中疾控通报:西安感染新冠检验师接种疫苗仍被感染,原因找到了!

2021-04-28 “心关注”公众号 “心关注”公众号

4月20日,《中国疾病预防控制中心周报(英文)》在线发表了西安市一名医院检验人员在已接受了两剂COVID-19疫苗后,仍感染新冠病毒的调查报告。

4月20日,《中国疾病预防控制中心周报(英文)》在线发表了西安市一名医院检验人员在已接受了两剂COVID-19疫苗后,仍感染新冠病毒的调查报告。

原因是她在发病前5天可能暴露于携带有英国变异病毒环境条件中。

该病例属于轻症患者并已于4月9日出院。报告认为,接种新冠疫苗使得患者临床症状较轻、病程短暂、病毒载量较低几乎没有传染性。同时提醒医务人员,即使接种疫苗后,在新冠肺炎患者救治过程中仍需按规定进行适当的个人防护。

2021年3月17日,这名在新冠定点医院隔离区工作的检验人员被确诊为新冠肺炎。她主要工作是在隔离病房采集COVID-19病人的咽喉拭子,在隔离区BSL-2实验室进行血液、尿液和粪便常规检测。在进入隔离区工作之前,她已经接受了两剂新冠疫苗。

根据流行病学调查,该检验人员很可能是在3月12日为2例新冠境外输入(从乌兹别克斯坦回国)病例采集咽拭子时感染。病毒检测证实,3月12日这两名境外人员体内的病毒载量很高,为新冠病毒英国变异株(B.1.1.7)。当天,该检验人员先后为两位患者采集了两个鼻咽拭子和一个口咽拭子,这是一个高风险的操作过程,患者可能会出现打喷嚏或干呕,从而短时间内排出高浓度的新冠病毒。同时,这位检验人员患有慢性鼻炎,习惯用嘴呼吸,这会增加吸入病毒的风险。有研究发现,过敏性鼻炎和哮喘对新冠病毒感染的易感性风险更大。

这名检验人员确诊当日体温37.9℃,咳嗽头痛,但没有呼吸困难或呼吸急促,临床症状较轻。3月19日,最高体温为37.2℃,咳嗽略有加重,嗅觉轻微下降。3月20日,体温正常,嗅觉有所改善,次日起症状消失。整个病程中她的血氧饱和度处于正常水平,未进行吸氧。4月9日,康复出院。

在她发病后,33名同一医疗小组的同事立即被转移到另一家定点医院进行隔离观察。3月17日至3月19日进行的三次连续qRT-PCR检测均为阴性,无发烧或其他不适。其中30位为完成两剂次疫苗接种的医护人员,新冠抗体呈阳性反应,总抗体平均值为19.77(范围为1.7~150.83),IgG抗体平均值为20.29(范围为3.69~64.33),该检测试剂的测定值采集了数百个环境样本,包括隔离区医护人员的临时宿舍、宿舍楼内外环境和医院的其他病区内外环境。除该检验人员宿舍样本核酸检测呈阳性外,其余环境标本均为阴性。

报告称在完成新冠疫苗2剂次接种14天后,包括检验人员在内的31名医护人员均呈现血清新冠抗体阳转,特别是该检验人员发病2天后的血清抗体滴度极高,说明疫苗免疫有效。报告也称没有一种疫苗会是100%有效,除了个体差异、疫苗转运接种过程的技术原因外,高危暴露是疫苗保护失败的重要原因。一项新冠疫苗III期临床试验也表明,与普通社区人群相比,新冠疫苗在新冠肺炎病人救治的医护人员保护率较低。从这名检验人员的临床过程来看,该患者症状轻、病程短,这极大可能是得益于新冠疫苗接种。

报告再次提醒医务人员,新冠肺炎病人临床救治是高危医疗行为,即使接种疫苗后,仍需正确的个人防护和良好的临床操作。良好的感染预防和控制措施以及正确的个人防护对于降低医院获得性COVID-19风险至关重要。

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    2021-04-28 carrotlyl

    好消息

    0

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    2021-04-28 jyzxjiangqin

    好文章!

    0

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    2021-04-23 公卫新人

    新冠肺炎,疫情何时才能消失

    0

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