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Kim AE, Bennett JC, Luiten K, O'Hanlon JA, Wolf CR, Magedson A, Han PD, Acker Z, Regelbrugge L, McCaffrey KM, Stone J, Reinhart D, Capodanno BJ, Morse SS, Bedford T, Englund JA, Boeckh M, Starita LM, Uyeki TM, Carone M, Weil A, Chu HY. Comparative diagnostic utility of SARS-CoV-2 rapid antigen and molecular testing in a community setting. J Infect Dis 2024:jiae150. [PMID: 38531685 DOI: 10.1093/infdis/jiae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND SARS-CoV-2 antigen-detection rapid diagnostic tests (Ag-RDTs) have become widely utilized but longitudinal characterization of their community-based performance remains incompletely understood. METHODS This prospective longitudinal study at a large public university in Seattle, WA utilized remote enrollment, online surveys, and self-collected nasal swab specimens to evaluate Ag-RDT performance against real-time reverse transcription polymerase chain reaction (rRT-PCR) in the context of SARS-CoV-2 Omicron. Ag-RDT sensitivity and specificity within 1 day of rRT-PCR were evaluated by symptom status throughout the illness episode and Orf1b cycle threshold (Ct). RESULTS From February to December 2022, 5,757 participants reported 17,572 Ag-RDT results and completed 12,674 rRT-PCR tests, of which 995 (7.9%) were rRT-PCR-positive. Overall sensitivity and specificity were 53.0% (95% CI: 49.6-56.4%) and 98.8% (98.5-99.0%), respectively. Sensitivity was comparatively higher for Ag-RDTs used 1 day after rRT-PCR (69.0%), 4 to 7 days post-symptom onset (70.1%), and Orf1b Ct ≤20 (82.7%). Serial Ag-RDT sensitivity increased with repeat testing ≥2 (68.5%) and ≥4 (75.8%) days after an initial Ag-RDT-negative result. CONCLUSION Ag-RDT performance varied by clinical characteristics and temporal testing patterns. Our findings support recommendations for serial testing following an initial Ag-RDT-negative result, especially among recently symptomatic persons or those at high-risk for SARS-CoV-2 infection.
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Affiliation(s)
- Ashley E Kim
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Julia C Bennett
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kyle Luiten
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jessica A O'Hanlon
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Caitlin R Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ariana Magedson
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Peter D Han
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Zack Acker
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Lani Regelbrugge
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Jeremey Stone
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - David Reinhart
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Benjamin J Capodanno
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Stephen S Morse
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Trevor Bedford
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Howard Hughes Medical Institute, Seattle, WA, USA
| | | | - Michael Boeckh
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lea M Starita
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Ana Weil
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Bennett JC, Luiten KG, O'Hanlon J, Han PD, McDonald D, Wright T, Wolf CR, Lo NK, Acker Z, Regelbrugge L, McCaffrey KM, Pfau B, Stone J, Schwabe-Fry K, Lockwood CM, Guthrie BL, Gottlieb GS, Englund JA, Uyeki TM, Carone M, Starita LM, Weil AA, Chu HY. Utilizing a university testing program to estimate relative effectiveness of monovalent COVID-19 mRNA booster vaccine versus two-dose primary series against symptomatic SARS-CoV-2 infection. Vaccine 2024; 42:1332-1341. [PMID: 38307746 DOI: 10.1016/j.vaccine.2024.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Vaccine effectiveness (VE) studies utilizing the test-negative design are typically conducted in clinical settings, rather than community populations, leading to bias in VE estimates against mild disease and limited information on VE in healthy young adults. In a community-based university population, we utilized data from a large SARS-CoV-2 testing program to estimate relative VE of COVID-19 mRNA vaccine primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection from September 2021 to July 2022. We used the test-negative design and logistic regression implemented via generalized estimating equations adjusted for age, calendar time, prior SARS-CoV-2 infection, and testing frequency (proxy for test-seeking behavior) to estimate relative VE. Analyses included 2,218 test-positive cases (59 % received monovalent booster dose) and 9,615 test-negative controls (62 %) from 9,066 individuals, with median age of 21 years, mostly students (71 %), White (56 %) or Asian (28 %), and with few comorbidities (3 %). More cases (23 %) than controls (6 %) had COVID-19-like illness. Estimated adjusted relative VE of primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection was 40 % (95 % CI: 33-47 %) during the overall analysis period and 46 % (39-52 %) during the period of Omicron circulation. Relative VE was greater for those without versus those with prior SARS-CoV-2 infection (41 %, 34-48 % versus 33 %, 9 %-52 %, P < 0.001). Relative VE was also greater in the six months after receiving a booster dose (41 %, 33-47 %) compared to more than six months (27 %, 8-42 %), but this difference was not statistically significant (P = 0.06). In this relatively young and healthy adult population, an mRNA monovalent booster dose provided increased protection against symptomatic SARS-CoV-2 infection, overall and with the Omicron variant. University testing programs may be utilized for estimating VE in healthy young adults, a population that is not well-represented by routine VE studies.
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Affiliation(s)
- Julia C Bennett
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Kyle G Luiten
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jessica O'Hanlon
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Peter D Han
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Devon McDonald
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tessa Wright
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Caitlin R Wolf
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Natalie K Lo
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Zack Acker
- Brotman Baty Institute, Seattle, WA, USA
| | | | | | - Brian Pfau
- Brotman Baty Institute, Seattle, WA, USA
| | - Jeremey Stone
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Christina M Lockwood
- Brotman Baty Institute, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Brandon L Guthrie
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA; Environmental Health & Safety Department, University of Washington, Seattle, WA, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Lea M Starita
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Ana A Weil
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA
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3
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Pfau B, Opsahl J, Crew R, Best S, Han PD, Heidl S, McDermot E, Stone J, Schwabe-Fry K, MacMillan MP, O'Hanlon J, Sohlberg S, Acker Z, Ehmen B, Englund JA, Konnick EQ, Chu HY, Weil AA, Lockwood CM, Starita LM. Tiny swabs: nasal swabs integrated into tube caps facilitate large-scale self-collected SARS-CoV-2 testing. J Clin Microbiol 2024; 62:e0128523. [PMID: 38131692 PMCID: PMC10865831 DOI: 10.1128/jcm.01285-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
The COVID-19 pandemic spurred the development of innovative solutions for specimen collection and molecular detection for large-scale community testing. Among these developments is the RHINOstic nasal swab, a plastic anterior nares swab built into the cap of a standard matrix tube that facilitates automated processing of up to 96 specimens at a time. In a study of unsupervised self-collection utilizing these swabs, we demonstrate comparable analytic performance and shipping stability compared to traditional anterior nares swabs, as well as significant improvements in laboratory processing efficiency. The use of these swabs may allow laboratories to accommodate large numbers of sample collections during periods of high testing demand. Automation-friendly nasal swabs are an important tool for high-throughput processing of samples that may be adopted in response to future respiratory viral pandemics.
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Affiliation(s)
- Brian Pfau
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Jordan Opsahl
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Ruben Crew
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Sabrina Best
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Peter D. Han
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Sarah Heidl
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Evan McDermot
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Jeremy Stone
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | | | | | - Jessica O'Hanlon
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah Sohlberg
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Zack Acker
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Brenna Ehmen
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Janet A. Englund
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Eric Q. Konnick
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Helen Y. Chu
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Ana A. Weil
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Christina M. Lockwood
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Lea M. Starita
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - The Seattle Flu Alliance InvestigatorsBedfordTrevorBoeckhMichaelChuHelen Y.EnglundJanet A.LockwoodChristina M.LutzBarry R.PrenticeRobinShendureJayStaritaLea M.WaghmereAlpanaWeilAna A.
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
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4
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O’Hanlon JA, Acker Z, Bennett JC, Han PD, McDonald D, Wright T, Luiten KG, Regelbrugge L, McCaffrey K, Pfau BA, Wolf CR, Pothan LC, Gottlieb GS, Harb K, Hughes J, Starita L, Chu HY, Weil AA. 1916. Evaluation of nasal swab collection methods on a university campus during the SARS-CoV-2 pandemic. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Characterizing SARS-CoV-2 outbreaks on university campuses is critical for informed public health measures and understanding transmission dynamics. Figure 1.Dropbox and Kiosk Samples Collected September 10, 2021 to April 23, 2022.
Methods
Faculty, staff, and students at a major public university in Seattle, WA, USA were enrolled in a COVID-19 testing study. Individuals could test using observed self-swabs at on-campus kiosks or unobserved self-swabs using a kit and returning it to a dropbox on campus. Sample collection volume for observed self-swabs was limited by staffing and space. All samples were returned to the laboratory and tested for SARS-CoV-2 by qRT-PCR.
Results
From September 10, 2021 to April 23, 2022, 38,400 individuals were enrolled in the study. Of these individuals, 5,089 used dropboxes only, 14,421 used kiosks only, and 5,820 used both. A total of 21,653 dropbox swabs and 75,493 observed self-swabs were collected. Median age was similar between individuals using dropboxes and observed self-swabs (20 vs. 22 years). A greater proportion of dropbox users were students compared to faculty and staff (students made up 83% of dropbox only population, 75% of kiosk only, and 86% of both, χ² p-value< 0.0001). Symptom data was reported for 65,349 swabs. Dropbox users were less likely to have symptoms compared to observed self-swab users (24% of swabs vs. 54%, χ² p-value< 0.0001). SARS-CoV-2 positivity was slightly lower for dropboxes compared to kiosks (4% vs. 5%; p=0.001). Dropboxes were highly utilized during periods of increased testing demand, including after academic breaks and variant emergence (Figure 1). Of the total tests distributed for use, a greater proportion of dropbox kits were unable to be resulted (6%) compared to observed self-swab kits (0.02%).
Conclusion
Dropboxes provided a flexible, high-volume collection method at times of increased testing demand. Individuals who used dropboxes were less likely to report symptoms and slightly less likely to test positive, suggesting a role for dropbox utilization in high-risk asymptomatic individuals during periods of high community transmission on a university campus.
Disclosures
Geoffrey S. Gottlieb, MD, PhD, Abbott Molecular Diagnostics: Grant/Research Support|Alere Technologies: Grant/Research Support|BMGF: Grant/Research Support|BMS: Grant/Research Support|Cerus Corp.: Grant/Research Support|Gilead Sciences: Grant/Research Support|Janssen Pharmaceutica: Grant/Research Support|Merck & Co: Grant/Research Support|Roche Molecular Systems: Grant/Research Support|THERA Technologies/TaiMed Biologics: Grant/Research Support|ViiV Healthcare: Grant/Research Support Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.
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Affiliation(s)
- Jessica A O’Hanlon
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington , Seattle, Washington, USA, Seattle, Washington
| | - Zack Acker
- Brotman Baty Institute , Seattle, Washington
| | | | - Peter D Han
- University of Washington , Seattle, Washington
| | | | | | | | | | | | | | | | | | | | - Katia Harb
- University of Washington , Seattle, Washington
| | | | - Lea Starita
- University of Washington , Seattle, Washington
| | - Helen Y Chu
- University of Washington , Seattle, Washington
| | - Ana A Weil
- University of Washington , Seattle, Washington
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5
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Hansen C, Perofsky AC, Burstein R, Famulare M, Boyle S, Prentice R, Marshall C, McCormick BJJ, Reinhart D, Capodanno B, Truong M, Schwabe-Fry K, Kuchta K, Pfau B, Acker Z, Lee J, Sibley TR, McDermot E, Rodriguez-Salas L, Stone J, Gamboa L, Han PD, Duchin JS, Waghmare A, Englund JA, Shendure J, Bedford T, Chu HY, Starita LM, Viboud C. Trends in Risk Factors and Symptoms Associated With SARS-CoV-2 and Rhinovirus Test Positivity in King County, Washington, June 2020 to July 2022. JAMA Netw Open 2022; 5:e2245861. [PMID: 36484987 PMCID: PMC9856230 DOI: 10.1001/jamanetworkopen.2022.45861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Few US studies have reexamined risk factors for SARS-CoV-2 positivity in the context of widespread vaccination and new variants or considered risk factors for cocirculating endemic viruses, such as rhinovirus. OBJECTIVES To evaluate how risk factors and symptoms associated with SARS-CoV-2 test positivity changed over the course of the pandemic and to compare these with the risk factors associated with rhinovirus test positivity. DESIGN, SETTING, AND PARTICIPANTS This case-control study used a test-negative design with multivariable logistic regression to assess associations between SARS-CoV-2 and rhinovirus test positivity and self-reported demographic and symptom variables over a 25-month period. The study was conducted among symptomatic individuals of all ages enrolled in a cross-sectional community surveillance study in King County, Washington, from June 2020 to July 2022. EXPOSURES Self-reported data for 15 demographic and health behavior variables and 16 symptoms. MAIN OUTCOMES AND MEASURES Reverse transcription-polymerase chain reaction-confirmed SARS-CoV-2 or rhinovirus infection. RESULTS Analyses included data from 23 498 individuals. The median (IQR) age of participants was 34.33 (22.42-45.08) years, 13 878 (59.06%) were female, 4018 (17.10%) identified as Asian, 654 (2.78%) identified as Black, and 2193 (9.33%) identified as Hispanic. Close contact with an individual with SARS-CoV-2 (adjusted odds ratio [aOR], 3.89; 95% CI, 3.34-4.57) and loss of smell or taste (aOR, 3.49; 95% CI, 2.77-4.41) were the variables most associated with SARS-CoV-2 test positivity, but both attenuated during the Omicron period. Contact with a vaccinated individual with SARS-CoV-2 (aOR, 2.03; 95% CI, 1.56-2.79) was associated with lower odds of testing positive than contact with an unvaccinated individual with SARS-CoV-2 (aOR, 4.04; 95% CI, 2.39-7.23). Sore throat was associated with Omicron infection (aOR, 2.27; 95% CI, 1.68-3.20) but not Delta infection. Vaccine effectiveness for participants fully vaccinated with a booster dose was 93% (95% CI, 73%-100%) for Delta, but not significant for Omicron. Variables associated with rhinovirus test positivity included being younger than 12 years (aOR, 3.92; 95% CI, 3.42-4.51) and experiencing a runny or stuffy nose (aOR, 4.58; 95% CI, 4.07-5.21). Black race, residing in south King County, and households with 5 or more people were significantly associated with both SARS-CoV-2 and rhinovirus test positivity. CONCLUSIONS AND RELEVANCE In this case-control study of 23 498 symptomatic individuals, estimated risk factors and symptoms associated with SARS-CoV-2 infection changed over time. There was a shift in reported symptoms between the Delta and Omicron variants as well as reductions in the protection provided by vaccines. Racial and sociodemographic disparities persisted in the third year of SARS-CoV-2 circulation and were also present in rhinovirus infection. Trends in testing behavior and availability may influence these results.
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Affiliation(s)
- Chelsea Hansen
- Brotman Baty Institute, University of Washington, Seattle
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Amanda C. Perofsky
- Brotman Baty Institute, University of Washington, Seattle
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Roy Burstein
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Michael Famulare
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Shanda Boyle
- Brotman Baty Institute, University of Washington, Seattle
| | - Robin Prentice
- Brotman Baty Institute, University of Washington, Seattle
| | | | | | - David Reinhart
- Brotman Baty Institute, University of Washington, Seattle
| | - Ben Capodanno
- Brotman Baty Institute, University of Washington, Seattle
| | - Melissa Truong
- Brotman Baty Institute, University of Washington, Seattle
| | | | - Kayla Kuchta
- Brotman Baty Institute, University of Washington, Seattle
| | - Brian Pfau
- Brotman Baty Institute, University of Washington, Seattle
| | - Zack Acker
- Brotman Baty Institute, University of Washington, Seattle
| | - Jover Lee
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Thomas R. Sibley
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Evan McDermot
- Brotman Baty Institute, University of Washington, Seattle
| | | | - Jeremy Stone
- Brotman Baty Institute, University of Washington, Seattle
| | - Luis Gamboa
- Brotman Baty Institute, University of Washington, Seattle
| | - Peter D. Han
- Brotman Baty Institute, University of Washington, Seattle
- Department of Genome Sciences, University of Washington, Seattle
| | - Jeffery S. Duchin
- Public Health Seattle and King County, Seattle, Washington
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
- School of Public Health, University of Washington, Seattle
| | - Alpana Waghmare
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Janet A. Englund
- Brotman Baty Institute, University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Jay Shendure
- Brotman Baty Institute, University of Washington, Seattle
- Department of Genome Sciences, University of Washington, Seattle
- Howard Hughes Medical Institute, Seattle, Washington
| | - Trevor Bedford
- Brotman Baty Institute, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Genome Sciences, University of Washington, Seattle
- Howard Hughes Medical Institute, Seattle, Washington
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | - Lea M. Starita
- Brotman Baty Institute, University of Washington, Seattle
- Department of Genome Sciences, University of Washington, Seattle
| | - Cécile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
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