ArticleThe Journal of infection2021
Epidemiological data and genome sequencing reveals that nosocomial transmission of SARS-CoV-2 is underestimated and mostly mediated by a small number of highly infectious individuals.
Article in The Journal of infection, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers.
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Who cites it
46 citing papers in PubMed, 69 citations in OpenAlex.
- Min-frame transformation enables more sensitive viral genome alignment.bioRxiv : the preprint server for biology · 2026Article
- Healthcare-associated COVID-19 in Ontario, Canada: case classification and relative mortality.BMC infectious diseases · 2026Article
- Lessons from Two Early COVID-19 Hospital Outbreaks in Germany to Inform Strategies for Controlling Emerging Nosocomial Outbreaks of Highly Transmissible Respiratory Viruses.Journal of clinical medicine · 2026Article
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- Prioritizing Risk Factors for Nosocomial COVID-19 Infection in a Taiwanese Hospital: An Integrated DEMATEL-ANP-IPA Approach.Risk management and healthcare policy · 2026Article
- Characteristics of pediatric SARS-CoV-2 healthcare-associated infection outbreaks in Germany, 2020-2023: a retrospective observational study.European journal of pediatrics · 2025Observational
- The potential of genomic epidemiology: capitalizing on its practical use for impact in the healthcare setting.Frontiers in public health · 2025Article
- SARS-CoV-2 delta variant in African lions (Panthera leo) and humans at Utah's Hogle Zoo, USA, 2021-22.Zoonoses and public health · 2024Article
- Morbidity and Mortality of Hospital-Onset SARS-CoV-2 Infections Due to Omicron Versus Prior Variants : A Propensity-Matched Analysis.Annals of internal medicine · 2024Article
- Nanopore sequencing of influenza A and B in Oxfordshire and the United Kingdom, 2022-23.The Journal of infection · 2024Article
- Outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 in a Rural Community Hospital during Omicron Predominance.Microorganisms · 2024Article
- In Support of Universal Admission Testing for SARS-CoV-2 During Significant Community Transmission.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- The utility of whole-genome sequencing to inform epidemiologic investigations of SARS-CoV-2 clusters in acute-care hospitals.Infection control and hospital epidemiology · 2024Article
- Article
- Assessment of Hospital-Onset SARS-CoV-2 Infection Rates and Testing Practices in the US, 2020-2022.JAMA network open · 2023Article
- SARS-CoV-2 Outbreak Investigation Using Contact Tracing and Whole-Genome Sequencing in an Ontario Tertiary Care Hospital.Microbiology spectrum · 2023Article
- Linking sporadic hospital clusters during a community surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) B.1.617.2 delta variant: The utility of whole-genome sequencing.Infection control and hospital epidemiology · 2023Article
- Combining epidemiological data and whole genome sequencing to understand SARS-CoV-2 transmission dynamics in a large tertiary care hospital during the first COVID-19 wave in The Netherlands focusing on healthcare workers.Antimicrobial resistance and infection control · 2023Article
- Epidemiology of healthcare-associated SARS-CoV-2 outbreaks in Germany between March 2020 and May 2022.The Journal of hospital infection · 2023Article
- Article
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Authors and funding
21 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesDespite robust efforts, patients and staff acquire SARS-CoV-2 infection in hospitals. We investigated whether whole-genome sequencing enhanced the epidemiological investigation of healthcare-associated SARS-CoV-2 acquisition.
methodsFrom 17-November-2020 to 5-January-2021, 803 inpatients and 329 staff were diagnosed with SARS-CoV-2 infection at four Oxfordshire hospitals. We classified cases using epidemiological definitions, looked for a potential source for each nosocomial infection, and evaluated genomic evidence supporting transmission.
resultsUsing national epidemiological definitions, 109/803(14%) inpatient infections were classified as definite/probable nosocomial, 615(77%) as community-acquired and 79(10%) as indeterminate. There was strong epidemiological evidence to support definite/probable cases as nosocomial. Many indeterminate cases were likely infected in hospital: 53/79(67%) had a prior-negative PCR and 75(95%) contact with a potential source. 89/615(11% of all 803 patients) with apparent community-onset had a recent hospital exposure. Within 764 samples sequenced 607 genomic clusters were identified (>1 SNP distinct). Only 43/607(7%) clusters contained evidence of onward transmission (subsequent cases within ≤ 1 SNP). 20/21 epidemiologically-identified outbreaks contained multiple genomic introductions. Most (80%) nosocomial acquisition occurred in rapid super-spreading events in settings with a mix of COVID-19 and non-COVID-19 patients.
conclusionsCurrent surveillance definitions underestimate nosocomial acquisition. Most nosocomial transmission occurs from a relatively limited number of highly infectious individuals.
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