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you get the achievement for getting the best ending which require to not embrace anyone, but there might be additional requirement.
Once your at the point where everything is good don't sleep. Or make sure every NPC is treated with medicine then sleep. I think I only had 1 or 2 (NPC's) that died and it wasn't by me and sean was missing so I didn't sleep and all was good. If your docks went hostile thats not what I did and I got the achievement. It should be as simple as don't embrace any talking, Named NPC! Like at the beginning of the game when the game teaches you about the embrace with Cox. Don't do it, ever if you want that achievement.
sparing sean turns him into a crazed skal same with charming crane. the missing people count against you because you will eventually have to kill them if you go to their area.
Nope, you don't have to turn that bastard, either.
What about your districts health level? Did you mesmerize citizen so that they allow you into their house?
The achievement will activate if you don't Embrace any Citizens throughout the game - you also need to not kill the Vicar during the boss fight with Mary.
My districts are all sanitized but the one Aloysius died in, and his is healthy, and everyone healed when he died, best outcome ever..