Risk Factors for Healthcare Personnel Infection With Endemic Coronaviruses (HKU1, OC43, NL63, 229E): Results from the Respiratory Protection Effectiveness Clinical Trial (ResPECT)

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents a large risk to healthcare personnel (HCP). Quantifying the risk of coronavirus infection associated with workplace activities is an urgent need. Methods We assessed the association of worker characteristics, occupational roles and behaviors, and participation in procedures with the risk of endemic coronavirus infection among HCP who participated in the Respiratory Protection Effectiveness Clinical Trial (ResPECT), a cluster randomized trial to assess personal protective equipment to prevent respiratory infections and illness conducted from 2011 to 2016. Results Among 4689 HCP seasons, we detected coronavirus infection in 387 (8%). HCP who participated in an aerosol-generating procedure (AGP) at least once during the viral respiratory season were 105% (95% confidence interval, 21%–240%) more likely to be diagnosed with a laboratory-confirmed coronavirus infection. Younger individuals, those who saw pediatric patients, and those with household members <5 years of age were at increased risk of coronavirus infection. Conclusions Our analysis suggests that the risk of HCP becoming infected with an endemic coronavirus increases approximately 2-fold with exposures to AGPs. Our findings may be relevant to the coronavirus disease 2019 (COVID-19) pandemic; however, SARS-CoV-2, the virus that causes COVID-19, may differ from endemic coronaviruses in important ways. Clinical Trials Registration NCT01249625.

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1716. Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.122 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S51-S51

Author(s):

Lewis Radonovich ◽

Michael S Simberkoff ◽

Mary Bessesen ◽

Alexandria C Brown ◽

Derek Cummings ◽

...

Keyword(s):

Clinical Trial ◽

Respiratory Infections ◽

Controlled Trial ◽

Respiratory Illness ◽

Healthcare Personnel ◽

Respiratory Protection ◽

Protective Effects ◽

Becton Dickinson ◽

High Exposure ◽

Cluster Randomized

Abstract Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT) Background Respiratory protection (RP) for healthcare personnel (HCP) is controversial and clinical studies are inconclusive about the effectiveness of N95 respirators (N95) and medical masks (MM) for protecting HCP from workplace viral respiratory infections and illnesses (VRII). Methods We conducted a cluster-randomized, investigator-blinded, multisite effectiveness study comparing N95 to MM in geographically diverse, high exposure outpatient settings between 2011 and 2016. Each year during VRII season, participants wore assigned devices when within 6 feet of patients with known or suspected respiratory illness. Respiratory swabs were collected from symptomatic and asymptomatic participants. Diaries detailed VRII exposures, influenza vaccination, adherence to RP and hand hygiene, and manifestations of illness. The primary and secondary outcomes were the incidence of laboratory-confirmed influenza (LCI) using polymerase chain reaction (PCR) and hemagglutinin inhibition assays (HAI), and acute respiratory illness (ARI), influenza-like illness (ILI), laboratory-confirmed respiratory illness (LCRI), and laboratory-detected respiratory infection (LDRI) (figure). Intervention protective effects were estimated using unadjusted odds and incidence rate ratios. Results 5,180 HCP seasons enrolled and randomized (2,243 to N95 and 2,446 to MM), with 4,689 (91%) completing the study. In the intention-to-treat cohort (ITT), among participants in the N95 and MM groups, respectively, 207 (8.2%) and 193 (7.2%) were diagnosed with LCI (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.93–1.40); 1,556 (61.9%) and 1711 (64.1%) were diagnosed with ARI (relative risk (RR) 0.99, CI 0.92–1.06); 128 (5.1%) and 166 (6.2%) were diagnosed with ILI (RR 0.87, CI 0.68–1.10), 371 (14.8%) and 417 (15.6%) were diagnosed with LCRI (RR 0.97, CI 0.84–1.12); and 679 (27.0%) and 745 (27.9%) were diagnosed with LDRI (RR 0.99, CI 0.89–1.09). The adjusted ITT and per-protocol analyses yielded similar results. Conclusion In this outpatient-based, cluster-randomized, controlled trial, neither N95 nor MM resulted in superior protection from LCI or VRII. Disclosures C. Gaydos, BioFire: Consultant, Consulting fee. Cepheid: Speaker’s Bureau, Speaker honorarium. Becton Dickinson: Speaker’s Bureau, Speaker honorarium.

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The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel

BMC Infectious Diseases ◽

10.1186/s12879-016-1494-2 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 13

Author(s):

Lewis J. Radonovich ◽

Mary T. Bessesen ◽

Derek A. Cummings ◽

Aaron Eagan ◽

Charlotte Gaydos ◽

...

Keyword(s):

Clinical Trial ◽

Respiratory Infections ◽

Healthcare Personnel ◽

Respiratory Protection ◽

Cluster Randomized ◽

Mask Effectiveness

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Impact of mandatory vaccination of healthcare personnel on rates of influenza and other viral respiratory pathogens

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.324 ◽

2021 ◽

pp. 1-5

Author(s):

Michael S. Simberkoff ◽

Susan M. Rattigan ◽

Charlotte A. Gaydos ◽

Cynthia L. Gibert ◽

Geoffrey J. Gorse ◽

...

Keyword(s):

Influenza Vaccination ◽

Health Systems ◽

Viral Infections ◽

Respiratory Infections ◽

Healthcare Personnel ◽

Respiratory Pathogens ◽

Respiratory Illnesses ◽

Vaccination Rates ◽

Increased Risk ◽

Viral Respiratory

Abstract Objective: The implementation of mandatory influenza vaccination policies among healthcare personnel (HCP) is controversial. Thus, we examined the affect of mandatory influenza vaccination policies among HCP working in outpatient settings. Setting: Four Veterans’ Affairs (VA) health systems and three non-VA medical centers. Methods: We analyzed rates of influenza and other viral causes of respiratory infections among HCP working in outpatient sites at 4 VA health systems without mandatory influenza vaccination policies and 3 non-VA health systems with mandatory influenza vaccination policies. Results: Influenza vaccination was associated with a decreased risk of influenza (odds ratio, 0.17; 95% confidence interval [CI], 0.13–0.22) but an increased risk of other respiratory viral infections (incidence rate ratio, 1.26; 95% CI, 1.02–1.57). Conclusions: Our fitted regression models suggest that if influenza vaccination rates in clinics where vaccination was not mandated had equalled those where vaccine was mandated, HCP influenza infections would have been reduced by 52.1% (95% CI, 51.3%–53.0%). These observations, their possible causes, and additional strategies to reduce influenza and other viral respiratory illnesses among HCP working in ambulatory clinics warrant further investigation.

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Facemask against viral respiratory infections among Hajj pilgrims: A challenging cluster-randomized trial

PLoS ONE ◽

10.1371/journal.pone.0240287 ◽

2020 ◽

Vol 15 (10) ◽

pp. e0240287 ◽

Cited By ~ 2

Author(s):

Mohammad Alfelali ◽

Elizabeth A. Haworth ◽

Osamah Barasheed ◽

Al-Mamoon Badahdah ◽

Hamid Bokhary ◽

...

Keyword(s):

Randomized Trial ◽

Respiratory Infections ◽

Cluster Randomized Trial ◽

Cluster Randomized ◽

Viral Respiratory Infections ◽

Viral Respiratory

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1204. Increased Risk of Respiratory Infections Among Healthcare Personnel (HCP) Caring for Children

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1067 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S432-S433

Author(s):

Ann-Christine Nyquist ◽

Susan M Rattigan ◽

Cynthia L Gibert ◽

Geoffrey Gorse ◽

Trish M Perl ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Infection ◽

Respiratory Infections ◽

Smoking Status ◽

Respiratory Illness ◽

The United States ◽

Healthcare Personnel ◽

Respiratory Protection ◽

Older Individuals ◽

Increased Risk

Abstract Background Healthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015. Methods Swabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults. Results The main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses. Conclusion The risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections. Disclosures Trish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.

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Longitudinal Trends in Vaccine Hesitancy in a Cohort of Mothers Surveyed in Washington State, 2013-2015

Public Health Reports ◽

10.1177/0033354917711175 ◽

2017 ◽

Vol 132 (4) ◽

pp. 451-454 ◽

Cited By ~ 18

Author(s):

Nora B. Henrikson ◽

Melissa L. Anderson ◽

Douglas J. Opel ◽

John Dunn ◽

Edgar K. Marcuse ◽

...

Keyword(s):

Item Analysis ◽

Cluster Randomized Trial ◽

Washington State ◽

Vaccine Hesitancy ◽

Point Reduction ◽

Increased Risk ◽

Cluster Randomized ◽

Level Cluster ◽

First Time

Parents who refuse or delay vaccines because of vaccine hesitancy place children at increased risk for vaccine-preventable disease. How parental vaccine hesitancy changes as their children age is not known. In 2015, we conducted a follow-up survey of 237 mothers enrolled in a 2-arm clinic-level cluster randomized trial (n = 488) in Washington State that was completed in 2013. We surveyed mothers at their baby’s birth, age 6 months, and age 24 months using a validated measure of vaccine hesitancy. Both mean hesitancy scores (mean 4.1-point reduction; 95% CI, 2.5-5.6; P = .01) and the proportion of mothers who were vaccine hesitant (9.7% at baseline vs 5.9% at 24 months; P = .01) decreased significantly from child’s birth to age 24 months. Changes from baseline were similar for first-time mothers and experienced mothers. Individual item analysis suggested that the decrease may have been driven by increases in maternal confidence about the safety and efficacy of vaccines. Our results suggest that hesitancy is a dynamic measure that may peak around childbirth and may remit as experience with vaccines accumulates.

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