Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003
Creators: name: Reynolds, Mary G
name: Anh, Bach Huy
name: Thu, Vu Hoang
name: Montgomery, Joel M
name: Bausch, Daniel G
name: Shah, J Jina
name: Maloney, Susan
name: Leitmeyer, Katrin
name: Huy, Vu Quang
name: Horby, Peter
name: Plant, Aileen J
name: Uyeki, Timothy M
Publisher: name: Robert Koch-Institut, Infektionskrankheiten / Erreger
Year: 2006
Subjects: subject: Adult
subject: Humans
subject: Travel
subject: Disease Outbreaks
subject: Middle Aged
subject: Risk Factors
subject: Antibodies
subject: Viral/blood
subject: Case-Control Studies
subject: Cohort Studies
subject: Hong Kong/ethnology
subject: Hospital Units
subject: Infectious Disease Transmission
subject: Patient-to-Professional/analysis
subject: Nursing Staff
subject: Hospital
subject: Occupational Exposure/analysis
subject: Occupational Exposure/statistics &amp; numerical data
subject: Personnel
subject: Risk Assessment
subject: SARS Virus/immunology
subject: Seroepidemiologic Studies
subject: Severe Acute Respiratory Syndrome/epidemiology
subject: Severe Acute Respiratory Syndrome/transmission
subject: Vietnam/epidemiology
subject: 610 Medizin

description: Background: In March of 2003, an outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in Northern Vietnam. This outbreak began when a traveler arriving from Hong Kong sought medical care at a small hospital (Hospital A) in Hanoi, initiating a serious and substantial transmission event within the hospital, and subsequent limited spread within the community. Methods: We surveyed Hospital A personnel for exposure to the index patient and for symptoms of disease during the outbreak. Additionally, serum specimens were collected and assayed for antibody to SARS-associated coronavirus (SARS-CoV) antibody and job-specific attack rates were calculated. A nested case-control analysis was performed to assess risk factors for acquiring SARS-CoV infection. Results: One hundred and fifty-three of 193 (79.3%) clinical and non-clinical staff consented to participate. Excluding job categories with &lt; 3 workers, the highest SARS attack rates occurred among nurses who worked in the outpatient and inpatient general wards (57.1, 47.4%, respectively). Nurses assigned to the operating room/intensive care unit, experienced the lowest attack rates (7.1%) among all clinical staff. Serologic evidence of SARS-CoV infection was detected in 4 individuals, including 2 non-clinical workers, who had not previously been identified as SARS cases; none reported having had fever or cough. Entering the index patient's room and having seen (viewed) the patient were the behaviors associated with highest risk for infection by univariate analysis (odds ratios 20.0, 14.0; 95% confidence intervals 4.1-97.1, 3.6-55.3, respectively). Conclusion: This study highlights job categories and activities associated with increased risk for SARS-CoV infection and demonstrates that a broad diversity of hospital workers may be vulnerable during an outbreak. These findings may help guide recommendations for the protection of vulnerable occupational groups and may have implications for other respiratory infections such as influenza.