Measures to control SARS-CoV-2 often include the regular disinfection of public surfaces. The frequency of SARS-CoV-2 detection on surfaces in the surrounding of confirmed cases was evaluated in this systematic review. Overall, 26 studies showed 0 and 100% rates of contamination with SARS-CoV-2 RNA on surfaces in the surrounding of patients. Seven studies with at least 100 samples mostly showed detection rates between 1.4 and 19%. Two other studies did not detect infectious SARS-CoV-2 on any surface. Similar results were obtained from surfaces in the surrounding of confirmed SARS- and influenza-patients. A contamination of public surfaces with infectious virus is considerably less likely because there are much less potential viral spreaders around a surface, the contact time between a person and the surface is much shorter, and the asymptomatic carriers typically have no symptoms. In addition, a hand contact with a contaminated surface transfers only a small part of the viral load. A simple cleaning reduces the number of infectious viruses already by 2 log10-steps. That is why public surfaces should in general be cleaned because the wide use of biocidal agents for surface disinfection further increases the microbial selection pressure without an expectable health benefit.
Currently, the emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available information about the persistence of human and veterinary coronaviruses on inanimate surfaces as well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.
BACKGROUND: The unique characteristics of long-term care facilities (LTCFs) including host factors and living conditions contribute to the spread of contagious pathogens. Control measures are essential to interrupt the transmission and to manage outbreaks effectively.
AIM: The aim of this systematic review was to verify the causes and problems contributing to transmission and to identify control measures during outbreaks in LTCFs.
METHODS: Four electronic databases were searched for articles published from 2007 to 2018. Articles written in English reporting outbreaks in LTCFs were included. The quality of the studies was assessed using the risk-of-bias assessment tool for nonrandomized studies.
FINDINGS: A total of 37 studies were included in the qualitative synthesis. The most commonly reported single pathogen was influenza virus, followed by group A streptococcus (GAS). Of the studies that identified the cause, about half of them noted outbreaks transmitted via person-to-person. Suboptimal infection control practice including inadequate decontamination and poor hand hygiene was the most frequently raised issue propagating transmission. Especially, lapses in specific care procedures were linked with outbreaks of GAS and hepatitis B and C viruses. About 60% of the included studies reported affected cases among staff, but only a few studies implemented work restriction during outbreaks.
CONCLUSIONS: This review indicates that the violation of basic infection control practice could be a major role in introducing and facilitating the spread of contagious diseases in LTCFs. It shows the need to promote compliance with basic practices of infection control to prevent outbreaks in LTCFs.
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS: We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS: Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION: The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.
BACKGROUND: Respiratory infections among older adults in long-term care facilities (LTCFs) are a major global concern, yet a rigorous systematic synthesis of the literature on the burden of respiratory infections in the LTCF setting is lacking. To address the critical need for evidence regarding the global burden of respiratory infections in LTCFs, we assessed the burden of respiratory infections in LTCFs through a systematic review of the published literature.
METHODS: We identified articles published between April 1964 and March 2019 through searches of PubMed (MEDLINE), EMBASE, and the Cochrane Library. Experimental and observational studies published in English that included adults aged ≥60 residing in LTCFs who were unvaccinated (to identify the natural infection burden), and that reported measures of occurrence for influenza, respiratory syncytial virus (RSV), or pneumonia were included. Disagreements about article inclusion were discussed and articles were included based on consensus. Data on study design, population, and findings were extracted from each article. Findings were synthesized qualitatively.
RESULTS: A total of 1451 articles were screened for eligibility, 345 were selected for full-text review, and 26 were included. Study population mean ages ranged from 70.8 to 90.1 years. Three (12%) studies reported influenza estimates, 7 (27%) RSV, and 16 (62%) pneumonia. Eighteen (69%) studies reported incidence estimates, 7 (27%) prevalence estimates, and 1 (4%) both. Seven (27%) studies reported outbreaks. Respiratory infection incidence estimates ranged from 1.1 to 85.2% and prevalence estimates ranging from 1.4 to 55.8%. Influenza incidences ranged from 5.9 to 85.2%. RSV incidence proportions ranged from 1.1 to 13.5%. Pneumonia prevalence proportions ranged from 1.4 to 55.8% while incidence proportions ranged from 4.8 to 41.2%.
CONCLUSIONS: The reported incidence and prevalence estimates of respiratory infections among older LTCF residents varied widely between published studies. The wide range of estimates offers little useful guidance for decision-making to decrease respiratory infection burden. Large, well-designed epidemiologic studies are therefore still necessary to credibly quantify the burden of respiratory infections among older adults in LTCFs, which will ultimately help inform future surveillance and intervention efforts.
BACKGROUND: The effectiveness of interventions to increase influenza vaccination uptake in people aged 60 years and older varies by country and participant characteristics. This review updates versions published in 2010 and 2014.
OBJECTIVES: To assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community.
SEARCH METHODS: We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, CINAHL, and ERIC for this update, as well as WHO ICTRP and ClinicalTrials.gov for ongoing studies to 7 December 2017. We also searched the reference lists of included studies.
SELECTION CRITERIA: Randomised controlled trials (RCTs) and cluster-randomised trials of interventions to increase influenza vaccination in people aged 60 years or older in the community.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as specified by Cochrane.
MAIN RESULTS: We included three new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high-income countries. Heterogeneity limited some meta-analyses. We assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low-quality. We identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).Increasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants)One successful intervention that could be meta-analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).Some interventions could not be meta-analysed due to significant heterogeneity: 17 studies tested simple reminders (11 with 95% CI entirely above unity); 16 tested personalised reminders (12 with 95% CI entirely above unity); two investigated customised compared to form letters (both 95% CI above unity); and four studies examined the impact of health risk appraisals (all had 95% CI above unity). One study of a lottery for free groceries was not effective.Enhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants)We meta-analysed results from two studies of home visits (OR 1.30, 95% CI 1.05 to 1.61) and two studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). We were unable to conduct meta-analyses of two studies of home visits by nurses plus a physician care plan (both with 95% CI above unity) and two studies of free vaccine compared to no intervention (both with 95% CI above unity). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and one study of home visits compared to safety interventions was not.Provider- or system-based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants)One successful intervention that could be meta-analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).We were unable to meta-analyse four studies that looked at physician reminders (three studies with 95% CI above unity) and three studies of facilitator encouragement of vaccination (two studies with 95% CI above unity). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.Interventions at the societal levelNo studies reported on societal-level interventions.Study funding sourcesStudies were funded by government health organisations (n = 33), foundations (n = 9), organisations that provided healthcare services in the studies (n = 3), and a pharmaceutical company offering free vaccines (n = 1). Fifteen studies did not report study funding sources.
AUTHORS' CONCLUSIONS: We identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review.
ANTECEDENTES: La vacuna de la gripe de los profesionales sanitarios (TS) es importante para la protección del personal y los pacientes, sin embargo, la cobertura de vacunación en el PS permanece por debajo de los objetivos recomendados. Las teorías psicológicas del cambio de comportamiento pueden ayudar a dirigir intervenciones para mejorar la absorción de la vacuna. Los objetivos fueron: (1) revisar la eficacia de las intervenciones basadas en las teorías psicológicas de cambio de comportamiento para mejorar las tasas de vacunación contra la gripe de TS, y (2) determinar qué teorías psicológicas han sido utilizados para predecir el PS nivel de vacunación contra la gripe.
MÉTODOS: MEDLINE, EMBASE, CINAHL, PsycINFO, el Instituto Joanna Briggs, SocINDEX, y Cochrane Database of Systematic Reviews en busca de estudios que aplicaron las teorías psicológicas del cambio de comportamiento para mejorar y / o predecir la absorción de vacunación contra la influenza en el PS.
RESULTADOS: La búsqueda bibliográfica se obtuvo un total de 1810 publicaciones; 10 artículos cumplieron con los criterios de elegibilidad. Todos los estudios utilizaron las teorías de cambio de comportamiento para predecir el comportamiento de vacunación trabajador sanitario; intervenciones evaluadas en base a ninguno con estas teorías. El Modelo de Creencias de Salud era la teoría más frecuentemente empleado para predecir la absorción de vacunación contra la influenza en el PS. Los estudios de predicción restantes emplean la teoría del comportamiento planificado, la actitud de percepción de riesgo, y el Modelo Triandis de comportamiento interpersonal. Las construcciones de marco de cambio de comportamiento tuvieron éxito en la diferenciación entre el PS vacunados y no vacunados. constructos clave identificados incluyen: actitudes respecto a la eficacia y seguridad de la vacuna contra la influenza, la percepción de riesgo y el beneficio para sí mismo y otros, auto-eficacia, señales para la acción, y las normas socio-profesionales. Los marcos de cambio de comportamiento, junto con las variables sociodemográficas, predijo con éxito el 85-95% de TS nivel de vacunación contra la gripe.
CONCLUSIÓN: La vacunación es un comportamiento complejo. Nuestros resultados sugieren que las teorías psicológicas de cambio de comportamiento son prometedoras herramientas para aumentar el PS nivel de vacunación contra la gripe. Se necesitan más estudios para desarrollar y evaluar nuevas intervenciones basadas en las teorías de cambio de comportamiento, que pueden ayudar a alcanzar las metas recomendadas de vacunación de TS.
Antecedentes: En ausencia de un registro de vacunación de adultos, las estimaciones de la cobertura de la gripe y la vacunación contra el neumococo proceden de encuestas y otras fuentes de datos. MÉTODOS: Revisión sistemática y metanálisis de estudios que examinaron la cobertura vacunal en adultos australianos de 1990 a 2015, centrándose en grupos financiados bajo el Programa Nacional de Inmunización, e intervalos previos y posteriores a la introducción de la financiación universal. RESULTADOS: Veintidós estudios cumplieron los criterios de inclusión; 18 utilizaron auto-reporte para determinar el estado de vacunación. Hubo 130 estimaciones únicas de la cobertura extraída. Entre los adultos de ≥65 años de edad, durante el período de financiación universal (a partir de 1999), la estimación resumida de la cobertura anual de vacunación contra la gripe a partir de 27 estimaciones puntuales fue de 74,8% (IC del 95%: 73,4-76,2%, rango 63,9-82,4%); Antes de este período (1992-1998) de 10 estimaciones puntuales fue 61,3% (95% IC 58,0-64,6%, rango 44,3-71,3%). Para el período de financiación universal para la vacunación antineumocócica (a partir de 2005), la estimación resumida de la cobertura fue del 56,0% (IC del 95%: 53,2-58,8%, rango 51,2-72,8%, estimaciones de 10 puntos); Antes de 2005 era 35.4% (95% IC 18.8-52.0%, rango 15.4-45.2%). La cobertura de ambas vacunas fue significativamente mayor después de la introducción de la financiación universal. La cobertura de la vacunación contra la influenza en los 18-65 años con una indicación médica fue menor pero los datos no se combinaron. Siete estudios informaron sobre aborígenes australianos con tres estudios que informaron cinco estimaciones de cobertura para la vacunación contra la influenza en adultos ≥65 años (rango 71% - 89%). CONCLUSIONES: La cobertura de vacunación contra la influenza y el neumococo ha aumentado desde la introducción de la financiación universal, pero sigue siendo subóptima, con una cobertura neumocócica inferior a la de la gripe. IMPLICACIONES: Esta revisión destaca la necesidad de más datos de cobertura en general y en grupos de alto riesgo, para apoyar los programas de salud pública para mejorar la cobertura.
La vacunación antigripal se recomienda para los trabajadores de la salud (PS), pero la cobertura es a menudo baja. Se revisaron los estudios que evalúan las intervenciones para aumentar la cobertura de vacunación contra la gripe estacional en trabajadores sanitarios, incluyendo un análisis de meta-regresión para cuantificar el efecto de cada componente. Se identificaron cuarenta y seis estudios elegibles. Dominios que confieren un alto riesgo de sesgo se identificaron en la mayoría de los estudios. La vacunación obligatoria fue el componente de intervención más eficaz (riesgo de ser no vacunadas CI [RRunvacc] = 0,18, 95%: 0,08-0,45), seguido de mandatos "blandas", tales como declaraciones de declinación (RRunvacc = 0,64, IC del 95%: 0,45 0,92), el aumento de la conciencia (RRunvacc = 0,83; IC del 95%: desde 0,71 hasta 0,97) y un mayor acceso (RRunvacc = 0,88; IC del 95%: 0,78 a 1,00). Para incentivos la diferencia no fue significativa, mientras que para la educación se observó ningún efecto. La heterogeneidad fue considerable (τ (2) = 0,083). Estos resultados indican que existen alternativas eficaces a la vacunación de la gripe trabajadores sanitarios obligatorios, y deben estudiarse con mayor detalle en futuros estudios.
Antecedentes: La enfermedad neumocócica invasiva (DPI) y la neumonía neumocócica son comunes y llevan una morbilidad y mortalidad significativas. Las estrategias actuales para prevenir la enfermedad neumocócica se están revisando en el Reino Unido (Reino Unido). Realizamos una revisión sistemática para evaluar la carga de la enfermedad tipo neumocócica del adulto de vacuna específicamente en el Reino Unido. MÉTODOS: Se realizó una revisión sistemática y se informó de acuerdo con las directrices de MOOSE. Se incluyeron los estudios pertinentes de 1990 a 2015. El resultado primario fue la incidencia de la enfermedad neumocócica tipo vacuna, centrándose en la vacuna antineumocócica polisacárida (PPSV), la vacuna conjugada 13-valente (PCV13) y la vacuna conjugada 7-valente (PCV7). Los datos de la vigilancia en Inglaterra y Gales a partir de 2013/14 muestran una incidencia de 6,85 por 100.000 habitantes en todos los grupos de edad adulta para IPD y una incidencia de 20,58 por 100.000 habitantes en los mayores de 65 años. Las incidencias correspondientes al IPD del serotipo PCV13 fueron 1,4 por 100.000 y 3,72 por 100.000. Los datos más recientes disponibles para la neumonía adquirida en la comunidad (PAC), incluyendo la enfermedad no invasiva, mostraron una incidencia de 20,6 por 100.000 para la PAC neumocócica para adultos y de 8,6 por 100.000 para la CAP del serotipo PCV13. Tanto las fuentes de datos IPD como CAP en el Reino Unido sugieren un efecto continuo de protección del rebaño de la vacunación infantil con PCV13, causando una reducción en la proporción de casos causados por serotipos PCV13 en adultos. A pesar de ello, la aplicación de las tasas de incidencia a las estimaciones de la población del Reino Unido sugiere que más de 4000 pacientes anualmente se hospitalizará con PAC serotipo PCV13 y más de 900 se verán afectados por DPI, aunque con una tendencia a disminuir con el tiempo. Hubo pocos datos recientes sobre la distribución de serotipos en grupos de alto riesgo, como aquellos con enfermedades respiratorias o cardíacas crónicas y no hay datos disponibles para la PAC de tipo de vacuna (CAP) administrada en la comunidad donde es probable que haya una considerable carga no medida. CONCLUSIÓN: Los datos disponibles más recientes sugieren que la enfermedad neumocócica de VT sigue teniendo una alta carga en los adultos del Reino Unido a pesar del impacto de la vacunación infantiles con PCV13. IPD estimaciones representan sólo una fracción de la carga total de la enfermedad neumocócica. REGISTRO DEL ESTUDIO: PROSPERO CRD42015025043.
Measures to control SARS-CoV-2 often include the regular disinfection of public surfaces. The frequency of SARS-CoV-2 detection on surfaces in the surrounding of confirmed cases was evaluated in this systematic review. Overall, 26 studies showed 0 and 100% rates of contamination with SARS-CoV-2 RNA on surfaces in the surrounding of patients. Seven studies with at least 100 samples mostly showed detection rates between 1.4 and 19%. Two other studies did not detect infectious SARS-CoV-2 on any surface. Similar results were obtained from surfaces in the surrounding of confirmed SARS- and influenza-patients. A contamination of public surfaces with infectious virus is considerably less likely because there are much less potential viral spreaders around a surface, the contact time between a person and the surface is much shorter, and the asymptomatic carriers typically have no symptoms. In addition, a hand contact with a contaminated surface transfers only a small part of the viral load. A simple cleaning reduces the number of infectious viruses already by 2 log10-steps. That is why public surfaces should in general be cleaned because the wide use of biocidal agents for surface disinfection further increases the microbial selection pressure without an expectable health benefit.
