Contact-Tracing Outcomes Among Household Contacts of Fully Vaccinated Coronavirus Disease 2019 (COVID-19) Patients: San Francisco, California, 29 January-2 July 2021

BACKGROUND

The extent to which vaccinated persons diagnosed with coronavirus disease 2019 (COVID-19) can transmit to other vaccinated and unvaccinated persons is unclear.

METHODS

Using data from the San Francisco Department of Public Health, this report describes outcomes of household contact tracing during 29 January-2 July 2021, where fully vaccinated patients with COVID-19 were the index case in the household.

RESULTS

Among 248 fully vaccinated patients with breakthrough infections, 203 (82%) were symptomatic and 105 were identified as the index patient within their household. Among 179 named household contacts, 71 (40%) contacts tested, over half (56%) were fully vaccinated and the secondary attack rate was 28%. Overall transmission from a symptomatic fully vaccinated patient with breakthrough infection to household contacts was suspected in 14 of 105 (13%) of households. Viral genomic sequencing of samples from 44% of fully vaccinated patients showed that 82% of those sequenced were infected by a variant of concern or interest and 77% by a variant carrying mutation(s) associated with resistance to neutralizing antibodies.

CONCLUSIONS

Transmission from fully vaccinated symptomatic index patients to vaccinated and unvaccinated household contacts can occur. Indoor face masking and timely testing of all household contacts should be considered when a household member receives a positive test result in order to identify and interrupt transmission chains.

Coronavirus Disease 2019 Outbreak in a San Francisco Homeless Shelter

We report the public health response to a COVID-19 outbreak in a San Francisco shelter where 67% of residents and 17% of staff tested positive for SARS-CoV-2. We describe the limited utility of case investigation, person-based contact tracing and symptom screening, and the benefits of mass testing in outbreak response.

Lessons From Mass-Testing for Coronavirus Disease 2019 in Long-Term Care Facilities for the Elderly in San Francisco

COVID-19 can cause significant mortality in the elderly in Long Term Care Facilities (LTCF). We describe four LTCF outbreaks where mass testing identified a high proportion of asymptomatic infections (4-41% in health care workers and 20-75% in residents), indicating that symptom-based screening alone is insufficient for monitoring for COVID-19 transmission.

Trends in Neisseria Gonorrheae Antimicrobial Susceptibility in California, 2005–2016

Background

Resistant Neisseria gonorrheae (NG) is a growing concern in California, nationally, and globally. Since 1987, California has participated in the Gonococcal Isolate Surveillance Project (GISP), a Centers for Disease Control and Prevention-funded project to monitor trends in antimicrobial susceptibility in sentinel STD clinic sites throughout the United States. We sought to describe trends in California NG susceptibility to ceftriaxone (CRO) and azithromycin (AZI), recommended therapy for NG, for 2005–2016.

Methods

Per GISP protocol, cultures are collected from the first 25 men presenting with NG urethritis each month at GISP clinic sites in California, and antimicrobial susceptibility testing (AST) is performed via agar dilution at GISP regional laboratories. Reduced susceptibility (RS) to CRO was defined as minimum inhibitory concentration (MIC) ≥0.125 µg/ml and AZI MIC ≥2 µg/ml. Demographics and MIC trends over time were examined.

Results

Between 2005 and 2016, there were 9,692 NG isolates submitted in California GISP clinics. There were 24 (0.25%) isolates with RS to CRO and 92 (0.96%) isolates with RS to AZI. There was a higher proportion of isolates from men who have sex with men with RS to AZI (but not CRO) compared with men who have sex with women (chi-squared P-values: AZI = 0.0015; CRO = 0.70). In 2016, the percent of isolates demonstrating RS to AZI increased to 3.69% (n = 32), compared with 0.69% of isolates with RS to AZI in 2005–2015 (chi-squared P-value < .0001); there was no significant difference in the percent of isolates with RS to CRO in 2016 compared with prior years (Figure 1). Figures 2 and 3 demonstrate the distribution of AZI MICs and CRO MICs, respectively, from 2005–2016. There have been no isolates to date in California GISP with RS to both ceftriaxone and azithromycin.

Conclusion

Gonococcal surveillance data demonstrate an increase in the proportion of isolates with decreased susceptibility to azithromycin in 2016 in California compared with prior years. Although there has never been a documented treatment failure to the recommended therapy of CRO and AZI in California, clinicians should remain vigilant for treatment failures given these concerning increases.

Disclosures

All authors: No reported disclosures.

Ocular Syphilis - Eight Jurisdictions, United States, 2014-2015

Ocular syphilis, a manifestation of Treponema pallidum infection, can cause a variety of ocular signs and symptoms, including eye redness, blurry vision, and vision loss. Although syphilis is nationally notifiable, ocular manifestations are not reportable to CDC. Syphilis rates have increased in the United States since 2000. After ocular syphilis clusters were reported in early 2015, CDC issued a clinical advisory (1) in April 2015 and published a description of the cases in October 2015 (2). Because of concerns about an increase in ocular syphilis, eight jurisdictions (California, excluding Los Angeles and San Francisco, Florida, Indiana, Maryland, New York City, North Carolina, Texas, and Washington) reviewed syphilis surveillance and case investigation data from 2014, 2015, or both to ascertain syphilis cases with ocular manifestations. A total of 388 suspected ocular syphilis cases were identified, 157 in 2014 and 231 in 2015. Overall, among total syphilis surveillance cases in the jurisdictions evaluated, 0.53% in 2014 and 0.65% in 2015 indicated ocular symptoms. Five jurisdictions described an increase in suspected ocular syphilis cases in 2014 and 2015. The predominance of cases in men (93%), proportion of those who are men who have sex with men (MSM), and percentage who are HIV-positive (51%) are consistent with the epidemiology of syphilis in the United States. It is important for clinicians to be aware of potential visual complications related to syphilis infections. Prompt identification of potential ocular syphilis, ophthalmologic evaluation, and appropriate treatment are critical to prevent or manage visual symptoms and sequelae of ocular syphilis.

A case series of three US adults with Japanese encephalitis, 2010-2012

BACKGROUND

Japanese encephalitis (JE) virus is the leading cause of vaccine-preventable encephalitis in Asia. Although the risk for acquiring JE for most travelers to Asia is low, it varies based on the destination, season, trip duration, and activities.

METHODS

We present case reports of three US adults who were infected with JE virus while traveling or residing in Asia.

RESULTS

Among the three JE patients, the first made a 10-day trip to mainland China and participated in outdoor activities in a rural area, the second had been resident in Taiwan for 4 months, and the third, fatal case was an expatriate living in South Korea.

CONCLUSIONS

JE should be considered in the differential diagnosis for any patient with an acute neurologic infection, who has recently been in a JE-endemic country. Health-care providers should assess the itineraries of travelers to JE-endemic countries, provide guidance on personal protective measures to prevent vector-borne diseases, and consider recommending JE vaccine for travelers at increased risk for JE virus infection.

Does Barrett's oesophagus develop over time in patients with chronic gastro-oesophageal reflux disease?

BACKGROUND

Barrett's oesophagus is present in 8-10% of patients with gastro-oesophageal reflux disease (GERD).

AIM

We performed a cohort study to determine the incidence of Barrett's oesophagus in patients with chronic heartburn symptoms.

METHODS

We identified patients, with GERD and/or Barrett's oesophagus between 1998 and 2004 by primary or secondary International Classification of Diseases (ICD-9) codes of 530.81 and/or 530.2, who had two or more oesophagogastroduodenoscopies performed at least 6 months apart.

RESULTS

We screened 11 040 patients (41 390 random data entries by ICD-9 code) and enrolled 515 (4.6%) GERD patients and 169 (1.5%) Barrett's oesophagus patients. The mean (+/-s.d.) number of oesophagogastroduodenoscopies in the GERD cohort was 3.2 +/- 1.8 (range: 2-15) over 3.4 +/- 2.2 (range: 0.5-11) years. None of the 412 (80%) GERD patients with non-erosive disease developed Barrett's oesophagus over a mean follow-up time of 3.4 +/- 2.2 years (95% CI: 0-0.9%). Five (1%) of the 103 GERD patients with erosive oesophagitis developed subsequent Barrett's oesophagus. Fifty-seven per cent of the GERD patients were on PPI therapy at the time of index endoscopy. None of the 169 Barrett's oesophagus patients had normal index oesophagogastroduodenoscopies within a mean retrospective time period of 4.5 +/- 2.8 years (95% CI: 0-2%). Using the ICD-9 code of 530.2 as a predictor of the presence of Barrett's oesophagus, the sensitivity was 79% with a specificity of 88%.

CONCLUSION

The majority of patients with GERD do not appear to develop Barrett's oesophagus when it is not present on the index endoscopy.