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A pilot study to investigate the risk of SARS-CoV-2 household transmission following hospital discharge of confirmed cases in Vientiane Capital, Lao PDR. 一项试点研究,旨在调查老挝首都万象确诊病例出院后严重急性呼吸系统综合征冠状病毒2型家庭传播的风险。
Pub Date : 2021-12-01
Mayfong Mayxay, Phimpha Paboriboune, Xaipasong Xaiyaphet, Khamfong Kunlaya, Manivanh Vongsouvath, Bountoy Sibounheuang, Audrey Dubot-Pérès, Andrew J H Simpson, Matthew T Robinson, Khamla Choumlivong, Vangnakhone Dittaphong, Manichanh Thongsana, Anouphet Chanthamavong, Phetkim Sayasene, Bandith Soumphonphakdy, Khamphoua Soutthisombat, Bouathep Phoumindr, Rattanaxay Phetsouvanh, Phonepadith Xangsayarath, Elizabeth A Ashley

Background: Global guidelines from the World Health Organization on discharging patients diagnosed with COVID-19 changed in 2021 to a symptom-based rather than negative PCR-based approach. Studies have shown that shedding of viable virus continues for approximately eight days after symptom onset in most patients. In Vientiane, Laos, until now, patients diagnosed with asymptomatic or mild COVID-19 are hospitalised for 2 weeks and then, if they still test PCR positive for SARS-CoV-2, stay for a further week in a designated quarantine hotel before being discharged home.

Objective: The aim of this pilot study was to investigate the risk of transmission of SARS-CoV-2 to household contacts of discharged patients who are still PCR-positive following 2-3 weeks quarantine in Vientiane, Lao PDR.

Methods: Adult participants, who were resident in Vientiane Capital and who were about to be discharged from hospital (after 2 weeks hospitalisation), or from a quarantine hotel, following a further one-week quarantine, were screened to assess eligibility for the study. The household of each case was visited a maximum of 48 hours before or up to 24 hours after the participant was discharged and a nasopharyngeal swab was taken from all household members. Repeat nasopharyngeal swabs from cases and contacts were taken on day 7 and day 14 after discharge home of each case.

Results: Between 20th May 2021 and 27th August 2021, 55 cases and 84 contacts in 27 households were enrolled in the study. The median [range] age of all 139 included participants was 26.5 years [3 months to 83 years] and 83 (60%) were female. By household, the median [range] number of cases and contacts were 1 [1-6] and 3 [1-13] respectively. At discharge home 32/48 (67%) cases tested positive for SARS-CoV-2. By day 7 11 of 47 cases (23%) still tested positive for SARS-CoV-2 by PCR and by day 14 this number was 2/24 (8%). No contacts tested positive during follow up and the numbers tested at the time of discharge of the case, 7 days later and 2 weeks later were 56, 57 and 37 respectively. Loss to follow up at day 7 and day 14 ranged from 15-50% (participants not at home at the time of visits).

Conclusion: In this pilot study we found no evidence of onward transmission of SARS-CoV-2 to contacts of cases discharged home with a positive PCR result. This suggests the current discharge policy for mild to moderate COVID-19 case following 2 weeks in hospital in the Lao PDR is safe.

背景:2021年,世界卫生组织关于新冠肺炎确诊患者出院的全球指南改为基于症状的方法,而不是基于阴性PCR的方法。研究表明,在大多数患者出现症状后,存活病毒的脱落会持续大约八天。在老挝万象,到目前为止,被诊断为无症状或轻度新冠肺炎的患者住院2周,然后,如果他们的SARS-CoV-2 PCR检测结果仍然呈阳性,在出院回家之前,在指定的隔离酒店再住一周。目的:本试点研究的目的是调查在老挝万象隔离2-3周后仍呈PCR阳性的出院患者的家庭接触者传播严重急性呼吸系统综合征冠状病毒2型的风险,在进一步隔离一周后,对他们进行了筛查,以评估是否符合研究资格。每个病例的家庭在参与者出院前48小时或出院后24小时内进行了探访,并从所有家庭成员身上采集了鼻咽拭子。在每个病例出院回家后的第7天和第14天,对病例和接触者进行重复鼻咽拭子检测。结果:在2021年5月20日至2021年8月27日期间,27个家庭的55例病例和84名接触者参与了这项研究。所有139名参与者的中位[范围]年龄为26.5岁[3个月至83岁],83名(60%)为女性。按家庭划分,病例和接触者的中位数[范围]分别为1[1-6]和3[1-13]。出院时,32/48(67%)病例的严重急性呼吸系统综合征冠状病毒2型检测呈阳性。到第7天,47例病例中仍有11例(23%)通过PCR检测出严重急性呼吸系统综合征冠状病毒2型呈阳性,到第14天,这一数字为2/24(8%)。随访期间没有接触者检测呈阳性,病例出院时、7天后和2周后检测的人数分别为56人、57人和37人。第7天和第14天的随访损失在15-50%之间(参与者在就诊时不在家)。结论:在这项试点研究中,我们没有发现任何证据表明严重急性呼吸系统综合征冠状病毒2型传播给PCR结果呈阳性的出院病例的接触者。这表明,老挝目前对住院2周后轻度至中度新冠肺炎病例的出院政策是安全的。
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Valasan kanphaet Lao
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