Autochthonous Outbreak of SARS-CoV-2 Omicron Variant in Booster-Vaccinated (3 Doses) Healthcare Workers in Southern Italy: Just the Tip of the Iceberg?

Abstract

The Omicron variant of concern (VOC), first detected in Italy at the end of November 2021, has since spread rapidly, despite high vaccine coverage in the Italian population, especially in healthcare workers (HCWs). This study describes an outbreak of SARS-CoV-2 Omicron infection in 15 booster-vaccinated HCWs. On 16 December 2021, two HCWs working in the same ward were infected with SARS-CoV-2. The Omicron VOC was suspected due to S gene target failure on molecular testing. Further investigation revealed that 15 (65%) of 23 HCWs attending a social gathering on 13 December were infected with Omicron, as shown by whole-genome sequencing, with a phylogenetic tree suggesting a common source of exposure. Five of these HCWs experienced mild symptoms. A patient with multiple chronic conditions hospitalized in the same ward was also infected by one of the HCWs involved in the outbreak. Despite being booster vaccinated, this patient required ICU treatment. Ten subjects achieved negativity in 10-19 days. The outbreak in booster-vaccinated subjects confirms the high transmissibility and immune evasion of the Omicron VOC. More stringent non-pharmaceutical interventions, administration of booster doses, and genomic surveillance are crucial long-term strategies to mitigate the consequences of the spread of the Omicron VOC.

Keywords: COVID-19 vaccine; Italy; SARS-CoV-2 Omicron variant; epidemiology; hospitalization; outbreak; surveillance.

Figure 1

(A) Phylogenetic analysis of hCoV19/Italy/PUG_UNIBA_APU_BA391/2021. Other genomes were retrieved from GISAID (https://www.gisaid.org, accessed on 14 February 2021). (B) Phylogenetic tree of 12 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron VOC full genome sequences from Apulia, including the 10 genomes identified in this study. Clade information using the GISAID and Nextstrain nomenclatures is shown. The strain of the patient is underlined in red.

Figure 1

(A) Phylogenetic analysis of hCoV19/Italy/PUG_UNIBA_APU_BA391/2021. Other genomes were retrieved from GISAID (https://www.gisaid.org, accessed on 14 February 2021). (B) Phylogenetic tree of 12 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron VOC full genome sequences from Apulia, including the 10 genomes identified in this study. Clade information using the GISAID and Nextstrain nomenclatures is shown. The strain of the patient is underlined in red.