Linked nosocomial COVID-19 outbreak in three facilities for people with intellectual and developmental disabilities due to SARS-CoV-2 variant B.1.1.519 with spike mutation T478K in the Netherlands

Koen M F Gorgels,Audrey Y J Hensels,Jozef Dingemans,Volker Hackert,Lieke B Van Alphen,Casper D J Den Heijer,Christian J P A Hoebe,Paul H M Savelkoul,Brian M J W Van Der Veer

doi:10.1186/s12879-022-07121-y

Koen M F Gorgels, Audrey Y J Hensels + Show 7 more

Open Access

https://doi.org/10.1186/s12879-022-07121-y

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Abstract

BackgroundIndividuals with intellectual and developmental disabilities (IDD) living in congregated settings have increased risk of COVID-19 infection and mortality. Little is known about variant B.1.1.519 with spike mutation T478K, dominant in Mexico. We describe a linked SARS-CoV-2 B.1.1.519 outbreak in three IDD facilities in the Netherlands.MethodsFollowing notification of the index, subsequent cases were identified through serial PCR group testing. Positive specimens were submitted for whole-genome-sequencing. Clinical information was gathered through interviews with staff members of the three facilities.ResultsAttack rate (AR) in clients of the index facility was 92% (23/25), total AR in clients 45% (33/73) and in staff members 24% (8/34). 55% (18/33) of client cases were asymptomatic, versus 25% (2/8) of staff members. Five client cases (15%) were hospitalized, two died (6%). Sequencing yielded the same specific B.1.1.519 genotype in all three facilities. No significant difference in median viral load was established comparing the B.1.1.519 variant with other circulating variants. The index of the linked outbreak reported no travel history or link to suspected or confirmed cases suggesting regional surveillance. Observed peak regional prevalence of B.1.1.519 during the outbreak supports this.ConclusionAR, morbidity and mortality prior to control measures taking effect were high, probably related to the specific characteristics of the IDD setting and its clients. We assessed no evidence for intrinsic contributing properties of variant B.1.1.519. Our study argues for enhanced infection prevention protocols in the IDD setting, and prioritization of this group for vaccination against COVID-19.

Highlights

Individuals with intellectual and developmental disabilities (IDD) living in congregated settings have increased risk of COVID-19 infection and mortality
This paper describes the first confirmed introduction of B.1.1.519 as a novel variant in the Netherlands after analysis of positive cases related to three outbreaks in facilities for people with IDD: two residential care facilities and a care farm with daycare activities
A full range of infection prevention measures to manage the risk related to Covid-19 transmission had been implemented, including the use of medical face masks by staff members

Summary

Introduction

Individuals with intellectual and developmental disabilities (IDD) living in congregated settings have increased risk of COVID-19 infection and mortality. Individuals with intellectual and developmental disabilities (IDD) have increased risk for contracting COVID-19 [3] and COVID-19 related mortality [4]. Living in congregated settings, like residential care facilities, increases risk of fatal outcomes [5, 6]. The World Health Organization (WHO) reports that overcrowding, lack of facilities for personal and environmental hygiene, insufficient isolation facilities and inadequate numbers of supervising staff may compromise infection control in long-stay mental care institutions [7]. While institutions tend to report adequate access to Personal Protective Equipment (PPE), unfamiliarity with its use may compromise adequate application and increase anxiety among staff members [7]

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