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Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19.
Indian Journal of Medical Research ( IF 4.2 ) Pub Date : 2020-05-01 , DOI: 10.4103/ijmr.ijmr_2234_20 Pranab Chatterjee 1 , Tanu Anand 2 , Kh Jitenkumar Singh 3 , Reeta Rasaily 4 , Ravinder Singh 5 , Santasabuj Das 6 , Harpreet Singh 7 , Ira Praharaj 8 , Raman R Gangakhedkar 8 , Balram Bhargava 9 , Samiran Panda 10
Background & objectives: Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country.
Methods: A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE.
Results: Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2.
Interpretations & conclusions: Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.
中文翻译：
印度的医护人员和 SARS-CoV-2 感染：COVID-19 时期的病例对照调查。
背景和目标：医护人员 (HCW) 感染 COVID-19 的风险较高。虽然与产生气溶胶的程序相关的强烈职业暴露强调了医护人员使用个人防护设备 (PPE) 的必要性，但病原体 [严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2)] 的高传播效率也可能导致超出此类环境的感染。印度国家 COVID-19 工作组凭经验推荐羟氯喹 (HCQ) 是一种重新利用的抗疟药物，以应对这种增加的风险。在此背景下，目前的调查旨在确定该国医护人员感染 SARS-CoV-2 的相关因素。
方法：采用病例对照设计，参与者从 ICMR 维护的全国 COVID-19 检测数据门户中随机抽取。使用实时逆转录聚合酶链反应 (qRT-PCR) 诊断为 SARS-CoV-2 阳性（病例）或阴性（对照）的医护人员的检测结果和联系方式可从该数据库获得。一份包含 20 项的简短问卷调查了有关工作地点、执行的程序和 PPE 使用的信息。
结果：与对照组相比，病例年龄稍大（34.7 岁对 33.5 岁），男性更多（58% 对 50%）。在多变量分析中，进行气管插管的医护人员感染 SARS-CoV-2 的几率更高 [调整优势比 (AOR)：4.33，95% 置信区间 (CI)：1.16-16.07]。服用 4 次或更多维持剂量的 HCQ 与感染几率显着下降相关（AOR：0.44；95% CI：0.22-0.88）；HCQ 暴露频率与此类减少之间存在剂量反应关系（趋势 = 48.88 的χ [2]；P <0.001）。此外，使用 PPE 与降低感染 SARS-CoV-2 的几率独立相关。
解释和结论：在获得 HCQ 预防的临床试验结果之前，本研究为政策制定者提供了可操作的信息，以保护处于 COVID-19 应对前沿的 HCW。需要将持续摄入 HCQ 预防措施以及适当使用 PPE 的公共卫生信息与个人层面的风险稳态结合起来考虑。
更新日期：2020-06-23
Indian Journal of Medical Research ( IF 4.2 ) Pub Date : 2020-05-01 , DOI: 10.4103/ijmr.ijmr_2234_20 Pranab Chatterjee 1 , Tanu Anand 2 , Kh Jitenkumar Singh 3 , Reeta Rasaily 4 , Ravinder Singh 5 , Santasabuj Das 6 , Harpreet Singh 7 , Ira Praharaj 8 , Raman R Gangakhedkar 8 , Balram Bhargava 9 , Samiran Panda 10
Affiliation
Background & objectives: Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country.
Methods: A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE.
Results: Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2.
Interpretations & conclusions: Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.
中文翻译：
印度的医护人员和 SARS-CoV-2 感染：COVID-19 时期的病例对照调查。
背景和目标：医护人员 (HCW) 感染 COVID-19 的风险较高。虽然与产生气溶胶的程序相关的强烈职业暴露强调了医护人员使用个人防护设备 (PPE) 的必要性，但病原体 [严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2)] 的高传播效率也可能导致超出此类环境的感染。印度国家 COVID-19 工作组凭经验推荐羟氯喹 (HCQ) 是一种重新利用的抗疟药物，以应对这种增加的风险。在此背景下，目前的调查旨在确定该国医护人员感染 SARS-CoV-2 的相关因素。
方法：采用病例对照设计，参与者从 ICMR 维护的全国 COVID-19 检测数据门户中随机抽取。使用实时逆转录聚合酶链反应 (qRT-PCR) 诊断为 SARS-CoV-2 阳性（病例）或阴性（对照）的医护人员的检测结果和联系方式可从该数据库获得。一份包含 20 项的简短问卷调查了有关工作地点、执行的程序和 PPE 使用的信息。
结果：与对照组相比，病例年龄稍大（34.7 岁对 33.5 岁），男性更多（58% 对 50%）。在多变量分析中，进行气管插管的医护人员感染 SARS-CoV-2 的几率更高 [调整优势比 (AOR)：4.33，95% 置信区间 (CI)：1.16-16.07]。服用 4 次或更多维持剂量的 HCQ 与感染几率显着下降相关（AOR：0.44；95% CI：0.22-0.88）；HCQ 暴露频率与此类减少之间存在剂量反应关系（趋势 = 48.88 的χ [2]；P <0.001）。此外，使用 PPE 与降低感染 SARS-CoV-2 的几率独立相关。
解释和结论：在获得 HCQ 预防的临床试验结果之前，本研究为政策制定者提供了可操作的信息，以保护处于 COVID-19 应对前沿的 HCW。需要将持续摄入 HCQ 预防措施以及适当使用 PPE 的公共卫生信息与个人层面的风险稳态结合起来考虑。
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