.cdc.gov/covid-data-tracker/#variant-proportions
Uriu K, Ito J, Kosugi Y, Tanaka YL, Mugita Y, Guo Z et al. Transmissibility, infectivity, and immune evasion of the SARS-CoV-2 BA.2.86 variant. Lancet Infect Dis. Noviembre de 2023;23(11):e460-461.
Bobrovitz N, Ware H, Ma X, Li Z, Hosseini R, Cao C et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis. mayo de 2023;23(5):556-567.
Marking U, Havervall S, Norin NG, Bladh O, Christ W, Gordon M et al. Correlates of protection and viral load trajectories in omicron breakthrough infections in triple vaccinated healthcare workers. Nat Commun. 22 de marzo de 2023;14(1):1577.
Harris E. Hybrid COVID-19 Immunity Common by Fall of 2022. JAMA. 3 de julio de 2023;330(1):13.
Levine-Tiefenbrun M, Yelin I, Alapi H, Katz R, Herzel E, Kuint J et al. Viral loads of Delta-variant SARS-CoV-2 breakthrough infections after vaccination and booster with BNT162b2. Nat Med. diciembre de 2021;27(12):2108-2110.
Dadras O, Afsahi AM, Pashaei Z, Mojdeganlou H, Karimi A, Habibi P et al. The relationship between COVID-19 viral load and disease severity: A systematic review. Immun Inflamm Dis. marzo de 2022;10(3):e580.
Ruiz-Rodriguez P, Francés-Gómez C, Chiner-Oms Á,
López MG, Jiménez-Serrano S, Cancino-Muñoz I et al. Evolutionary and Phenotypic Characterization of Two Spike Mutations in European Lineage 20E of SARS-CoV-2. Buchrieser C, editor. mBio. 21 de diciembre de 2021;12(6):e02315-21.
Barberá-Riera M, Barneo-Muñoz M, Bellido Blasco J, Gascó-Laborda JC, Porru S, Alfaro C et al. Detection of SARS-CoV-2 in aerosols in long term care facilities and other indoor spaces with known COVID-19 outbreaks. Environ Res. noviembre de 2023;117730.
Torres I, Bellido-Blasco JB, Gimeno C, Burgos JS, Albert E, Moya-Malo R et al. SARS-CoV-2 Delta-variant breakthrough infections in nursing home residents at midterm after Comirnaty® COVID-19 vaccination. J Med Virol. agosto de 2022;94(8):3776-3782.
Cruz-Loustaunau D, Álvarez-Hernández G, Candia-Plata MDC, Leyva-Gastelum M. Cycle threshold and viral load in SARS-CoV-2-infected patients in Sonora, Mexico. Gac Médica México. 21 de septiembre de 2023;159(3):11324.
Roversi M, Coltella L, Piccioni L, Raucci U, Torelli A, Papini L et al. Relationship between viral load and symptoms in children infected with SARS-CoV-2. Pediatr Res. marzo de 2023;93(4):897-904.
Ergoren MC, Akan G, Volkan E, Kandemis E, Evren EU, Evren H et al. The “vaccine” hubbub: Viral load comparisons of SARS-CoV-2 Delta and Omicron variants against different vaccine–booster vaccine combinations. J Med Virol. enero de 2023;95(1):e28309.
Causa R, Tamayo C, Almagro Nievas D, Bermúdez Tamayo C. COVID-19 and functional dependence: cohort study of an outbreak in a nursing home for elderly. Rev Esp Salud Pública 2021. March 26th e202103045;(95). https://ojs.sanidad.gob.es/index.php/resp/article/view/573
Bernadou A, Bouges S, Catroux M, Rigaux JC, Laland C, Levêque N et al. High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020. BMC Infect Dis. diciembre de 2021;21(1):198.
Hurraß J, Golmohammadi R, Bujok S, Bork M, Thelen F, Wagner P et al. Explosive COVID-19 outbreak in a German nursing home and the possible role of the air ventilation system. J Hosp Infect. diciembre de 2022;130:34-43.
Patel MC, Chaisson LH, Borgetti S, Burdsall D, Chugh RK, Hoff CR et al. Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility. Clin Infect Dis. 31 de diciembre de 2020;71(11):2920-2926.
Pierobon A, Zotto AD, Antico A, De Antoni ME, Vianello L, Gennari M et al. Outbreak of SARS-CoV-2 B.1.617.2 (delta) variant in a nursing home 28 weeks after two doses of mRNA anti-COVID-19 vaccines: evidence of a waning immunity. Clin Microbiol Infect. abril de 2022;28(4):614.e5-614.e7.
Čokić V, Popovska Z, Lijeskić O, Šabić L, Djurković-Djaković O. Three Outbreaks of COVID-19 in a Single Nursing Home over Two Years of the SARS-CoV-2 Pandemic. Aging Dis. 2023;14(1):99.
Meyer ED, Sandfort M, Bender J, Matysiak-Klose D, Dörre A, Bojara G et al. BNT162b2 vaccination reduced infections and transmission in a COVID-19 outbreak in a nursing home in Germany, 2021. Influenza Other Respir Viruses [Internet]. Enero de 2023 [consultado 1 de agosto de 2023];17(1). Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/irv.13051
Downloads
Additional Files
Published
Versions
- 2024-08-22 (2)
- 2024-05-24 (1)
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Juan Carlos Gascó-Laborda, María Gil-Fortuño, Javier Ortiz-Rambla, Noemi Meseguer-Ferrer, Javier Pérez-Olaso, Lledó Lluch-Bacas, Raul Moya-Malo, Diego Moliner Urdiales, Juan Bellido-Blasco
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Usted es libre de:
Compartir — copiar y redistribuir el material en cualquier medio o formato.
La licenciante no puede revocar estas libertades en tanto usted siga los términos de la licencia.
Bajo los siguientes términos:
Atribución — Usted debe dar crédito de manera adecuada , brindar un enlace a la licencia, e indicar si se han realizado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo de la licenciante.
NoComercial — Usted no puede hacer uso del material con propósitos comerciales.
SinDerivadas — Si remezcla, transforma o crea a partir del material, no podrá distribuir el material modificado.
No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Avisos:
No tiene que cumplir con la licencia para elementos del material en el dominio público o cuando su uso esté permitido por una excepción o limitación aplicable.
No se dan garantías. La licencia podría no darle todos los permisos que necesita para el uso que tenga previsto. Por ejemplo, otros derechos como publicidad, privacidad, o derechos morales pueden limitar la forma en que utilice el material.
