Strategies For Prevention Of Transmission Research Articles

P-1975. Detection of SARS-CoV-2 Specific Secretory IgA and Neutralizing Antibodies in Nasal Secretions of Seronegative Individuals Previously Exposed to COVID-19

Abstract Background Mucosal immunity may contribute to clearing SARS-CoV-2 infection prior to systemic infection. We describe detection of SARS-CoV-2 specific nasal mucosal antibodies in a group of exposed household individuals that evaded systemic infection and remained seronegative.Figure 1.SARS-CoV-2-specific nasal SIgA. SARS-CoV-2-specific nasal SIgA in control and exposed participants (A). Positive thresholds of 0.20 and 6.30 AU/mL were calculated for unadjusted and adjusted SIgA, respectively, based on mean + 3 standard deviation of the control samples. Exposed participants were stratified by the positive threshold and unadjusted (B) SIgA and adjusted (C) SIgA were compared to controls and infected participants. Wilcoxon rank-sum tests determined if medians differed significantly. Methods Between June 2020 and February 2023, nasopharyngeal swabs (NPS) samples and acute and convalescent blood were collected from individuals exposed to a SARS-CoV-2-confirmed household member. Nasal secretory IgA (SIgA) antibodies targeting the SARS-CoV-2 spike protein were measured using a modified ELISA.Figure 2.SARS-CoV-2-specific nasal unadjusted (A) and adjusted (B) SIgA levels at Day 1 (enrollment), Day 8, and Day 15 for exposed seronegative with positive nasal SIgA and infected participants. SARS-CoV-2-specific nasal unadjusted (A) and adjusted (B) SIgA levels at Day 1 (enrollment), Day 8, and Day 15 for exposed seronegative with positive nasal SIgA and infected participants. Wilcoxon signed-rank tests were used to determine if medians (gray) differed significantly. Results Of 36 exposed individuals without SARS-CoV-2 detected by RT-PCR of NPS specimens and seronegative for SARS-CoV-2-specific IgG at acute and convalescent visits, 13 (36.1%) had positive SARS-CoV-2-specific SIgA levels detected in the nasal mucosa. These individuals had significantly higher nasal SIgA (median 0.52 AU/mL) compared with never-exposed, never-infected controls (n=29, 0.001 AU/mL) and infected-family members (n=43, 0.0002 AU/mL) during the acute visit, respectively (both P< 0.001, Figure 1). The nasal SARS-CoV-2-specific SIgA decreased rapidly over two weeks in the exposed seronegative individuals (Day 1 [0.52 AU/mL] vs. Day 8 [0.18 AU/mL] vs. Day 15 [median 0.02 AU/mL], P = 0.001 and 0.13, respectively, Figure 2). In contrast, SIgA increased in infected family members (Day 1 [0.0002 AU/mL] vs. Day 8 [0.65 AU/mL] vs. Day 15 [median 1.14 AU/mL], P < 0.001 and P = 0.09, respectively, Figure 2). Conclusion Transient nasal SARS-CoV-2-specific SIgA detected in exposed, seronegative individuals may have a protective role in preventing systemic infection. Elucidating factors associated with the induction of nasal SIgA response that prevent systemic invasion may inform infection and transmission prevention strategies. Disclosures Pia S. Pannaraj, MD, MPH, AstraZeneca: Grant/Research Support|Pfizer: Grant/Research Support

The Identification of Predominant Faecal Contamination Sources in Water Using Host-Specific Genetic Markers in Water-Stressed Rural Communities of Vhembe District Municipality, South Africa

It is critical to attribute faecal contamination to its original source in order to assess public health risks and implement effective interventions to mitigate future contamination. This study aimed to identify the primary sources of faecal contamination in water using microbial source tracking markers in water-stressed rural communities. A total of 1128 water samples were collected sequentially from the main source (river/borehole) to the households. Six host-specific genetic markers were used to detect faecal contamination in the water samples (BacHum and HF183, BacCow, Pig-2-Bac, Cytb and BacCan). Of the 564 water samples tested during the wet season, 37.94% (n = 214) were positive for human and animal-specific Bacteroidales marker genes, while 31.73% (n = 179) of the 564 tested during the dry season were also positive. During the wet season, animal faecal contamination was more prevalent among the positive samples (Cytb: 20.56%, n = 44; BacCan: 19.16%, n = 41). By contrast, human-origin faecal contamination was dominant during the dry season (BacHum: 23.46%, n = 42; HF183: 21.23%, n = 38). Identifying the origin of faecal contamination will assist in implementing targeted intervention strategies for the effective prevention of pathogen transmission in water-stressed rural communities in order to protect public health.

Transmission Routes and Prevention Strategies of Multidrug-Resistant Organism Infections in Hospitals

With the spread of multidrug-resistant organisms (MDROs) in hospitals, infection control faces significant challenges. MDROs refer to microorganisms resistant to three or more antimicrobial agents, commonly including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase-producing bacteria (ESBL). These resistant organisms primarily transmit through direct contact, indirect contact, and airborne routes within hospitals. Effective prevention and control of these infections require a comprehensive approach, including strict hand hygiene and personal protection, implementation of infection control standards, environmental cleaning and disinfection, management of medical device sterilization, and rational use of antimicrobial agents along with resistance monitoring. This paper summarizes the transmission routes and prevention strategies for MDRO infections, providing references for hospital management and clinical practice. Future research should focus on optimizing prevention measures and resistance monitoring to address the changing patterns of resistant organisms and enhance infection control effectiveness.

Comparison of Medicare Claims-based Clostridioides difficile infection classification to chart review using a linked cohort

Background: Medicare claims are frequently used to study Clostridioides difficile infection (CDI) epidemiology. Categorizing CDI based on location of onset and potential exposure is critical in understanding transmission patterns and prevention strategies. While claims data are well-suited for identifying prior healthcare utilization exposures, they lack specimen collection and diagnosis dates to assign likely location of onset. Algorithms to classify CDI onset and healthcare association using claims data have been published, but the degree of misclassification is unknown. Methods: We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016-2020 to Medicare beneficiaries using residence, birth date, sex, and hospitalization and/or healthcare exposure dates. Uniquely linked patients with fee-for-service Medicare A/B coverage and complete EIP case report forms were included. Patients with a claims CDI diagnosis code within ±28 days of a positive CDI test reported to EIP were categorized as hospital-onset (HO), long-term care facility onset (LTCFO), or community-onset (CO, either healthcare facility-associated [COHCFA] or community-associated [CA]) using a previously published algorithm based on claim type, ICD-10-CM code position, and duration of hospitalization (if applicable). EIP classifies CDI into these categories using positive specimen collection date and other information from chart review (e.g. admit/discharge dates). We assessed concordance of EIP and claims case classifications using Cohen’s kappa. Results: Of 10,002 eligible EIP-identified CDI cases, 7,064 were linked to a unique beneficiary; 3,451 met Medicare A/B fee-for-service coverage inclusion criteria. Of these, 650 (19%) did not have a claims diagnosis code ±28 days of the EIP specimen collection date (Table); 48% (313/650) of those without a claims diagnosis code were categorized by EIP as CA CDI. Among those with a CDI diagnosis code, concurrence of claims-based and EIP CDI classification was 68% (κ=0.56). Concurrence was highest for HO and lowest for COHCFA CDI. A substantial number of EIP-classified CO CDIs (30%, Figure) were misclassified as HO using the claims-based algorithm; half of these had a primary ICD-10 diagnosis code of sepsis (226/454; 50%). Conclusions: Evidence of CDI in claims data was found for 81% of EIP-reported CDI cases. Medicare classification algorithms concurred with the EIP classification in 68% of cases. Discordance was most common for community-onset CDI patients, many of whom were hospitalized with a primary diagnosis of sepsis. Misclassification of CO-CDI as HO may bias findings of claims-based CDI studies.

Genomic surveillance of Clostridioides difficile transmission and virulence in a healthcare setting.

Clostridioides difficile infection remains a leading cause of hospital-associated diarrhea, despite increased antibiotic stewardship and transmission prevention strategies. This suggests a changing genomic landscape of C. difficile. Our study provides insight into the nature of prevalent C. difficile strains in a hospital setting and transmission patterns among carriers. Longitudinal sampling of surfaces and patient stool revealed that both toxigenic and nontoxigenic strains of C. difficile clade 1 dominate these two wards. Moreover, quantification of transmission in carriers of these clade 1 isolates underscores the need to revisit infection prevention measures in this patient group. We identified unique genetic signatures associated with virulence in this clade. Our data highlight the complexities of preventing transmission of this pathogen in a hospital setting and the need to investigate the mechanisms of in vivo persistence and virulence of prevalent lineages in the host gut microbiome.

“It’s about time they taught us”: a qualitative study evaluating the barriers to finding and screening child contacts under five at risk for TB in Gauteng Province, South Africa from the provider and caregiver perspectives

BackgroundInadequate numbers of children under five years of age who are exposed to tuberculosis (TB) in the home (child contact) are initiated on TB preventive treatment (TPT) in South Africa. We assessed barriers of initiating isoniazid preventive therapy (IPT) in this age group.MethodsWe conducted a qualitative study at two primary health clinics in the Ekurhuleni district in Gauteng Province. Between April and July 2019, we enrolled facility managers, TB staff and parents or legal guardians of child contacts (caregivers) attending for care, at the two facilities. Semi-structured questionnaires, facility observations and in-depth interviews using a semi-structured interview guide were used to collect data. Findings from the semi-structured questionnaires with facility staff and facility observations were summarized. Thematic analysis with a deductive approach was used to analyse the data from the in-depth interviews with caregivers.ResultsTwo facility managers took part in the study and were assisted to complete the semi-structured questionnaires by TB staff. Fifteen caregivers aged between 18 and 43 years were interviewed of which 13 (87%) were female. Facility managers and TB staff (facility staff) felt that even though caregivers knew of family members who were on TB treatment, they delayed bringing their children for TB screening and TPT. Facility staff perceived caregivers as not understanding the purpose and benefits of TB prevention strategies such as TPT. Caregivers expressed the desire for their children to be screened for TB. However, caregivers lacked knowledge on TB transmission and the value of TB prevention in children at high risk of infection.ConclusionWhile facility staff perceived caregivers to lack responsibility, caregivers expressed limited knowledge on the value of screening their children for TB as reasons for not accessing TB preventive services. Health education on TB transmission, screening, and TB prevention strategies at a community level, clinics, creches, schools and via media are important to achieve the global end TB goal of early detection and prevention of TB.

Demographic Characteristics of Unvaccinated Asymptomatic and Symptomatic SARS-CoV-2 Cases in Barwon South West, Victoria, Australia.

We investigated 328 SARS-CoV-2 cases in Barwon South West, Victoria, Australia, in the 2020 pre-vaccination period, comparing infections with symptoms to those that remained asymptomatic. De-identified self-reported data on case characteristics and symptom progression from three sequential questionnaires were examined. Multivariable logistic regression was used to model associations between demographic profiles and symptoms. Asymptomatic infections were more than three times as likely to be seen in ethnic minority groups than the Caucasian population after adjusting for gender and age [OR 3.2, 95% CI 1.5-6.7, p < 0.01] and were more common among cases of Asian background [OR 2.8, 95%CI 1.2-6.4]. Asymptomatic infections were also more common in youth and younger adults, but cases were approximately seven times more likely to be in seniors (≥65 years) compared with those 24 years of age or younger after adjusting for sex and ethnicity [OR 6.9, 95% CI 1.3-35.8]. The overrepresentation of ethnic minority groups among asymptomatic infections is suggestive of genetic haplotype variability by ethnic group, conferring greater cross-protection from other coronaviruses in the initial phase of the COVID-19 pandemic. Replication of this analysis in the post-vaccination era and reassessment of symptom expression according to ethnicity in a community with established vaccine and infection-induced immunity would determine whether this is a sustained association or one confined to the early stages of a pandemic in an immunologically naive population. These findings may, in part, reflect differences in testing patterns by ethnicity and true differences in disease expression, both of which are important to understand in order to inform transmission prevention strategies and tailored risk messaging according to ethnic background.

The spatial-temporal pattern of Japanese encephalitis and its influencing factors in Guangxi, China.

Japanese encephalitis (JE) is a major global public health threat. Using Japanese encephalitis incidence data from 2004 to 2010 in Guangxi Province, China, this study comprehensively explored the driving forces and the interactive effects between environmental and social factors of Japanese encephalitis using the Geo-detector method. The results indicated that the incidence of Japanese encephalitis showed a fluctuating downward trend from 2004 to 2010. The onset of JE was seasonal, mainly concentrated in June-July, and highly aggregated in northwestern Guangxi. Among the factors associated with Japanese encephalitis, days with temperatures >30 °C, accumulated temperatures >25 °C, slope, the normalized difference vegetation index, the gross domestic product of tertiary industries, the gross domestic product of primary industries and the number of pigs slaughtered showed higher contributions to Japanese encephalitis incidence. An enhanced interactive effect was found between environmental and social factors, and the interaction between days with humidity levels >80% and the gross domestic product of tertiary industries had the greatest combined effect on JE. These findings enhanced the understanding of the combined effect of social and environmental factors on the incidence of Japanese encephalitis and could help improve Japanese encephalitis transmission control and prevention strategies.

Strategi Ladokgi TNI AL R.E. Martadinata dalam Pencegahan Penularan Covid-19 Guna Mendukung Tugas TNI Angkatan Laut

Dental and oral health services at Indonesian Navy Dental Institution R.E Martadinata might continue during the COVID-19 pandemic so as not to interfere with the duties of Indonesian Navy soldiers. For this reason, the implementation of dental and oral treatment might implement the procedures to prevent COVID-19 transmission. This study aimed to analyze transmission prevention procedures and strategies to prevent transmission of COVID-19. This study used a qualitative method with a descriptive design. The results showed that: 1) the procedure for preventing the transmission of COVID-19 in Indonesian Navy Dental Institution R.E Martadinata was carried out by applying strict health protocols and testing; 2) The strategy carried out is to provide initial training such as Basic Life Support, COVID-19 screening training, and PCR examinations, and increase the capacity of health workers by installing air purifiers in every room, equipping dental units with High Volume Evacuators (HVE). The conclusion in the study was that the procedure for preventing the transmission of COVID-19 and the strategy carried out by Indonesian Navy Dental Institution R.E Martadinata were good for preventing the transmission of COVID-19. Thus, dental and oral treatment services can continue to run properly without neglecting the safety of health workers and patients.

Buruli ulcer - A neglected tropical disease in the Barwon region of Victoria, Australia: An emerging public health threat with local and national ramifications.

Mycobacterium ulcerans (MU) is known to be endemic in heavily touristed coastal regions of Victoria and is the cause of Buruli ulcer (BU) disease. The incidence, severity and geographic spread of MU infection/BU disease is increasing, including metropolitan Victorian suburbs. While the specifics of disease transmission and effective prevention strategies remain uncertain, severe complications can be mitigated by health systems that provide vigilant population surveillance to underpin early recognition, early specialist involvement and definitive treatment for the individual. Current theories regarding disease transmission and 'best practice' (or best guess) prevention and mitigation measures are presented herein. Opportunities to improve the health system response to this emerging public health threat are identified. It is incumbent upon all healthcare providers, including ED clinicians, to contribute by familiarising themselves with the established and emerging areas of endemicity of MU infection and the array of BU clinical presentations.

Strategies for COVID-19 transmission control and mitigation in a psychiatric hospital in Mexico.

In the context of the emerging COVID-19 pandemic, one of the great challenges is to generate effective strategies for the control of nosocomial infections, specifically in psychiatric hospitals with populations considered at risk (older adults or individuals with comorbidities). This article describes the strategies for prevention, containment and treatment of infection transmission implemented during a COVID-19 outbreak that occurred in July 2020 in a psychiatric hospital of the State of Mexico. The population was comprised by women with prolonged hospital stay (mean = 24 years), mostly geriatric (mean = 64 years), with various psychiatric disorders and comorbidities. In total, 19 COVID-19-positive cases were diagnosed, out of which thirteen had mild symptoms and six were asymptomatic. There were no alterations in mental state, psychiatric symptoms or underlying diseases. Algorithms were developed for the management and treatment of suspected/confirmed COVID-19 cases. Finally, the generation of comprehensive strategies, quick and timely actions, as well as adequate management of human resources favoring interdisciplinary work, were deemed to have contributed to contain and mitigate the COVID-19 outbreak, which constitutes a precedent in the psychiatric field with institutionalized patients.

Serologic follow-up of solid organ transplant recipients who received organs from donors with reactive syphilis tests: A retrospective cohort study.

The increased procurement of organs from donors with risk factors for blood-borne diseases and the expanding syphilis epidemic have resulted in a growing number of organs transplanted from donors with reactive syphilis serology in our center. Based on guidelines, recipients typically receive therapy shortly after the transplant, but data on outcomes are limited. The primary objective of this study was to determine syphilis seroconversion rates at three months post-transplant in recipients of solid organs procured from donors with reactive syphilis serology. Organ donors and recipients were tested for syphilis antibody; positive results were confirmed with Treponema pallidum Particle Agglutination (TPPA). Eleven donors with reactive syphilis antibody donated organs to 25 syphilis negative recipients. Three recipients seroconverted at post-transplant month 3. All of them had received therapy shortly after transplant. TPPA was negative in all 3. Despite post-transplant treatment, 3 of 25 (12%) syphilis negative recipients of organs from syphilis positive donors seroconverted at 3 months. All remained TPPA negative possibly reflecting passive antibody transfer or differing test sensitivity to low level treponemal antibodies. Further studies are needed to assess optimal syphilis transmission prevention strategies and follow up recipient testing in organ transplantation.

Health education impact on knowledge and management of arboviral diseases in Kenya: Evidence from randomised control trials

ABSTRACT Communities’ knowledge and management strategies are crucial for mitigating and controlling the threat of existing and emerging diseases. In this study, we conducted randomised control trials (RCT) to examine the impact of health education on households’ knowledge and management of three Arboviral Diseases (ADs); Rift Valley fever, Chikungunya fever, and Dengue fever in Kenya. The study was based on a sample of 629 households drawn from the three of Kenya’s AD hotspot counties; Baringo, Kwale, and Kilifi. Employing a difference-in-difference method, our findings indicate that health education intervention significantly improved households’ understanding of ADs transmission modes, causes, and prevention strategies. However, this intervention did not sufficiently influence households’ disease management behaviour. We recommend the implementation of community engagement and outreach initiatives which have the potential to drive behavioural changes at the household level, thus enhancing the management and control of ADs in Kenya.

Epidemija morbila na teritoriji Smedereva

The Republic of Serbia is a country with endemic measles transmission. Decline of MMR immunization coverage resulted in measles resurgence in Serbia at the beginning of 2023. Aim of this study is a description of measles outbreak at the territory of the City of Smederevo between January and April 2023 and identification of interventions for prevention of future measles outbreaks in the Republic of Serbia. The national active measles surveillance data were analysed. The outbreak involved 43 measles cases, of whom 42 were classified as laboratory confirmed and one as epidemiologically linked. Most of cases were aged 1 to 4 years (44.2%) and 20 to 49 years (32.6%) while the highest age-specific incidence rates were registered in children younger than 12 months (80.6/10,000) and children aged 1 to 4 years (50.5/10,000). Most of cases with known vaccination status (92.9%) were unvaccinated including 8 children younger than 12 months not yet eligible for vaccination according to the national immunization schedule. Number of hospitalized cases were 20 (46.5%) including two cases with pneumonia. Among 14 cases who contracted measles in healthcare settings 5 were employees of General Hospital Smederevo. Genom sequencing was performed in 10 cases and B3 genotype of morbilli virus was detected in all cases. In order to prevent future measles outbreaks in the Republic of Serbia it is necessary to achieve and maintain target values of coverage and timeliness of MMR vaccination. Timely notification of suspected cases and diagnosis of measles as well as immunization of susceptible employees of healthcare institutions are key strategies for prevention of measles transmission in healthcare settings.

Social stigma against individuals with COVID-19: scale development and validation

ABSTRACT Background: Social stigma toward individuals with COVID-19 is a public phenomenon that significantly impacts the prevention of this disease. The study aimed to develop and examine the scale of social stigma against people with COVID-19. Methods: A cross-sectional study was conducted from June to August 2021 using random sampling. Two hundred twenty-five people were involved in the study. All people are domiciled in Bandung Regency, West Java, Indonesia and have never been infected with COVID-19. The scale was designed based on the dimensional structure of social stigma and then evaluated the scale's psychometric properties. Result: The study found that instruments with 12 items had a content validity index of 1.0. Cronbach's alpha coefficient of 0.875 showed as satisfactory. Exploratory factor analysis was performed on the first sample (n = 100), and four factors were extracted from the exploratory factor analysis: ignorance/labelling, stereotype, separation, and discrimination. Following this, the confirmatory factor analysis in the remaining sample (n = 120) showed a good fit between the four-factor model and the theoretical model of social stigma. Conclusions: The social stigma scale has been determined to be valid and reliable. Health practitioners can use this scale to predict social stigma toward individuals with COVID-19 to develop better transmission prevention strategies and improved quality of care.

Differences in strategies for prevention of COVID-19 transmission in hospitals: nationwide survey results from the Republic of Korea

BackgroundHospital infection control measures against coronavirus disease 2019 (COVID-19) are often based on expert discretion due to the lack of detailed guidelines.AimTo survey the current strategies for preventing COVID-19 spread in medical institutions.MethodsThirteen key issues related to COVID-19 transmission prevention within medical institutions were selected via discussion among infectious diseases specialists, and related critical questions were subsequently obtained following a review of national-level guidelines in government databases. Six hospitals had an open survey between 11th and 25th August 2020 to provide responses to these topics. An online questionnaire developed from these data was sent to infection control teams of 46 South Korean hospitals between 31st January 2021 and 20th February 2021.FindingsAll 46 hospitals responded to the survey. All operated screening clinics, but 89.1% (41/46) allowed symptomatic patients without COVID-19-associated symptoms to visit the general outpatient clinics. Most hospitals (87.2%; 34/39) conducted PCR tests for all hospitalised patients. Of 35/46 (76.1%) hospitals with preemptive isolation policies for hospitalised patients, 31 (88.6%) released patients from isolation after a single negative PCR test while most (76.9%; 20/26) allowed shared-room accommodation for patients meeting the national criteria for release from isolation despite positive PCR results with above cycle threshold values (34.6%; 9/26) or after a certain period that satisfied the national criteria (26.9%; 7/26).ConclusionIndividual hospitals in South Korea are currently relying on experience to frame relevant guidelines and responded differently to some infection control issues on hospital settings during the COVID-19 pandemic.

Evaluating COVID-19 Transmission Prevention Measures in Public Rental Flats (Rusunawa)

Surabaya is an urbanized area with one of the highest numbers of confirmed COVID-19 cases in Indonesia. With Surabaya's healthcare system on the brink of collapse, housing is crucial in extending healthcare facilities. Therefore, adequate housing is the most prioritized prerequisite for people to cope with the transmission rate of the virus. Unfortunately, public rental flats (rusunawa) are among the most vulnerable housing types due to their high density, lack of adequate facilities, and low environmental quality. This paper presents a two-stage investigation to uncover Coronavirus transmission prevention strategies in dense urban settlements, namely in rusunawa. First, the research observes transmission prevention strategies and measures employed by rusunawa residents and managers. Second, the investigation concludes with evaluating the effectiveness of the identified strategies and measures using cross-tabulation analysis. Data for this research was collected using questionnaires distributed among rusunawa residents and managers. Results indicate that effective prevention strategies differ across vulnerability groups. Thus, research findings can potentially help stakeholders and decision-makers enhance their approach to prevent Coronavirus transmission. Not only that, but research findings can also help inform and anticipate future outbreaks.

430. Strategies for Prevention of COVID-19 Transmission in Hospitals

BackgroundInfection control measures against the coronavirus disease 2019 (COVID-19) within a hospital often rely on expert experience and intuition due to the lack of clear guidelines. This study surveyed current strategies for the prevention of the spread of COVID-19 in medical institutions.MethodsUpon systematic review of the guidelines at the national level, 14 key topics were selected. Six hospitals were provided an open survey that assessed their responses to these topics between August 11 and 25, 2020. Using these data, an online questionnaire was developed and sent to the infection control teams of 46 hospitals in South Korea. The survey was conducted between January 31, 2021, and February 20, 2021.ResultsAll 46 hospitals responded to the survey, and 24 hospitals (52.2%) had treated 100 or more cases of COVID-19. All hospitals operated screening clinics, and the criteria were respiratory symptoms (100%), fever (97.8%), and epidemiological association (93.5%). It was found that 89.1% (41/46) of hospitals allowed symptomatic patients to visit their general outpatient clinics if fever or respiratory symptoms were not associated with COVID-19. Most hospitals (87.2%; 34/39) conducted polymerase chain reaction (PCR) tests for all hospitalized patients. Moreover, 76.1% (35/46) of hospitals implemented preemptive isolation policies for hospitalized patients, of which 97.1% (34/35) were released from isolation after a single negative PCR test. A little over half of the hospitals (58.7%; 27/46) treated patients that met the national criteria for release from isolation but consistently had positive PCR results. Of these hospitals, 63% (17/27) used N95/KF94 masks, and 40.7% (11/27) used surgical masks without other personal protective equipment for treating them. Most hospitals (76.9%; 20/26) accommodated them in shared rooms when the cycle threshold value of the PCR test was more than a certain value (34.6%; 9/26), or after a certain period that satisfied the national criteria (26.9%; 7/26). Finally, 76.1% (35/46) of hospitals performed emergency procedures or operations on suspected patients.Table 1. Screening and selective treatment policy to prevent COVID-19 patients from entering the hospital NoteValues are presented as number (%) Abbreviations: COVID-19, coronavirus disease 2019; PCR, polymerase chain reaction 1 This question requested the respondent to select multiple items. 2 Suspected cases of COVID-19 include fever, respiratory symptoms, and epidemiological associations with COVID-19 patients. NoteValues are presented as number (%) Abbreviations: COVID-19, coronavirus disease 2019; PCR, polymerase chain reaction; PAPR, powered air-purifying respirator; Ct, cycle threshold 1 This question requested the respondent to select multiple items. 2 It includes infectious diseases, pulmonology, and the infection control and prevention office. 3 One hospital that wrote a non-categorical answer for the question was excluded. The hospital made a decision after discussing it with an infectious diseases specialist.ConclusionVarious guidelines were being applied by each medical institution, but there was a lack of an explicit set of national guidelines to support them.Disclosures All Authors: No reported disclosures

COVID-19 transmission during swimming-related activities: a rapid systematic review

BackgroundThere are uncertainties about mitigating strategies for swimming-related activities in the context of the COVID-19 pandemic. There is an opportunity to learn from the experience of previous re-openings to better plan the future one. Our objectives are to systematically review the evidence on (1) the association between engaging in swimming-related activities and COVID-19 transmission; and (2) the effects of strategies for preventing COVID-19 transmission during swimming-related activities.MethodsWe conducted a rapid systematic review. We searched in the L·OVE (Living OVerview of Evidence) platform for COVID-19. The searches covered the period from the inception date of each database until April 19, 2021. We included non-randomized studies for the review on association of COVID-19 transmission and swimming-related activities. We included guidance documents reporting on the strategies for prevention of COVID-19 transmission during swimming-related activities. We also included studies on the efficacy and safety of the strategies. Teams of two reviewers independently assessed article eligibility. For the guidance documents, a single reviewer assessed the eligibility and a second reviewer verified the judgement. Teams of two reviewers extracted data independently. We summarized the findings of included studies narratively. We synthesized information from guidance documents according to the identified topics and subtopics, and presented them in tabular and narrative formats.ResultsWe identified three studies providing very low certainty evidence for the association between engaging in swimming-related activities and COVID-19 transmission. The analysis of 50 eligible guidance documents identified 11 topics: ensuring social distancing, ensuring personal hygiene, using personal protective equipment, eating and drinking, maintaining the pool, managing frequently touched surfaces, ventilation of indoor spaces, screening and management of sickness, delivering first aid, raising awareness, and vaccination. One study assessing the efficacy of strategies to prevent COVID-19 transmission did not find an association between compliance with precautionary restrictions and COVID-19 transmission.ConclusionsThere are major gaps in the research evidence of relevance to swimming-related activities in the context of the COVID-19 pandemic. However, the synthesis of the identified strategies from guidance documents can inform public health management strategies for swimming-related activities, particularly in future re-opening plans.

HIV knowledge and attitudes among minority pregnant patients and their non-pregnant partners in an urban hospital clinic

ObjectiveHIV seroconversion during pregnancy disproportionately affects urban, minority pregnant individuals. In order to prevent perinatal HIV transmission, it is essential that individuals are aware of HIV risk factors and effective transmission prevention strategies are employed. Thus, we aimed to examine knowledge about HIV transmission and attitudes about HIV among low-income, minority pregnant individuals and their partners living in a high HIV prevalence area. MethodsIn this qualitative study, pregnant participants were HIV-seronegative individuals receiving publicly-funded prenatal care in an urban academic center in the United States. Pregnant individuals and their partners were recruited to participate in a quality improvement program offering HIV testing to partners of pregnant people. Semi-structured guides were used to conduct individual interviews about participant sources of information about HIV, knowledge about transmission, and attitudes regarding those living with HIV. Transcripts were analyzed using the constant comparative method to determine themes and subthemes. ResultsOf 51 participants, 29 were pregnant individuals and 22 were non-pregnant partners. We found that inaccurate knowledge about perinatal HIV transmission was prevalent. Sources of information about HIV included reputable literary information or educational experiences, broadcast media, and word-of-mouth sources. Participants held dichotomous perceptions of people living with HIV. ConclusionsAmong low-income, minority pregnant people and their partners in a high HIV prevalence area, inaccuracies and lack of knowledge about HIV transmission were common. Efforts to educate pregnant individuals and their partners about HIV and perinatal HIV transmission should address common misconceptions and use popular sources of information.