{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:55:27Z","timestamp":1790747727438,"version":"4.1.0"},"reference-count":18,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Infection Prevention"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nursing homes were affected by COVID-19, and limited testing capacity during the first wave highlighted the value of complementary surveillance approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize clinical presentations, virological findings, and mortality identified through syndromic and virological surveillance during two COVID-19 waves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A retrospective study was conducted in 16 nursing homes in Northeastern France, including 1,493 residents monitored from February 2020 to February 2021. Residents were classified into four clinical sign patterns: combined general and respiratory signs (G and R), R only, G only, and asymptomatic positive SARS-CoV-2 tests (T+ only). Outbreaks were defined by at least three residents presenting G and R or T+ only within four consecutive days. Wave 2 analyses were conducted separately before and during immunization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Outbreak frequency and duration remained high during both epidemic waves, although smaller facilities were less likely to experience outbreaks. The proportion of residents presenting G and R declined from 62.9% during wave 1 to 53.0% and 38.9% during the pre-immunization and immunization periods, respectively (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), whereas G only presentations increased. Virological testing coverage among CSPs increased from 41.0% to 84.8% and 79.2%, respectively. Estimated 8-week mortality decreased from 25.4% to 20.5% and 12.8% (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.002). In multivariable analysis, clinical sign patterns (highest risk among G and R), older age, male sex, and not being tested were independently associated with mortality, while epidemic period was not.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings highlight the complementary value of syndromic and virological surveillance for characterizing COVID-19 outbreaks in nursing homes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17571774261477859","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:56:46Z","timestamp":1787918206000},"page":"238-244","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19 in nursing homes: What syndromic and virological surveillance revealed about the first two epidemic waves"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7746-5605","authenticated-orcid":false,"given":"Philippe","family":"Gaspard","sequence":"first","affiliation":[{"name":"Rouffach Hospital Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4524-9064","authenticated-orcid":false,"given":"Martin","family":"Martinot","sequence":"additional","affiliation":[{"name":"Colmar Civil Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"e_1_3_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008457"},{"key":"e_1_3_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.17533"},{"key":"e_1_3_7_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192215298"},{"key":"e_1_3_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2020.06.013"},{"key":"e_1_3_7_6_1","unstructured":"European Centre for Disease Prevention and Control (2023) Protocol for point prevalence surveys of health-care-associated infections and antimicrobial use in European long-term care facilities version 4.0. Available at: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/PRO-20221017-419_Final.pdf. (accessed 28 August 2025)."},{"key":"e_1_3_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.infpip.2025.100444"},{"key":"e_1_3_7_8_1","first-page":"22","article-title":"Avis relatif \u00e0 l\u2019\u00e9volution des mesures organisationnelles de pr\u00e9vention de la transmission et de la diffusion du SARS-CoV-2 en Ehpad et en USLD","author":"Haut Conseil de la sant\u00e9 publique","year":"2021","unstructured":"Haut Conseil de la sant\u00e9 publique (2021) Avis relatif \u00e0 l\u2019\u00e9volution des mesures organisationnelles de pr\u00e9vention de la transmission et de la diffusion du SARS-CoV-2 en Ehpad et en USLD. Haut Conseil de la sant\u00e9 publique 22. Available at: https:\/\/www.hcsp.fr\/Explore.cgi\/Telecharger?NomFichier=hcspa20210302_covorgdelaprvenehpetenusl.pdf. (accessed 7 June 2026).","journal-title":"Haut Conseil de la sant\u00e9 publique"},{"key":"e_1_3_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-020-00677-5"},{"key":"e_1_3_7_10_1","first-page":"1","article-title":"La vaccination contre la Covid-19 en Ehpad et son effet sur la contamination des r\u00e9sidents: la campagne de vaccination des r\u00e9sidents d\u2019Ehpad au d\u00e9but de l\u2019ann\u00e9e 2021","volume":"86","author":"Miron de l'Espinay A","year":"2021","unstructured":"Miron de l'Espinay A, Pinel L (2021) La vaccination contre la Covid-19 en Ehpad et son effet sur la contamination des r\u00e9sidents: la campagne de vaccination des r\u00e9sidents d\u2019Ehpad au d\u00e9but de l\u2019ann\u00e9e 2021. Les Dossiers de la DREES 86: 1\u201330. Available at: https:\/\/drees.solidarites-sante.gouv.fr\/sites\/default\/files\/2021-11\/DD86.pdf. 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