Key summary points
Aim
By use of a newly established national automated registry-based surveillance system, this study describes SARS-CoV-2 infections, deaths and outbreaks among Danish long-term ...care facility residents in the first year of the COVID-19 pandemic 2020/2021. Also, to assess the magnitude of SARS-CoV-2 transmission in these settings
Findings
Less than half of the Danish long-term care facilities identified at least one case. Almost all (94%) cases were linked to an outbreak. Regional differences were observed with the Capital Region having substantial higher numbers of both cases and outbreaks compared to the other four Danish regions.
Message
A national automated registry-based surveillance system is key in monitoring and analysing patterns in numbers and outbreaks of SARS-CoV-2 in long-term care facilities. The majority of SARS-CoV-2 cases among long-term care facility residents were linked to an outbreak, highlighting the importance of investing efforts into avoiding introductions of the virus.
Purpose
To describe the occurrence of SARS-CoV-2 infections, deaths and outbreaks among residents in Danish long-term care facilities (LTCFs) from February 2020 to February 2021.
Methods
Danish COVID-19 national register data from a newly implemented automated surveillance system was used to describe incidence rate and deaths (per 1000 residents’ years), number of tests, SARS-CoV-2 infections and outbreaks among LTCF residents. A case was defined as a LTCF resident with a positive SARS-CoV-2 PCR test. An outbreak was defined as two or more cases in one LTCF within a 14-day period, and considered closed if no new cases had occurred within 28 days. Death was defined as occurring within 30-days of a positive test.
Results
A total of 55,359 residents living in 948 LTCFs were included. The median age of the residents was 85 years and 63% were female. There was a total of 3712 cases found among residents across 43% of all LTCFs. Nearly all (94%) cases were linked to outbreaks. Higher numbers of cases and outbreaks were seen in Denmark’s Capital Region compared to other regions. Overall, 22 SARS-CoV-2 deaths and 359 deaths (non-SARS-CoV-2) per 1000 resident years were identified in the study period.
Conclusion
Less than half of LTCFs identified any cases. The majority of cases were linked to outbreaks, emphasizing the importance of preventing introductions of SARS-CoV-2 into the facilities. Furthermore, it highlights the need to invest efforts into infrastructures, routine procedures and monitoring of SARS-CoV-2 in LTCFs to limit the introduction and the spread of SARS-CoV-2.
The composition of the human gut microbiome matures within the first years of life. It has been hypothesized that microbial compositions in this period can cause immune dysregulations and potentially ...cause asthma. Here we show, by associating gut microbial composition from 16S rRNA gene amplicon sequencing during the first year of life with subsequent risk of asthma in 690 participants, that 1-year-old children with an immature microbial composition have an increased risk of asthma at age 5 years. This association is only apparent among children born to asthmatic mothers, suggesting that lacking microbial stimulation during the first year of life can trigger their inherited asthma risk. Conversely, adequate maturation of the gut microbiome in this period may protect these pre-disposed children.
Children with asthma may have a disease course with or without exacerbations, but the relationship between exacerbations and lung function development is poorly understood.
To compare lung function ...trajectories from birth till adolescence in asthmatic children with and without exacerbations.
Children with asthma from the Copenhagen Prospective Studies on Asthma in Childhood
(COPSAC
) birth cohort had lung function and bronchial reactivity assessed repeatedly from 1 month to 13 years. Exacerbations were diagnosed at the COPSAC clinic defined as symptoms requiring hospitalization, oral or high-dose inhaled corticosteroid treatment. Mixed models were applied to analyze lung function trajectories.
Children with asthma with exacerbations (N = 50) had a trajectory of increased, fixed airway obstruction compared with children without exacerbations (N = 47): z-score difference in airway resistance (sRaw
) (95% confidence interval CI): +0.34 (+0.03; +0.66), P = .03, and maximal mid-expiratory flow (MMEF
): -0.41 (-0.69; -0.13), P = .004, but no differences in forced expiratory volume (FEV
): -0.14 (-0.41; +0.13), P = .29, or bronchial reactivity to methacholine (PD
): +0.08 (-0.26; +0.42), P = .65. This did not change comparing lung function trajectories before and after exacerbations: z-score difference (95% CI) sRaw
: -0.04 (-0.35; 0.27), P = .80; MMEF
: 0.01 (-0.02; 0.04), P = .55; FEV
: 0.02 (-0.02; 0.05), P = .42; and PD
: -0.01 (-0.06; 0.05), P = .88.
Children with asthma with exacerbations compared with children with asthma without exacerbations are characterized by increased airway obstruction since infancy through childhood. The airway obstruction is a fixed trajectory without progression due to exacerbations, suggesting that exacerbations are a consequence rather than a cause of diminished airway caliber in childhood.
The originally published version of this Article contained an incorrect version of Figure 3 that was introduced following peer review and inadvertently not corrected during the production process. ...Both versions contain the same set of abundance data, but the incorrect version has the children's asthma status erroneously disconnected from the abundance data, thereby producing the non-representative p values and graphic presentations. These errors have now been rectified, with the correct version of Figure 3 replaced in both the PDF and HTML versions of the Article.
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