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      Manejo de un brote de COVID-19 en un despliegue Translated title: Covid-19 outbreak management in a deployed setting

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          Abstract

          RESUMEN Antecedentes y objetivos: la pandemia por COVID-19 ha afectado a todos los ámbitos de la sociedad, las misiones internacionales no son una excepción. Con este trabajo pretendemos compartir nuestra experiencia con un brote de COVID-19 en zona de operaciones (ZO). Material y métodos: estudio observacional prospectivo del 23 de noviembre de 2021 al 22 de febrero de 2022. Las variables estudiadas fueron: sexo, edad, días desde la última dosis de vacuna, tipo de vacuna en primera y segunda dosis (Moderna, Pfizer o Astrazeneca), despliegue a zona de operaciones con una dosis o dos dosis, covid-19 previo a despliegue, covid-19 en despliegue, sintomatología (asintomático, anosmia, tos, fiebre, malestar general, cefalea, mucosidad) y voluntariedad para la vacunación en zona de operaciones. Resultados: un total de 188 (31,6% del contingente) resultaron positivos en el periodo estudiado, generando un total de 183 contactos estrechos. Del contingente, 23 (3,9%) fueron mujeres y 572 (96,1%) varones, con una media de edad de 32 años. El 64,4% fueron asintomáticos. Los síntomas presentados fueron: 10,9% anosmia, 35,9% tos, 9,4% mucosidad, 32,8% cefalea, 57,8% malestar general y 20,3% fiebre. Todos fueron casos leves. De los casos positivos, el 90% de los vacunados con una sola dosis fueron asintomáticos al diagnóstico versus un 64% de los vacunados con dos dosis (p = 0,01). Conclusiones: la experiencia con un brote de COVID-19 en zona de operaciones refleja la importancia de tomar medidas de prevención y control para el correcto desarrollo de la misión. Es fundamental el uso de mascarillas, así como intentar respetar la distancia social en las bases. El uso de test rápido de detección de antígeno como diagnóstico y cribado es una medida útil y asequible. Protocolos de cuarentena laxos permiten continuar con las operaciones sin aumentar en exceso el riesgo de infección.

          Translated abstract

          SUMMARY Background and objectives: The COVID-19 pandemic has affected all areas of our society, and international missions are not an exception. With this study we intended to share our experience with an outbreak of COVID-19 in an area of operations. Material and methods: A prospective observational study was performed from 11/23/2021 - 02/22/2022. The variables studied were: sex, age, days since the last vaccine dose, type of vaccine in the first and second doses (Moderna, Pfizer or Astrazeneca), in-theatre deployment with one or two doses, covid-19 prior to deployment, covid-19 during deployment, symptomatology (asymptomatic, anosmia, cough, fever, malaise, headache, runny nose) and volunteering for vaccination in area of operations. Results: A total of 188 (32.1% of the contingent) were positive during the period studied, with 183 close contacts. Of the contingent, 23 (3.9%) were women and 572 (96.1%) men, with a mean age of 32 years. 64.4% were asymptomatic. The symptoms presented were: 10.9% anosmia, 35.9% cough, 9.4% runny nose, 32.8% headache, 57.8% malaise and 20.3% fever. They were all mild cases. Of the positive cases, 90% of those who were vaccinated with a single dose were asymptomatic at diagnosis versus 64% of those vaccinated with two doses (p = 0.01). Conclusions: Our experience with a COVID-19 outbreak during a mission reflects the importance of prevention and control measures for the correct development of the mission. Use of masks is essential, as well as trying to maintain social distancing in the bases. The use of rapid antigen test for diagnosis and screening is a useful and affordable tool. Lax quarantine protocols allow the correct development of the operations without an increase in the risk of infection.

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          Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines

          Background Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), have been used since December 2020 in the United Kingdom. Real-world data have shown the vaccines to be highly effective against Covid-19 and related severe disease and death. Vaccine effectiveness may wane over time since the receipt of the second dose of the ChAdOx1-S (ChAdOx1 nCoV-19) and BNT162b2 vaccines. Methods We used a test-negative case–control design to estimate vaccine effectiveness against symptomatic Covid-19 and related hospitalization and death in England. Effectiveness of the ChAdOx1-S and BNT162b2 vaccines was assessed according to participant age and status with regard to coexisting conditions and over time since receipt of the second vaccine dose to investigate waning of effectiveness separately for the B.1.1.7 (alpha) and B.1.617.2 (delta) variants. Results Vaccine effectiveness against symptomatic Covid-19 with the delta variant peaked in the early weeks after receipt of the second dose and then decreased by 20 weeks to 44.3% (95% confidence interval [CI], 43.2 to 45.4) with the ChAdOx1-S vaccine and to 66.3% (95% CI, 65.7 to 66.9) with the BNT162b2 vaccine. Waning of vaccine effectiveness was greater in persons 65 years of age or older than in those 40 to 64 years of age. At 20 weeks or more after vaccination, vaccine effectiveness decreased less against both hospitalization, to 80.0% (95% CI, 76.8 to 82.7) with the ChAdOx1-S vaccine and 91.7% (95% CI, 90.2 to 93.0) with the BNT162b2 vaccine, and death, to 84.8% (95% CI, 76.2 to 90.3) and 91.9% (95% CI, 88.5 to 94.3), respectively. Greater waning in vaccine effectiveness against hospitalization was observed in persons 65 years of age or older in a clinically extremely vulnerable group and in persons 40 to 64 years of age with underlying medical conditions than in healthy adults. Conclusions We observed limited waning in vaccine effectiveness against Covid-19–related hospitalization and death at 20 weeks or more after vaccination with two doses of the ChAdOx1-S or BNT162b2 vaccine. Waning was greater in older adults and in those in a clinical risk group.
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            An Outbreak of Covid-19 on an Aircraft Carrier

            Abstract Background An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel. Methods We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms. Results The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected. Conclusions SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt. Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms.
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              Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection: test negative design study

              Abstract Objectives To determine whether time elapsed since the second injection of the Pfizer-BioNTech BNT162b2 mRNA vaccine was significantly associated with the risk of covid-19 infection after vaccination in people who received two vaccine injections. Design Test negative design study. Setting Electronic health records of a large state mandated healthcare organisation, Israel. Participants Adults aged ≥18 years who had received a reverse transcription polymerase chain reaction (RT-PCR) test between 15 May 2021 and 17 September 2021, at least three weeks after their second vaccine injection, had not received a third vaccine injection, and had no history of covid-19 infection. Main outcome measures Positive result for the RT-PCR test. Individuals who tested positive for SARS-CoV-2 and controls were matched for week of testing, age category, and demographic group (ultra-orthodox Jews, individuals of Arab ancestry, and the general population). Conditional logistic regression was adjusted for age, sex, socioeconomic status, and comorbid conditions. Results 83 057 adults received an RT-PCR test for SARS-CoV-2 during the study period and 9.6% had a positive result. Time elapsed since the vaccine injection was significantly longer in individuals who tested positive (P 90 days since vaccination were significantly increased compared with the reference of <90 days: 2.37 (95% confidence interval 1.67 to 3.36) for 90-119 days, 2.66 (1.94 to 3.66) for 120-149 days, 2.82 (2.07 to 3.84) for 150-179 days, and 2.82 (2.07 to 3.85) for ≥180 days (P<0.001 for each 30 day interval). Conclusions In this large population of adults tested for SARS-CoV-2 by RT-PCR after two doses of mRNA BNT162b2 vaccine, a gradual increase in the risk of infection was seen for individuals who received their second vaccine dose after at least 90 days.
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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                March 2023
                : 79
                : 1
                : 13-17
                Affiliations
                [2] Paracuellos de Jarama Madrid orgnameRegimiento de Infantería Nápoles N.º4 España
                [1] Madrid orgnameHospital Central de la Defensa «Gómez Ulla» orgdiv1Servicio de Pediatría España
                Article
                S1887-85712023000100003 S1887-8571(23)07900100003
                10.4321/s1887-85712023000100003
                6a6f0bf7-fe00-47a4-a359-a0a5f022874c

                http://creativecommons.org/licenses/by/4.0/

                History
                : 20 April 2022
                : 28 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 5
                Product

                SciELO Spain

                Categories
                Artículo Original

                Medicina militar,COVID-19,COVID-19 Vaccines,Disease Outbreaks,Military medicine,Vacunas COVID-19,Brotes infecciosos

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