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. 2022 Jul 28:10:933982.
doi: 10.3389/fped.2022.933982. eCollection 2022.

An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting

Affiliations

An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting

Firdose Lambey Nakwa et al. Front Pediatr. .

Abstract

Introduction: The provision of kangaroo mother care (KMC) involving continuous skin-to-skin care (SSC) is an important intervention in neonatal care, which is recommended even when women are infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2). We report on a nosocomial outbreak of SARS-CoV-2 infections in a KMC ward.

Methods: Contact tracing was conducted following the diagnosis of SARS-CoV-2 in a mother lodging in the KMC ward. All mother-newborn dyads in the KMC and healthcare workers (HCW) were tested for SARS-CoV-2 within 24-72 h of diagnosing the index case. Nasopharyngeal swab samples were obtained and tested from contacts, with a nucleic acid amplification test (NAAT) assay. Next-generation sequencing was done on positive samples. The secondary attack rate (SAR) was calculated assuming that the mother who presented with symptoms was the source of infection.

Results: Twelve (70.6%) of 17 mothers and 8 (42.1%) of 19 neonates who were in the KMC ward with the index case were found to be positive with SARS-CoV-2. Seven (87.5%) of the 8 neonates who tested positive had mothers who also tested positive. Seventy-five percent (9/12) of the mothers and 62.5% (5/8) of the neonates who tested positive were asymptomatic. Eight (27.6%) of 29 HCW were found to be positive and were all asymptomatic. One neonate died from Acinetobacter baumannii sepsis, and his post-mortem lung histopathology showed features compatible with SARS-CoV-2 pneumonia. The sequencing of 13 specimens, which included 1 mother-newborn dyad, indicated clustering to the same phylogenetic lineage with identical mutations. In assessing for factors contributing to this outbreak, it was found that spaces between beds were less than 1 m and mothers had their meals around the same table at the same time.

Conclusion: We report on a nosocomial outbreak of SARS-CoV-2 in a KMC ward, affecting a high number of mothers and neonates, and to a lesser extent HCWs. Although it is difficult to point to the index case as the source of this outbreak, as asymptomatic individuals can spread infection, the inadequate adherence to non-pharmaceutical interventions was assessed to have contributed to the spread of infection. This highlights the need for awareness and adherence to mitigation strategies to avoid SARS-CoV-2 outbreaks.

Keywords: SARS-CoV-2; langaroo mother care (KMC); neonate; non-pharmaceutical interventions (NPI); outbreak.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Schematic representation with the mothers and neonates who tested positive shaded in red. The beds shaded in green are mothers and neonates who tested negative, and the beds shaded in blue are not occupied. The large rectangle represents the maternal beds, the smaller rectangles adjacent to the large rectangles represent neonatal beds, and two smaller rectangles represent a set of twins. The purple circle represents the index case. The small orange rectangle represents the neonate who was not tested. Yellow triangles are doors. The dates below the beds are the dates of admission to the KMC ward.
FIGURE 2
FIGURE 2
The maximum clade credibility phylogeny of the mother and babies who tested positive during the outbreak in the Kangaroo care ward. Phylogenetic tree of 160 genomes collected in SA during the time that the outbreak had occurred. The maximum clade credibility phylogeny of the mothers and neonates who were tested during the outbreak in the KMC ward (red arrow). This indicates that the genomic data obtained from the 10 mothers and 3 neonates were clustered closely together.

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