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Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic.
JAMA Netw Open. 2020 05 01; 3(5):e209673.JN

Abstract

Importance

On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring.

Objective

To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms.

Design, Setting, and Participants

This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020.

Main Outcomes and Measures

The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19.

Results

Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms.

Conclusions and Relevance

Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently.

Authors+Show Affiliations

Department of Infection Control, Amphia Hospital, Breda, the Netherlands. Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, the Netherlands. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands. Department of Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands.Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands. Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands.Department of Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.Department of Infection Control, Amphia Hospital, Breda, the Netherlands.Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands.Department of Infection Control, Amphia Hospital, Breda, the Netherlands. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32437576

Citation

Kluytmans-van den Bergh, Marjolein F Q., et al. "Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic." JAMA Network Open, vol. 3, no. 5, 2020, pp. e209673.
Kluytmans-van den Bergh MFQ, Buiting AGM, Pas SD, et al. Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic. JAMA Netw Open. 2020;3(5):e209673.
Kluytmans-van den Bergh, M. F. Q., Buiting, A. G. M., Pas, S. D., Bentvelsen, R. G., van den Bijllaardt, W., van Oudheusden, A. J. G., van Rijen, M. M. L., Verweij, J. J., Koopmans, M. P. G., & Kluytmans, J. A. J. W. (2020). Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic. JAMA Network Open, 3(5), e209673. https://doi.org/10.1001/jamanetworkopen.2020.9673
Kluytmans-van den Bergh MFQ, et al. Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic. JAMA Netw Open. 2020 05 1;3(5):e209673. PubMed PMID: 32437576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic. AU - Kluytmans-van den Bergh,Marjolein F Q, AU - Buiting,Anton G M, AU - Pas,Suzan D, AU - Bentvelsen,Robbert G, AU - van den Bijllaardt,Wouter, AU - van Oudheusden,Anne J G, AU - van Rijen,Miranda M L, AU - Verweij,Jaco J, AU - Koopmans,Marion P G, AU - Kluytmans,Jan A J W, Y1 - 2020/05/01/ PY - 2020/5/22/entrez PY - 2020/5/22/pubmed PY - 2020/6/2/medline SP - e209673 EP - e209673 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 5 N2 - Importance: On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring. Objective: To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms. Design, Setting, and Participants: This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020. Main Outcomes and Measures: The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19. Results: Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms. Conclusions and Relevance: Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32437576/Prevalence_and_Clinical_Presentation_of_Health_Care_Workers_With_Symptoms_of_Coronavirus_Disease_2019_in_2_Dutch_Hospitals_During_an_Early_Phase_of_the_Pandemic_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.9673 DB - PRIME DP - Unbound Medicine ER -