South Korea: Outbreak of secondary infection with severe fever with thrombocytopenia syndrome (SFTS), Linked to giving CPR
The Korea Disease Control and Prevention Agency (KDCA) recently announced that it is conducting an epidemiological investigation and contact management after it was confirmed that a number of medical staff (7 people) were exposed to the blood and body fluids of a patient with Severe Fever with Thrombocytopenia Syndrome (SFTS) during CPR at a medical institution, becoming secondary infected.
The SFTS index patient (69-year-old female) showed symptoms such as fever starting on June 2, was admitted to a hospital in Boeun on June 4, and transferred to a general hospital in Cheongju on June 5. On June 9, she was transferred to a higher-level general hospital in Cheongju due to worsening symptoms such as fever and pancytopenia. Afterwards, the patient’s condition rapidly deteriorated, and she died of multiple organ failure on June 11 while receiving cardiopulmonary resuscitation in the intensive care unit.
Among the medical staff who participated in CPR at the time, 9 people developed symptoms such as fever, headache, muscle pain, and diarrhea from June 17 to 20. As a result of the SFTS confirmatory test, 7 people* were confirmed positive and reported to the local public health center. The epidemiological investigation results by the health authorities showed that the medical staff were exposed to blood and body fluids during the procedures such as endotracheal intubation, sputum suctioning, application of artificial respirators, and CPR. As the procedures were performed for a long time, the scope of the medical staff’s exposure increased.
* All 7 people have now recovered from their symptoms
The Korea Disease Control and Prevention Agency is currently monitoring the occurrence of symptoms for 28 days, which is twice the maximum incubation period (14 days), targeting medical staff and funeral directors who were directly exposed to the blood and body fluids of SFTS patients, as well as those who are temporally and spatially exposed (medical staff, family members) who are at risk of indirectly being exposed to blood and body fluids.
SFTS is mainly transmitted through the bite of a tick carrying the virus, but it can also be transmitted from person to person through droplets when exposed to blood and body fluids during the treatment of severely ill or deceased patients who are expected to secrete high concentrations of SFTS virus. From 2014 to the present, there have been a total of 35 cases of secondary human infection with SFTS, including 34 medical workers and 1 funeral director.
Since most secondary infected healthcare workers are infected while performing high-risk procedures (e.g., cardiopulmonary resuscitation, endotracheal intubation, tracheal suctioning, etc.) on SFTS patients, it is important to prevent contact with patient secretions by wearing personal protective equipment (N95 mask, goggles or face shield, full-body gown, double gloves).
Director of the Korea Disease Control and Prevention Agency Ji Young-mi requested, “Those who were confirmed to have been exposed through the epidemiological investigation of the group outbreak to immediately contact the public health center if symptoms develop during the follow-up observation period,” and emphasized, “This case has reconfirmed the risk of secondary infection in medical institutions, so medical workers should thoroughly follow infection control measures, such as wearing personal protective equipment when examining and treating SFTS patients.” She also urged, “Since SFTS is transmitted through tick bites during farm work and outdoor activities, people should wear long clothing, hats, socks, etc. to reduce exposure and use repellent.”