Abstract
Background: Short-term rehabilitation units present unique infection control challenges because of high turnover and medically complex residents. In June 2021, the Maricopa County Department of Public Health was notified of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta outbreak in a skilled nursing facility short-term rehabilitation unit. We describe the outbreak and assess vaccine effectiveness (VE).
Methods: Facility electronic medical records were reviewed for residents who spent > 1 night on the affected unit between June 10 and July 23, 2021, to collect demographics, SARS-CoV-2 test results, underlying medical conditions, vaccination status, and clinical outcomes. Coronavirus disease 2019 VE estimates using Cox proportional hazards models were calculated.
Results: Forty (37%) of 109 short-stay rehabilitation unit residents who met inclusion criteria tested positive for SARS-CoV-2. SARS-CoV-2-positive case-patients were mostly male (58%) and White (78%) with a median age of 65 (range, 27-92) years; 11 (27%) were immunocompromised. Of residents, 39% (10 cases, 32 noncases) received 2 doses and 9% (4 cases, 6 noncases) received 1 dose of messenger RNA (mRNA) vaccine. Among nonimmunocompromised residents, adjusted 2-dose primary-series mRNA VE against symptomatic infection was 80% (95% confidence interval, 15-95). More cases were hospitalized (33%) or died (38%) than noncases (10% hospitalized; 16% died).
Conclusions: In this large SARS-CoV-2 Delta outbreak in a high-turnover short-term rehabilitation unit, a low vaccination rate and medically complex resident population were noted alongside severe outcomes. VE of 2-dose primary-series mRNA vaccine against symptomatic infection was the highest in nonimmunocompromised residents. Health departments can use vaccine coverage data to prioritize facilities for assistance in preventing outbreaks.
Keywords: COVID-19; delta variant; local public health; outbreak; skilled nursing facility.
【저자키워드】 COVID-19, delta variant, outbreak, local public health, skilled nursing facility., 【초록키워드】 coronavirus disease, public health, SARS-CoV-2, infection control, Coronavirus disease 2019, Vaccine, coronavirus, vaccination, Hospitalized, mRNA vaccine, Delta, rehabilitation, Local, severe acute respiratory syndrome Coronavirus, delta variant, clinical outcomes, outcomes, Outbreaks, Coverage, mRNA, male, Effectiveness, Immunocompromised, estimate, skilled nursing facility, symptomatic infection, dose, local public health, Medical conditions, facility, demographics, health department, Vaccination Status, Messenger RNA, acute respiratory syndrome, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, 95% confidence interval, assistance, median age, complex, inclusion criteria, white, Department, positive, Cox proportional hazards models, SARS-CoV-2 test, vaccination rate, Public, electronic medical record, highest, tested, affected, died, calculated, adjusted, unique, Cox proportional hazard, 【제목키워드】 Delta, B.1.617.2, coronavirus 2, resident, Nursing, respiratory, investigation, facility,