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Nikiforuk AM, Kuchinski KS, Short K, Roman S, Irvine MA, Prystajecky N, Jassem AN, Patrick DM, Sekirov I. Nasopharyngeal angiotensin converting enzyme 2 (ACE2) expression as a risk-factor for SARS-CoV-2 transmission in concurrent hospital associated outbreaks. BMC Infect Dis 2024; 24:262. [PMID: 38408924 PMCID: PMC10898082 DOI: 10.1186/s12879-024-09067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/28/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Widespread human-to-human transmission of the severe acute respiratory syndrome coronavirus two (SARS-CoV-2) stems from a strong affinity for the cellular receptor angiotensin converting enzyme two (ACE2). We investigate the relationship between a patient's nasopharyngeal ACE2 transcription and secondary transmission within a series of concurrent hospital associated SARS-CoV-2 outbreaks in British Columbia, Canada. METHODS Epidemiological case data from the outbreak investigations was merged with public health laboratory records and viral lineage calls, from whole genome sequencing, to reconstruct the concurrent outbreaks using infection tracing transmission network analysis. ACE2 transcription and RNA viral load were measured by quantitative real-time polymerase chain reaction. The transmission network was resolved to calculate the number of potential secondary cases. Bivariate and multivariable analyses using Poisson and Negative Binomial regression models was performed to estimate the association between ACE2 transcription the number of SARS-CoV-2 secondary cases. RESULTS The infection tracing transmission network provided n = 76 potential transmission events across n = 103 cases. Bivariate comparisons found that on average ACE2 transcription did not differ between patients and healthcare workers (P = 0.86). High ACE2 transcription was observed in 98.6% of transmission events, either the primary or secondary case had above average ACE2. Multivariable analysis found that the association between ACE2 transcription (log2 fold-change) and the number of secondary transmission events differs between patients and healthcare workers. In health care workers Negative Binomial regression estimated that a one-unit change in ACE2 transcription decreases the number of secondary cases (β = -0.132 (95%CI: -0.255 to -0.0181) adjusting for RNA viral load. Conversely, in patients a one-unit change in ACE2 transcription increases the number of secondary cases (β = 0.187 (95% CI: 0.0101 to 0.370) adjusting for RNA viral load. Sensitivity analysis found no significant relationship between ACE2 and secondary transmission in health care workers and confirmed the positive association among patients. CONCLUSION Our study suggests that ACE2 transcription has a positive association with SARS-CoV-2 secondary transmission in admitted inpatients, but not health care workers in concurrent hospital associated outbreaks, and it should be further investigated as a risk-factor for viral transmission.
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Affiliation(s)
- Aidan M Nikiforuk
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Kevin S Kuchinski
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Katy Short
- Fraser Health Authority, V3L 3C2, New Westminster, BC, Canada
| | - Susan Roman
- Fraser Health Authority, V3L 3C2, New Westminster, BC, Canada
| | - Mike A Irvine
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, V5A 1S6, Burnaby, BC, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Agatha N Jassem
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - David M Patrick
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada
| | - Inna Sekirov
- British Columbia Centre for Disease Control, V5Z 4R4, Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, V6T 1Z4, Vancouver, BC, Canada.
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Elgersma IH, Fretheim A, Elstrøm P, Aavitsland P. Association between face mask use and risk of SARS-CoV-2 infection: Cross-sectional study. Epidemiol Infect 2023; 151:e194. [PMID: 37952983 PMCID: PMC10728967 DOI: 10.1017/s0950268823001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
We examined the association between face masks and risk of infection with SARS-CoV-2 using cross-sectional data from 3,209 participants in a randomized trial exploring the effectiveness of glasses in reducing the risk of SARS-CoV-2 infection. Face mask use was based on participants' response to the end-of-follow-up survey. We found that the incidence of self-reported COVID-19 was 33% (aRR 1.33; 95% CI 1.03-1.72) higher in those wearing face masks often or sometimes, and 40% (aRR 1.40; 95% CI 1.08-1.82) higher in those wearing face masks almost always or always, compared to participants who reported wearing face masks never or almost never. We believe the observed increase in the incidence of infection associated with wearing a face mask is likely due to unobservable and hence nonadjustable differences between those wearing and not wearing a mask. Observational studies reporting on the relationship between face mask use and risk of respiratory infections should be interpreted cautiously, and more randomized trials are needed.
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Affiliation(s)
- Ingeborg Hess Elgersma
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Petter Elstrøm
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Preben Aavitsland
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
- Pandemic Centre, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Boulos L, Curran JA, Gallant A, Wong H, Johnson C, Delahunty-Pike A, Saxinger L, Chu D, Comeau J, Flynn T, Clegg J, Dye C. Effectiveness of face masks for reducing transmission of SARS-CoV-2: a rapid systematic review. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2023; 381:20230133. [PMID: 37611625 PMCID: PMC10446908 DOI: 10.1098/rsta.2023.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023]
Abstract
This rapid systematic review of evidence asks whether (i) wearing a face mask, (ii) one type of mask over another and (iii) mandatory mask policies can reduce the transmission of SARS-CoV-2 infection, either in community-based or healthcare settings. A search of studies published 1 January 2020-27 January 2023 yielded 5185 unique records. Due to a paucity of randomized controlled trials (RCTs), observational studies were included in the analysis. We analysed 35 studies in community settings (three RCTs and 32 observational) and 40 in healthcare settings (one RCT and 39 observational). Ninety-five per cent of studies included were conducted before highly transmissible Omicron variants emerged. Ninety-one per cent of observational studies were at 'critical' risk of bias (ROB) in at least one domain, often failing to separate the effects of masks from concurrent interventions. More studies found that masks (n = 39/47; 83%) and mask mandates (n = 16/18; 89%) reduced infection than found no effect (n = 8/65; 12%) or favoured controls (n = 1/65; 2%). Seven observational studies found that respirators were more protective than surgical masks, while five found no statistically significant difference between the two mask types. Despite the ROB, and allowing for uncertain and variable efficacy, we conclude that wearing masks, wearing higher quality masks (respirators), and mask mandates generally reduced SARS-CoV-2 transmission in these study populations. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
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Affiliation(s)
- Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, 5790 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
| | - Janet A. Curran
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- School of Nursing, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Allyson Gallant
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- Faculty of Health, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Helen Wong
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- Faculty of Health, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Catherine Johnson
- IWK Health Centre, 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada
- Department of Health and Rehabilitation Services, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | | | - Lynora Saxinger
- Division of Infectious Diseases, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta, 116 Street & 85 Avenue, Edmonton, Alberta T6G 2R3, Canada
| | - Derek Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
- The Research Institute of St Joe's Hamilton, St Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N A46, Canada
| | - Jeannette Comeau
- Division of Infectious Diseases, Dalhousie University, 6299 South Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Trudy Flynn
- Patient/Public Partner, University of Oxford, 11A Mansfield Road, Oxford OX1 3SZ, UK
| | - Julie Clegg
- Patient/Public Partner, University of Oxford, 11A Mansfield Road, Oxford OX1 3SZ, UK
| | - Christopher Dye
- Department of Biology, University of Oxford, 11A Mansfield Road, Oxford OX1 3SZ, UK
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Cash-Goldwasser S, Reingold AL, Luby SP, Jackson LA, Frieden TR. Masks During Pandemics Caused by Respiratory Pathogens-Evidence and Implications for Action. JAMA Netw Open 2023; 6:e2339443. [PMID: 37906187 DOI: 10.1001/jamanetworkopen.2023.39443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Importance As demonstrated by the influenza virus and SARS-CoV-2, viruses spread by the respiratory route can cause deadly pandemics, and face masks can reduce the spread of these pathogens. The effectiveness of responses to future epidemics and pandemics will depend at least in part on whether evidence on masks, including from the COVID-19 pandemic, is utilized. Observations Well-designed observational studies have demonstrated the association of mask use with reduced transmission of SARS-CoV-2 in community settings, and rigorous evaluations of mask mandates have found substantial protection. Disagreement about whether face masks reduce the spread of SARS-CoV-2 has been exacerbated by a focus on randomized trials, which are limited in number, scope, and statistical power. Many effective public health policies have never been assessed in randomized clinical trials; such trials are not the gold standard of evidence for the efficacy of all interventions. Masking in the community to reduce the spread of SARS-CoV-2 is supported by robust evidence from diverse settings and populations. Data on the epidemiologic, environmental, and mask design parameters that influence the effectiveness of masking provide insights on when and how masks should be used to prevent transmission. Conclusions and Relevance During the next epidemic or pandemic caused by a respiratory pathogen, decision-makers will need to rely on existing evidence as they implement interventions. High-quality studies have shown that use of face masks in the community is associated with reduced transmission of SARS-CoV-2 and is likely to be an important component of an effective response to a future respiratory threat.
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Affiliation(s)
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle
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Li JX, Liao PL, Wei JCC, Hsu SB, Yeh CJ. A chronological review of COVID-19 case fatality rate and its secular trend and investigation of all-cause mortality and hospitalization during the Delta and Omicron waves in the United States: a retrospective cohort study. Front Public Health 2023; 11:1143650. [PMID: 37799149 PMCID: PMC10548482 DOI: 10.3389/fpubh.2023.1143650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has caused more than 690 million deaths worldwide. Different results concerning the death rates of the Delta and Omicron variants have been recorded. We aimed to assess the secular trend of case fatality rate (CFR), identify risk factors associated with mortality following COVID-19 diagnosis, and investigate the risks of mortality and hospitalization during Delta and Omicron waves in the United States. Methods This study assessed 2,857,925 individuals diagnosed with COVID-19 in the United States from January 2020, to June 2022. The inclusion criterion was the presence of COVID-19 diagnostic codes in electronic medical record or a positive laboratory test of the SARS-CoV-2. Statistical analysis was bifurcated into two components, longitudinal analysis and comparative analysis. To assess the discrepancies in hospitalization and mortality rates for COVID-19, we identified the prevailing periods for the Delta and Omicron variants. Results Longitudinal analysis demonstrated four sharp surges in the number of deaths and CFR. The CFR was persistently higher in males and older age. The CFR of Black and White remained higher than Asians since January 2022. In comparative analysis, the adjusted hazard ratios for all-cause mortality and hospitalization were higher in Delta wave compared to the Omicron wave. Risk of all-cause mortality was found to be greater 14-30 days after a COVID-19 diagnosis, while the likelihood of hospitalization was higher in the first 14 days following a COVID-19 diagnosis in Delta wave compared with Omicron wave. Kaplan-Meier analysis revealed the cumulative probability of mortality was approximately 2-fold on day 30 in Delta than in Omicron cases (log-rank p < 0.001). The mortality risk ratio between the Delta and Omicron variants was 1.671 (95% Cl 1.615-1.729, log-rank p < 0.001). Delta also had a significantly increased mortality risk over Omicron in all age groups. The CFR of people aged above 80 years was extremely high as 17.33%. Conclusion Male sex and age seemed to be strong and independent risk factors of mortality in COVID-19. The Delta variant appears to cause more hospitalization and death than the Omicron variant.
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Affiliation(s)
- Jing-Xing Li
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Shu-Bai Hsu
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
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Hua L, Wang Y, Mo B, Guo Z, Wang Y, Su Z, Huang M, Chen H, Ma X, Xie J, Luo M. The hidden inequality: the disparities in the quality of daily use masks associated with family economic status. Front Public Health 2023; 11:1163428. [PMID: 37397746 PMCID: PMC10313325 DOI: 10.3389/fpubh.2023.1163428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Wearing high-quality masks plays a critical role in reducing COVID-19 transmission. However, no study has investigated socioeconomic inequality in the quality of masks. Addressing this gap, this paper explored the relationships between mask's quality and family economic status. The cross-sectional survey was conducted in two Chinese universities by distributing structured questionnaires to assess participants' characteristics including family economic status, and meanwhile collecting their masks to evaluate the quality by measuring particle filtration efficiency. The valid responses were obtained from 912 students with mean age of 19.556 ± 1.453 years and were analyzed by using fractional or binary logistic regression. Three main findings were presented. First, inequality existed in the quality of masks. 36.07% of students were using unqualified masks with average filtration efficiency of 0.795 ± 0.119, which was much lower than China's national standard (0.9). Of those masks with identified production date, 11.43% were manufactured during COVID-19 outbreak when market was flooded with counterfeit production, and thus were of poor quality with average filtration efficiency of 0.819 ± 0.152. Second, better family economic status was associated with better masks' filtration efficiency and greater probability of using qualified masks. Third, students with better family economic status tend to use masks with individual packaging, and unique patterns and special designs, which may lead to inequality on a psychological level. Our analysis reveals the hidden socioeconomic inequality that exist behind cheap masks. In facing the challenges of future emerging infectious diseases, it is important to address the inequity to ensure equal access to affordable qualified personal protection equipment.
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Affiliation(s)
- Lei Hua
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
- School of Government, Sun Yat-sen University, Guangzhou, China
| | - Ying Wang
- School of Public Policy and Administration, Chongqing University, Chongqing, China
| | - Bijuan Mo
- School of Foreign Language, Hunan University of Technology and Business, Changsha, Hunan, China
| | - Zuqi Guo
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Yulei Wang
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Zexuan Su
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Minqi Huang
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Han Chen
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Xiaowen Ma
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Jiaxin Xie
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
| | - Mengxian Luo
- School of Public Administration, Nanfang College · Guangzhou, Guangzhou, China
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Andrejko KL, Myers JF, Fukui N, Nelson L, Zhao R, Openshaw J, Watt JP, Jain S, Lewnard JA, Pry JM. Real-world uptake of COVID-19 vaccination among individuals expressing vaccine hesitancy: A registry-linkage study. Vaccine 2023; 41:1649-1656. [PMID: 36746740 PMCID: PMC9889259 DOI: 10.1016/j.vaccine.2023.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/09/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Uptake of COVID-19 vaccination remains suboptimal in the United States and other settings. Though early reports indicated that a strong majority of people were interested in receiving the COVID-19 vaccine, the association between vaccine intention and uptake is not yet fully understood. Ourobjective was todescribe predictors of vaccine uptake, and estimate the sensitivity, specificity, and predictive values of self-reported COVID-19 vaccine status compared to a comprehensive statewide COVID-19 vaccine registry. METHODS A cohort of California residents that received a molecular test for SARS-CoV-2 infection during 24 February-5 December 2021 were enrolled in a telephone-administered survey. Survey participants were matched with records in a statewide immunization registry. Cox proportional hazards model were used to compare time to vaccination among those unvaccinated at survey enrollment by self-reported COVID-19 vaccination intention. RESULTS Among 864 participants who were unvaccinated at the time of interview, 272 (31%) had documentation of receipt of COVID-19 vaccination at a later date; including 194/423 (45.9%) who had initially reported being willing to receive vaccination, 41/185 (22.2%) who reported being unsure about vaccination, and 37/278 (13.3%) who reported unwillingness to receive vaccination.Adjusted hazard ratios (aHRs) for registry-confirmed COVID-19 vaccination were 0.49 (95% confidence interval: 0.32-0.76) and 0.21 (0.12-0.36) for participants expressing uncertainty and unwillingness to receive vaccination, respectively, as compared with participants who reported being willing to receive vaccination. Time to vaccination was shorter among participants from higher-income households (aHR = 3.30 [2.02-5.39]) and who reported co-morbidities or immunocompromising conditions (aHR = 1.54 [1.01-2.36]).Sensitivity of self-reported COVID-19 vaccination status was 82% (80-85%) overall, and 98% (97-99%) among those referencing vaccination records; specificity was 87% (86-89%). CONCLUSION Willingness to receive COVID-19 vaccination was an imperfect predictor of real-world vaccine uptake. Improved messaging about COVID-19 vaccination regardless of previous SARS-CoV-2 infection status may help improve uptake.
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Affiliation(s)
- Kristin L Andrejko
- California Department of Public Health, Richmond, CA, United States; Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, United States
| | - Jennifer F Myers
- California Department of Public Health, Richmond, CA, United States
| | - Nozomi Fukui
- California Department of Public Health, Richmond, CA, United States
| | - Lauren Nelson
- California Department of Public Health, Richmond, CA, United States
| | - Rui Zhao
- California Department of Public Health, Richmond, CA, United States
| | - John Openshaw
- California Department of Public Health, Richmond, CA, United States
| | - James P Watt
- California Department of Public Health, Richmond, CA, United States
| | - Seema Jain
- California Department of Public Health, Richmond, CA, United States
| | - Joseph A Lewnard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, United States; Division of Infectious Diseases & Vaccinology, School of Public Health, University of California, Berkeley, CA, United States; Center for Computational Biology, College of Engineering, University of California, Berkeley, CA, United States.
| | - Jake M Pry
- California Department of Public Health, Richmond, CA, United States; Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, United States.
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Tjaden AH, Gibbs M, Runyon M, Weintraub WS, Taylor YJ, Edelstein SL. Association between self-reported masking behavior and SARS-CoV-2 infection wanes from Pre-Delta to Omicron-predominant periods - North Carolina COVID-19 Community Research Partnership (NC-CCRP). Am J Infect Control 2023; 51:261-267. [PMID: 36209944 PMCID: PMC9537112 DOI: 10.1016/j.ajic.2022.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Wearing a face mask is a primary public health method to reduce SARS-CoV-2 transmission. METHODS We performed a nested case-control analysis within the North Carolina COVID-19 Community Research Partnership (NC-CCRP) of adults who completed daily surveillance surveys, April 2020 - February 2022. We assessed the association between self-reported mask wearing behavior during nonhousehold interactions and COVID-19 infection during 3 pandemic periods using conditional logistic regression models of risk of infection that were adjusted for demographics, vaccination status, and recent known exposure to COVID-19. RESULTS Among 3,901 cases and 27,813 date-matched controls, there was a significant interaction between mask use and time period (P < .001). Prior to July 2021, the odds of a reported infection were 66% higher (aOR = 1.66, 95% CI = 1.43-1.91) among participants reporting ≥1 day not wearing a mask compared to those who reported no days (1,592 cases, 11,717 controls). During the Delta-predominant period, the results were similar (aOR = 1.53, 95% CI = 1.23-1.89; 659 cases, 4,649 controls). This association was attenuated during the Omicron-predominant period, where odds of an infection was 16% higher (aOR = 1.16, 95% CI = 1.03-1.32; 1,563 cases, 10,960 controls). CONCLUSIONS While the effect of not wearing a mask remains significant, during the Omicron-predominant period we observed a decrease in the association between self-reported mask wearing and risk of SARS-CoV-2 infection.
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Affiliation(s)
- Ashley H. Tjaden
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD,Address correspondence to Ashley H. Tjaden, COVID-19 Community Research Partnership Coordinating Center, Biostatistics Center, Milken Institute School of Public Health, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA
| | - Michael Gibbs
- Department of Emergency Medicine, Atrium Health, Charlotte, NC
| | - Michael Runyon
- Department of Emergency Medicine, Atrium Health, Charlotte, NC
| | | | - Yhenneko J. Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC
| | - Sharon L. Edelstein
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD
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Tjaden AH, Edelstein SL, Ahmed N, Calamari L, Dantuluri KL, Gibbs M, Hinkelman A, Mongraw‐Chaffin M, Sanders JW, Saydah S, Plumb ID. Association between COVID-19 and consistent mask wearing during contact with others outside the household-A nested case-control analysis, November 2020-October 2021. Influenza Other Respir Viruses 2023; 17:e13080. [PMID: 36606308 PMCID: PMC9835433 DOI: 10.1111/irv.13080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Face masks have been recommended to reduce SARS-CoV-2 transmission. However, evidence of the individual benefit of face masks remains limited, including by vaccination status. METHODS As part of the COVID-19 Community Research Partnership cohort study, we performed a nested case-control analysis to assess the association between self-reported consistent mask use during contact with others outside the household and subsequent odds of symptomatic SARS-CoV-2 infection (COVID-19) during November 2020-October 2021. Using conditional logistic regression, we compared 359 case-participants to 3544 control-participants who were matched by date, adjusting for enrollment site, age group, sex, race/ethnicity, urban/rural county classification, and healthcare worker occupation. RESULTS COVID-19 was associated with not consistently wearing a mask (adjusted odds ratio [aOR] 1.49; 95% confidence interval [CI] [1.14, 1.95]). Compared with persons ≥14 days after mRNA vaccination who also reported always wearing a mask, COVID-19 was associated with being unvaccinated (aOR 5.94; 95% CI [3.04, 11.62]), not wearing a mask (aOR 1.62; 95% CI [1.07, 2.47]), or both unvaccinated and not wearing a mask (aOR 9.07; 95% CI [4.81, 17.09]). CONCLUSIONS Our findings indicate that consistent mask wearing can complement vaccination to reduce the risk of COVID-19.
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Affiliation(s)
- Ashley H. Tjaden
- Milken Institute School of Public Health, Biostatistics CenterGeorge Washington UniversityRockvilleMarylandUSA
| | - Sharon L. Edelstein
- Milken Institute School of Public Health, Biostatistics CenterGeorge Washington UniversityRockvilleMarylandUSA
| | - Naheed Ahmed
- Department of Population HealthNYU Grossman School of MedicineNew York CityNew YorkUSA
| | - Lydia Calamari
- Carolinas Medical CenterAtrium HealthCharlotteNorth CarolinaUSA
| | - Keerti L. Dantuluri
- Department of Pediatrics (Infectious Diseases)Levine Children's Hospital, Atrium HealthCharlotteNorth CarolinaUSA
| | - Michael Gibbs
- Carolinas Medical CenterAtrium HealthCharlotteNorth CarolinaUSA
| | - Amy Hinkelman
- Campbell University School of Osteopathic MedicineLillingtonNorth CarolinaUSA
| | - Morgana Mongraw‐Chaffin
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - John W. Sanders
- Section on Cardiovascular Medicine, Department of MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Sharon Saydah
- U.S. Centers for Disease Control and Prevention COVID‐19 ResponseAtlantaGeorgiaUSA
| | - Ian D. Plumb
- U.S. Centers for Disease Control and Prevention COVID‐19 ResponseAtlantaGeorgiaUSA
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Cowger TL, Murray EJ, Clarke J, Bassett MT, Ojikutu BO, Sánchez SM, Linos N, Hall KT. Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff. N Engl J Med 2022; 387:1935-1946. [PMID: 36351262 PMCID: PMC9743802 DOI: 10.1056/nejmoa2211029] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.
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Affiliation(s)
- Tori L Cowger
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Eleanor J Murray
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Jaylen Clarke
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Mary T Bassett
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Bisola O Ojikutu
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Sarimer M Sánchez
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Natalia Linos
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
| | - Kathryn T Hall
- From the François-Xavier Bagnoud Center for Health and Human Rights, Harvard T.H. Chan School of Public Health (T.L.C., M.T.B., N.L.), the Boston Public Health Commission (T.L.C., E.J.M., J.C., B.O.O., S.M.S., K.T.H.), the Department of Epidemiology, School of Public Health, Boston University (E.J.M.), the Division of Infectious Diseases, Massachusetts General Hospital (B.O.O., S.M.S.), and Brigham and Women's Hospital and Harvard Medical School (B.O.O., K.T.H.) - all in Boston
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Kim SS, Chung JR, Talbot HK, Grijalva CG, Wernli KJ, Kiniry E, Martin ET, Monto AS, Belongia EA, McLean HQ, Gaglani M, Mamawala M, Nowalk MP, Moehling Geffel K, Tartof SY, Florea A, Lee JS, Tenforde MW, Patel MM, Flannery B. Effectiveness of two and three mRNA COVID-19 vaccine doses against Omicron- and Delta-Related outpatient illness among adults, October 2021-February 2022. Influenza Other Respir Viruses 2022; 16:975-985. [PMID: 36825251 PMCID: PMC9353375 DOI: 10.1111/irv.13029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023] Open
Abstract
Background We estimated SARS-CoV-2 Delta- and Omicron-specific effectiveness of two and three mRNA COVID-19 vaccine doses in adults against symptomatic illness in US outpatient settings. Methods Between October 1, 2021, and February 12, 2022, research staff consented and enrolled eligible participants who had fever, cough, or loss of taste or smell and sought outpatient medical care or clinical SARS-CoV-2 testing within 10 days of illness onset. Using the test-negative design, we compared the odds of receiving two or three mRNA COVID-19 vaccine doses among SARS-CoV-2 cases versus controls using logistic regression. Regression models were adjusted for study site, age, onset week, and prior SARS-CoV-2 infection. Vaccine effectiveness (VE) was calculated as (1 - adjusted odds ratio) × 100%. Results Among 3847 participants included for analysis, 574 (32%) of 1775 tested positive for SARS-CoV-2 during the Delta predominant period and 1006 (56%) of 1794 participants tested positive during the Omicron predominant period. When Delta predominated, VE against symptomatic illness in outpatient settings was 63% (95% CI: 51% to 72%) among mRNA two-dose recipients and 96% (95% CI: 93% to 98%) for three-dose recipients. When Omicron predominated, VE was 21% (95% CI: -6% to 41%) among two-dose recipients and 62% (95% CI: 48% to 72%) among three-dose recipients. Conclusions In this adult population, three mRNA COVID-19 vaccine doses provided substantial protection against symptomatic illness in outpatient settings when the Omicron variant became the predominant cause of COVID-19 in the United States. These findings support the recommendation for a third mRNA COVID-19 vaccine dose.
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Affiliation(s)
- Sara S. Kim
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Karen J. Wernli
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Erika Kiniry
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Emily T. Martin
- University of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Arnold S. Monto
- University of Michigan School of Public HealthAnn ArborMichiganUSA
| | | | | | - Manjusha Gaglani
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | | | | | | | - Sara Y. Tartof
- Kaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Ana Florea
- Kaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Justin S. Lee
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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12
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Dias VMDCH, Oliveira AF, Marinho AKBB, Santos Ferreira CED, Domingues CEF, Fortaleza CMCB, Vidal CFDL, Carrilho CMDDM, Pinheiro DOBP, de Assis DB, Medeiros EA, Morejón KML, Weissmann L, Michelin L, Carneiro M, Nogueira MDSDP, de Oliveira PRD, Buralli RJ, Stucchi RSB, Lins RS, Costa SF, Chebabo A. COVID-19 and isolation: Risks and implications in the scenario of new variants. Braz J Infect Dis 2022; 26:102703. [PMID: 36100081 PMCID: PMC9444891 DOI: 10.1016/j.bjid.2022.102703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 01/08/2023] Open
Abstract
With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.
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Affiliation(s)
- Viviane Maria de Carvalho Hessel Dias
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil; Hospital Marcelino Champagnat, Curitiba, PR, Brazil.
| | | | - Ana Karolina Barreto Berselli Marinho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Serviço de Imunologia Clínica e Alergia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos Eduardo Dos Santos Ferreira
- Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, São Paulo, SP, Brazil; Laboratório Clínico ‒ Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Laboratório Central ‒ Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Claudia Fernanda de Lacerda Vidal
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Recife, PE, Brazil
| | | | - Debora Otero Britto Passos Pinheiro
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil; Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Denise Brandão de Assis
- Divisão de Infecção Hospitalar/Centro de Vigilância Epidemiológica Prof. Alexandre Vranjac/Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Alexandrino Medeiros
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Karen Mirna Loro Morejón
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Leonardo Weissmann
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Instituto de Infectologia Emilio Ribas, São Paulo, SP, Brazil; Faculdade de Medicina, Universidade de Ribeirão Preto (UNAERP), Guarujá, SP, Brazil
| | - Lessandra Michelin
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade de Caxias do Sul (UCS), Rio Grande do Sul, RS, Brazil
| | - Marcelo Carneiro
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Programa de Pós-Graduação Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Hospital Santa Cruz, Santa Cruz do Sul, RS, Brazil
| | | | - Priscila Rosalba Domingos de Oliveira
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rafael Junqueira Buralli
- Coordenação Geral de Saúde do Trabalhador, Departamento de Saúde Ambiental, do Trabalhador e Vigilância das Emergências em Saúde Pública, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
| | - Raquel Silveira Bello Stucchi
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Departamento de Clínica Médica, Área de Infectologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rodrigo Schrage Lins
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital Naval Marcílio Dias, Rio de Janeiro, RJ, Brazil
| | - Silvia Figueiredo Costa
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alberto Chebabo
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Limitations of Molecular and Antigen Test Performance for SARS-CoV-2 in Symptomatic and Asymptomatic COVID-19 Contacts. J Clin Microbiol 2022; 60:e0018722. [PMID: 35730949 PMCID: PMC9297839 DOI: 10.1128/jcm.00187-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
COVID-19 has brought unprecedented attention to the crucial role of diagnostics in pandemic control. We compared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test performance by sample type and modality in close contacts of SARS-CoV-2 cases. Close contacts of SARS-CoV-2-positive individuals were enrolled after informed consent. Clinician-collected nasopharyngeal (NP) swabs in viral transport media (VTM) were tested with a routine clinical reference nucleic acid test (NAT) and PerkinElmer real-time reverse transcription-PCR (RT-PCR) assay; positive samples were tested for infectivity using a VeroE6TMPRSS2 cell culture model. Self-collected passive drool was also tested using the PerkinElmer RT-PCR assay. For the first 4 months of study, midturbinate swabs were tested using the BD Veritor rapid antigen test. Between 17 November 2020 and 1 October 2021, 235 close contacts of SARS-CoV-2 cases were recruited, including 95 with symptoms (82% symptomatic for ≤5 days) and 140 asymptomatic individuals. Reference NATs were positive for 53 (22.6%) participants; 24/50 (48%) were culture positive. PerkinElmer testing of NP and saliva samples identified an additional 28 (11.9%) SARS-CoV-2 cases who tested negative by reference NAT. Antigen tests performed for 99 close contacts showed 83% positive percent agreement (PPA) with reference NAT among early symptomatic persons, but 18% PPA in others; antigen tests in 8 of 11 (72.7%) culture-positive participants were positive. Contacts of SARS-CoV-2 cases may be falsely negative early after contact, but more sensitive platforms may identify these cases. Repeat or serial SARS-CoV-2 testing with both antigen and molecular assays may be warranted for individuals with high pretest probability for infection.
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Lefferts B, Blake I, Bruden D, Hagen MB, Hodges E, Kirking HL, Bates E, Hoeldt A, Lamont B, Saydah S, MacNeil A, Bruce MG, Plumb ID. Antigen Test Positivity After COVID-19 Isolation - Yukon-Kuskokwim Delta Region, Alaska, January-February 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:293-298. [PMID: 35202352 DOI: 10.15585/mmwr.mm7108a3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Isolation is recommended during acute infection with SARS-CoV-2, the virus that causes COVID-19, but the duration of infectiousness varies among individual persons. Rapid antigen test results have been correlated with detection of viable virus (1-3) and might inform isolation guidance, but data are limited for the recently emerged SARS-CoV-2 B.1.1.529 (Omicron) variant. On January 5, 2022, the Yukon-Kuskokwim Health Corporation (YKHC) recommended that persons with SARS-CoV-2 infection isolate for 10 days after symptom onset (or, for asymptomatic persons, 10 days after a positive nucleic acid amplification or antigen test result). However, isolation could end after 5-9 days if symptoms were resolving or absent, fever was absent for ≥24 hours without fever-reducing medications, and an Abbott BinaxNOW COVID-19 Ag (BinaxNOW) rapid antigen test result was negative. Antigen test results and associated individual characteristics were analyzed among 3,502 infections reported to YKHC during January 1-February 9, 2022. After 5-9 days, 396 of 729 persons evaluated (54.3%) had a positive antigen test result, with a declining percentage positive over time. In a multivariable model, a positive antigen test result was more likely after 5 days compared with 9 days (adjusted odds ratio [aOR] = 6.39) or after symptomatic infection (aOR = 9.63), and less likely after previous infection (aOR = 0.30), receipt of a primary COVID-19 vaccination series (aOR = 0.60), or after both previous infection and receipt of a primary COVID-19 vaccination series (aOR = 0.17). Antigen tests might be a useful tool to guide recommendations for isolation after SARS-CoV-2 infection. During the 10 days after infection, persons might be infectious to others and are recommended to wear a well-fitting mask when around others, even if ending isolation after 5 days.
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Andrejko KL, Pry JM, Myers JF, Fukui N, DeGuzman JL, Openshaw J, Watt JP, Lewnard JA, Jain S. Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection - California, February-December 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:212-216. [PMID: 35143470 PMCID: PMC8830622 DOI: 10.15585/mmwr.mm7106e1] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tang W, Chen HL. Predictors of SARS-CoV-2 infection: is there a comprehensive analysis? Clin Infect Dis 2022:ciac099. [PMID: 35137001 PMCID: PMC9383467 DOI: 10.1093/cid/ciac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Robinson ML, Mirza A, Gallagher N, Boudreau A, Garcia L, Yu T, Norton J, Luo CH, Conte A, Zhou R, Kafka K, Hardick J, McManus DD, Gibson LL, Pekosz A, Mostafa H, Manabe YC. Limitations of molecular and antigen test performance for SARS-CoV-2 in symptomatic and asymptomatic COVID-19 contacts. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022. [PMID: 35169814 DOI: 10.1101/2022.02.05.22270481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES COVID-19 has brought unprecedented attention to the crucial role of diagnostics in pandemic control. We compared SARS-CoV-2 test performance by sample type and modality in close contacts of SARS-CoV-2 cases. METHODS Close contacts of SARS-CoV-2 positive individuals were enrolled after informed consent. Clinician-collected nasopharyngeal (NP) swabs in viral transport media (VTM) were tested with a nucleic acid test (NAT). NP VTM and self-collected passive drool were tested using the PerkinElmer real-time reverse transcription PCR (RT-PCR) assay. For the first 4 months of study, mid-turbinate swabs were tested using the BD Veritor rapid antigen test. NAT positive NP samples were tested for infectivity using a VeroE6TMPRSS2 cell culture model. RESULTS Between November 17, 2020, and October 1, 2021, 235 close contacts of SARS-CoV-2 cases were recruited, including 95 with symptoms (82% symptomatic for < 5 days) and 140 asymptomatic individuals. NP swab reference tests were positive for 53 (22.6%) participants; 24/50 (48%) were culture positive. PerkinElmer testing of NP and saliva samples identified an additional 28 (11.9%) SARS-CoV-2 cases who tested negative by clinical NAT. Antigen tests performed for 99 close contacts showed 83% positive percent agreement (PPA) with reference NAT among early symptomatic persons, but 18% PPA in others; antigen tests in 8 of 11 (72.7%) culture-positive participants were positive. CONCLUSIONS Contacts of SARS-CoV-2 cases may be falsely negative early after contact, which more sensitive platforms may identify. Repeat or serial SARS-CoV-2 testing with both antigen and molecular assays may be warranted for individuals with high pretest probability for infection.
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