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Comparing Dynamics and Determinants of SARS-CoV-2 Transmissions Among Health Care Workers of Adult and Paediatric Settings in Central Paris

32 Pages Posted: 2 Jul 2020

See all articles by Adrien Contejean

Adrien Contejean

Université de Paris, Faculté de Médecine

Jérémie Leporrier

Département de maladies infectieuses et de médecine tropicale, AP-HP, Hôpital Necker-Enfants malades

Etienne Canouï

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Fanny Alby-Laurent

Université de Paris, Faculté de Médecine

Emmanuel Lafont

Université de Paris, Faculté de Médecine

Lauren Beaudeau

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Perrine Parize

Département de maladies infectieuses et de médecine tropicale, AP-HP, Hôpital Necker-Enfants malades

Fabienne Lecieux

Service de santé au travail, AP-HP, Hôpital Cochin

Anges Greffet

Service de santé au travail, AP-HP, Hôpital Necker-Enfants malades

Gérard Chéron

Université de Paris, Faculté de Médecine

Rémy Gauzit

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Jacques Fourgeaud

Laboratoire De Virologie, AP-HP, Hôpital Necker-Enfants Malades

Anne-Sophie L'Honneur

Département De Virologie, AP-HP, Hôpital Cochin

Jean-Marc Treluyer

Département De Soins Intensifs Pédiatriques, AP-HP, Hôpital Necker-Enfants Malades; Hôpital Necker-Enfants Malades - Unité de Recherche Clinique / Centre Investigation Clinique

Caroline Charlier

Institut Pasteur - Biology of Infection Unit

Anne Casetta

Département De Soins Intensifs Pédiatriques, AP-HP, Hôpital Necker-Enfants Malades

Pierre Frange

EHU 7328 PACT, Institut Imagine, Université de Paris, Faculté de Médecine

Mariane Leruez-Ville

Laboratoire De Virologie, AP-HP, Hôpital Necker-Enfants Malades

Flore Rozenberg

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Olivier Lortholary

Université de Paris, Faculté de Médecine

Solen Kernéis

Assistance Publique-Hopitaux de Paris (AP-HP) - Equipe Mobile d’Infectiologie; Université de Paris

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Abstract

Background: From the start of the pandemic, health-care workers (HCW) have paid a heavy toll to the coronavirus desease-19 (COVID-19) outbreak. Routes of transmission however remain to be fully understood.

Methods: This prospective study compared two settings of a tertiary-care university hospital located in central Paris: a 1,500-bed adult and a 600-bed paediatric setting, accounting for a total of 13,278 employees. From February 24th until April 10th, 2020, all symptomatic HCW were screened for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on a nasopharyngeal swab. HCW screened positive were prospectively questioned by phone on their profession, symptoms, occupational and non-occupational exposures to SARS-CoV-2.

Findings: Among 1344 symptomatic HCW tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no death have been reported. Most HCW (70%) had patient-facing occupational activities and 22% in COVID-19 dedicated units. The total number of HCW cases peaked on week 13 (March 23rd, 2020) then decreased slowly until April 10th, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking for all hospital staff and personal protective equipment (PPE) for direct care to COVID-19 patients). Attack rates were of 3 · 2% and 2 · 3% in the adult and paediatric settings, respectively (p=0 · 0022). In the adult setting, HCW more frequently reported exposure to COVID-19 patients without PPE (25% versus 15%, p=0 · 046). In both settings, report of contacts with children attending out-of-home care facilities dramatically decreased all over the study period.

Interpretation: In central Paris, implementation of universal masking, reinforcement of hand hygiene, social distancing and PPE with medical masks for patients’ care allowed protection of HCW and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.

Funding Statement: None.

Declaration of Interests: AC reports personal fees and non-financial support from Janssen Cilag, outside the submitted work. RG reports personal fees and other from Sanofi, personal fees from MSD, personal fees from Eumedica, personal fees from Pfizer, personal fees from Frezenius, personal fees from Cubist, personal fees from Correvio, personal fees from Astellas, outside the submitted work. PF reports personal fees and nonfinancial support from MSD France, personal fees from ViiV Healthcare, non-financial support from Gilead Science, personal fees and non-financial support from Janssen Cilag, personal fees from Medtronic SAS, non-financial support from Astellas, non-financial support from GSK, outside the submitted work. MLV reports non-financial support from Biomerieux, non-financial support from Diasorin, outside the submitted work. OL reports personal fees from Pfizer, personal fees from Astellas, personal fees from MSD, personal fees from Gilead, outside the submitted work. SK reports research grants from bioMérieux, personal fees from Accelerate Diagnostics, bioMérieux, MSD and Menarini, and travel expenses from bioMérieux, Astellas, MSD and Pfizer, outside the submitted work. All other authors declare no conflict of interests.

Ethics Approval Statement: This study was approved by the Ethical Review Committee for publications of the Cochin university Hospital (CLEP) (N°: AAA-2020-08012). According to French policy, a non-opposition statement was obtained for all participants, meaning that all had received written detailed information on the objectives of the study and were free to request withdrawal of their consent for participation at any time.

Keywords: SARS-CoV-2; COVID-19; Health-care workers; Dynamics; Determinants; Adults; Paediatrics

Suggested Citation

Contejean, Adrien and Leporrier, Jérémie and Canouï, Etienne and Alby-Laurent, Fanny and Lafont, Emmanuel and Beaudeau, Lauren and Parize, Perrine and Lecieux, Fabienne and Greffet, Anges and Chéron, Gérard and Gauzit, Rémy and Fourgeaud, Jacques and L'Honneur, Anne-Sophie and Treluyer, Jean-Marc and Charlier, Caroline and Casetta, Anne and Frange, Pierre and Leruez-Ville, Mariane and Rozenberg, Flore and Lortholary, Olivier and Kernéis, Solen, Comparing Dynamics and Determinants of SARS-CoV-2 Transmissions Among Health Care Workers of Adult and Paediatric Settings in Central Paris (5/12/2020). Available at SSRN: https://ssrn.com/abstract=3605174 or http://dx.doi.org/10.2139/ssrn.3605174

Adrien Contejean

Université de Paris, Faculté de Médecine

Jérémie Leporrier

Département de maladies infectieuses et de médecine tropicale, AP-HP, Hôpital Necker-Enfants malades

Etienne Canouï

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Fanny Alby-Laurent

Université de Paris, Faculté de Médecine

Emmanuel Lafont

Université de Paris, Faculté de Médecine

Lauren Beaudeau

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Perrine Parize

Département de maladies infectieuses et de médecine tropicale, AP-HP, Hôpital Necker-Enfants malades

Fabienne Lecieux

Service de santé au travail, AP-HP, Hôpital Cochin

Anges Greffet

Service de santé au travail, AP-HP, Hôpital Necker-Enfants malades

Gérard Chéron

Université de Paris, Faculté de Médecine

Rémy Gauzit

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Jacques Fourgeaud

Laboratoire De Virologie, AP-HP, Hôpital Necker-Enfants Malades

Anne-Sophie L'Honneur

Département De Virologie, AP-HP, Hôpital Cochin

Jean-Marc Treluyer

Département De Soins Intensifs Pédiatriques, AP-HP, Hôpital Necker-Enfants Malades

Hôpital Necker-Enfants Malades - Unité de Recherche Clinique / Centre Investigation Clinique ( email )

United States

Caroline Charlier

Institut Pasteur - Biology of Infection Unit ( email )

France

Anne Casetta

Département De Soins Intensifs Pédiatriques, AP-HP, Hôpital Necker-Enfants Malades

Pierre Frange

EHU 7328 PACT, Institut Imagine, Université de Paris, Faculté de Médecine

Mariane Leruez-Ville

Laboratoire De Virologie, AP-HP, Hôpital Necker-Enfants Malades

Flore Rozenberg

Equipe Mobile d’Infectiologie, AP-HP, Hôpital Cochin

Olivier Lortholary

Université de Paris, Faculté de Médecine

Solen Kernéis (Contact Author)

Assistance Publique-Hopitaux de Paris (AP-HP) - Equipe Mobile d’Infectiologie ( email )

Paris
France

Université de Paris ( email )