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Alhuneafat L, Khalid MU, Jabri A, Deicke MD, Virk S, Jacobs MW, Hsich E, Alqarqaz M, Dunlap ME, Kassis-George H, Link C. Early pandemic in-hospital outcomes and mortality risk factors in COVID-19 solid organ transplant patients. Proc AMIA Symp 2024; 37:414-423. [PMID: 38628349 PMCID: PMC11018036 DOI: 10.1080/08998280.2024.2325310] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Solid organ transplant (SOT) recipients with COVID-19 have a higher risk of mortality than those without COVID-19. However, it is unclear how SOT patient outcomes compare to the general population without SOT who contract COVID-19. Methods We used the National Inpatient Sample from January to December 2020 to investigate inpatient outcomes seen in SOT recipients after contracting COVID-19 compared to nontransplant patients. We identified our study sample using ICD-10 CM and excluded those <18 years of age and those with dual organ transplants. Inpatient outcomes were compared in SOT and non-SOT COVID cohorts, and we further evaluated predictors of mortality in the SOT with COVID population. Results Out of the 1,416,445 COVID-19 admissions included in the study, 8315 (0.59%) were single SOT recipients. Our analysis that adjusted for multiple baseline characteristics and comorbidities demonstrated that COVID-19 in SOT patients was associated with higher rates of acute kidney injury (adjusted odds ratio [aOR] 2.34, 95% confidence interval [CI] 1.81-3.02, P < 0.01), lower rates of acute respiratory distress syndrome (aOR 0.68, 95% CI 0.54-0.85, P < 0.01), and similar rates of cardiac arrest, pulmonary embolism, circulatory shock, cerebrovascular events, and in-hospital mortality. Age >65 was associated with mortality in SOT patients. Conclusion In this nationally representative sample, SOT patients presenting with COVID-19 experienced similar rates of mortality compared to those without SOT. SOT patients were more likely to develop acute kidney injury. Further research is needed to understand the complex relationship between transplant patient outcomes and COVID-19.
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Affiliation(s)
- Laith Alhuneafat
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Muhammad Umar Khalid
- Department of Vascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ahmad Jabri
- Heart and Vascular Center, Henry Ford, Detroit, Michigan, USA
| | - Matthew D. Deicke
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Shiza Virk
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Max W. Jacobs
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Eileen Hsich
- Advanced Heart Failure and Transplant, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Mark E. Dunlap
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Hayah Kassis-George
- Advanced Heart Failure and Transplant, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Christopher Link
- Advanced Heart Failure and Transplant, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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2
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Jacobs MW, Bremmer DN, Shively NR, Moffa MA, Trienski TL, Carr DR, Buchanan CA, Walsh TL. Analysis of a beta-lactam allergy assessment protocol challenging diverse reported allergies managed by an antimicrobial stewardship program. Antimicrob Steward Healthc Epidemiol 2023; 3:e153. [PMID: 37771740 PMCID: PMC10523545 DOI: 10.1017/ash.2023.432] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 09/30/2023]
Abstract
Objective To assess the safety and efficacy of a novel beta-lactam allergy assessment algorithm managed by an antimicrobial stewardship program (ASP) team. Design Retrospective analysis. Setting One quaternary referral teaching hospital and one tertiary care teaching hospital in a large western Pennsylvania health network. Patients or participants Patients who received a beta-lactam challenge dose under the beta-lactam allergy assessment algorithm. Interventions A beta-lactam allergy assessment protocol was designed and implemented by an ASP team. The protocol risk stratified patients' reported allergies to identify patients appropriate for a challenge with a beta-lactam antibiotic. This retrospective analysis assessed the safety and efficacy of this protocol among patients receiving a challenge dose from November 2017 to July 2021. Results Over a 45-month period, 119 total patients with either penicillin or cephalosporin allergies entered the protocol. Following a challenge dose, 106 (89.1%) patients were treated with a beta-lactam. Eleven patients had adverse reactions to a challenge dose, one of which required escalation of care to the intensive care unit. Of the patients with an unknown or low-risk reported allergy, 7/66 (10.6%) had an observed adverse reaction compared to 3/42 (7.1%) who had an observed reaction with a reported high-risk or anaphylactic allergy. Conclusions Our implemented protocol was safe and effective, with over 90% of patients tolerating the challenge without incident and many going on to receive indicated beta-lactam therapy. This protocol may serve as a framework for other inpatient ASP teams to implement a low-barrier allergy assessment led by ASP teams.
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Affiliation(s)
- Max W. Jacobs
- Medicine Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Derek N. Bremmer
- Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA
| | - Nathan R. Shively
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USA
| | - Matthew A. Moffa
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Dustin R. Carr
- Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Thomas L. Walsh
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USA
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3
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Abalos CCD, Jaber TM, Bangash S, Jacobs MW, Turk M, Bhanot N, Min Z, Abdulmassih R. 2312. Utility of Intrathecal Antibiotic Administration in the Reduction of Ventriculoperitoneal (VP) Shunt Infections in our Urban Referral Health Center. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.144] [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
Infection is one of the primary causes of VP shunt failure, with an incidence rate of 7%-14%. Systemic antibiotics, administered intravenously (IV), are considered the standard of care (SOC) for perioperative prophylaxis. Prophylactic intrathecal (IT) administration of antibiotics, in addition to SOC, is practiced by some surgeons at our institution. Our objective was to study the impact of this modality on VP shunt infections.
Methods
A retrospective review of all VP shunt procedures at our institution from 2018–2020 was performed. Patients with active VP shunt infection were excluded. We compared the incidence of 90-day postoperative shunt infection in patients who received IT and SOC antibiotics (intervention group) to patients who only received SOC IV antibiotics (control group). Data collection included demographics, comorbidities, prophylactic antibiotics used, and pathogens implicated in shunt infections. T-test or Mann-Whitney U test was used for comparison of continuous variables; chi-square or Fisher’s exact test was used to assess the relationship between categorical variables. A value of p < 0.05, on two-tailed testing, was considered statistically significant.
Results
A total of 112 patients were included in the study. Control and intervention arms comprised 54 (48.2%) and 58 patients (51.8%), respectively. All patients received parenteral perioperative antibiotics. The most commonly used agent was cefazolin (83.9%). Patients in the intervention arm received 4 mg of gentamicin and 5 mg of vancomycin intrathecally.
Baseline characteristics were not statistically different between the groups.
Among the 112 patients, 12 (10.7%) developed shunt infection; 4 in the intervention and 8 in the control arm. Infection rates were not statistically different in these groups (χ2 (1) =1.83, p= 0.176). However, there was a statistically significant association between history of prior shunt (uninfected) placement and post-operative shunt infection (Fisher’s exact test, p = 0.025).
Conclusion
Our study did not reveal additional benefit of prophylactic IT antibiotic use in decreasing VP shunt infections. History of prior shunt placement was identified as risk factor, however. Limitations include relatively small sample size, retrospective, and a single-center study.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | | | - Max W Jacobs
- Allegheny Health Network , Pittsburgh, Pennsylvania
| | - Michael Turk
- Allegheny Health Network , Pittsburgh, Pennsylvania
| | - Nitin Bhanot
- Allegheny Health Network , Pittsburgh, Pennsylvania
| | - Zaw Min
- Allegheny General Hospital , Pittsburgh, PA
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4
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Shively NR, Jacobs MW, Moffa MA, Schorr RE, Walsh TL. 1655. Factors Associated with Acceptance of Telehealth-based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System. Open Forum Infect Dis 2022. [PMCID: PMC9752155 DOI: 10.1093/ofid/ofac492.121] [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
Background Telehealth-based antimicrobial stewardship programs (TeleASPs) have led to reduced broad-spectrum antimicrobial utilization. Data on factors associated with acceptance of stewardship recommendations are limited. Methods A TeleASP, facilitated by remote infectious disease physicians and local pharmacists, was implemented in 2 community hospitals from February 2018 through July 2020. Variables potentially affecting acceptance of TeleASP recommendations were tracked. Odds ratios of acceptance were determined utilizing multiple logistic regression. Results During the 30 month period, 4863 (91.2%) of the total 5333 recommendations were accepted. Hospitalist and Critical Care Medicine services had significantly higher odds of acceptance in univariable analysis, while General Surgery, Private Practice Primary Care Physician, Pulmonology, and Urology had lower odds of acceptance. Only Critical Care Medicine remained significant on multivariable analysis (OR 3.23, 95%CI 1.4–7.5). Other factors associated with a higher odds of acceptance in multivariable analysis were recommendations for antimicrobial dose/frequency adjustment (OR 2.63, 95%CI 1.6–4.3) and order for labs/tests (OR 3.30, 95%CI 2.1–5.2), while recommendations for antimicrobial de-escalation (OR 0.75, 95%CI 0.60–0.95) and antimicrobial discontinuation (OR 0.57, 95%CI 0.42–0.76) were associated with lower odds of acceptance. Female physicians were more likely to accept recommendations compared to males (93.1% vs 90.3% acceptance, OR 1.65; 95%CI 1.3–2.2). Compared to physicians with less than 3 years of experience, who had the highest acceptance rate (96.3%), physicians with 21 or more years of experience had the lowest (87.1%, OR 0.26; 95%CI 0.15–0.45). Conclusion TeleASP recommendations were accepted at a high rate. Acceptance rates were higher among female physicians, and recommendations to stop or de-escalate antimicrobials led to lower acceptance. Recommendations made to the most experienced physicians were the least accepted, which may be an important factor for stewardship programs to consider in education and intervention efforts. Disclosures Thomas L. Walsh, MD, Accelerate Diagnostics: Honoraria.
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5
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Shively NR, Jacobs MW, Moffa MA, Schorr RE, Walsh TL. Factors Associated with Acceptance of Telehealth-based Antimicrobial Stewardship Program Recommendations in a Community Hospital Health System. Open Forum Infect Dis 2022; 9:ofac458. [PMID: 36168548 PMCID: PMC9511121 DOI: 10.1093/ofid/ofac458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Telehealth-based antimicrobial stewardship programs (TeleASPs) have led to reduced broad-spectrum antimicrobial utilization. Data on factors associated with acceptance of stewardship recommendations are limited. Methods A TeleASP, facilitated by remote infectious disease physicians and local pharmacists, was implemented in 2 community hospitals from February 2018 through July 2020. Variables potentially affecting acceptance of TeleASP recommendations were tracked. Odds ratios of acceptance were determined utilizing multiple logistic regression. Results During the 30-month period, 4863 (91.2%) of the total 5333 recommendations were accepted. Factors associated with a higher odds of acceptance in multivariable analysis were recommendations for antimicrobial dose/frequency adjustment (odds ratio [OR], 2.63; 95% CI, 1.6–4.3) and order for labs/tests (OR, 3.30; 95% CI, 2.1–5.2), while recommendations for antimicrobial de-escalation (OR, 0.75; 95% CI, 0.60–0.95) and antimicrobial discontinuation (OR, 0.57; 95% CI, 0.42–0.76) were associated with lower odds of acceptance. Female physicians were more likely to accept recommendations compared with males (93.1% vs 90.3% acceptance; OR, 1.65; 95% CI, 1.3–2.2). Compared with physicians with <3 years of experience, who had the highest acceptance rate (96.3%), physicians with ≥21 years of experience had the lowest (87.1%; OR, 0.26; 95% CI, 0.15–0.45). Conclusions TeleASP recommendations were accepted at a high rate. Acceptance rates were higher among female physicians, and recommendations to stop or de-escalate antimicrobials led to lower acceptance. Recommendations made to the most experienced physicians were the least accepted, which may be an important factor for stewardship programs to consider in education and intervention efforts.
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Affiliation(s)
- Nathan R Shively
- Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
| | - Max W Jacobs
- Department of Medicine, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
| | - Matthew A Moffa
- Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
| | - Rebecca E Schorr
- Care Analytics, Highmark Health , Pittsburgh, Pennsylvania , USA
| | - Thomas L Walsh
- Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, Pennsylvania , USA
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6
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Moffa MA, Shively NR, Carr DR, Bremmer DN, Buchanan C, Trienski TL, Jacobs MW, Saini V, Walsh TL. Description of Hospitalizations due to the SARS-CoV-2 Omicron Variant Based on Vaccination Status. Open Forum Infect Dis 2022; 9:ofac438. [PMID: 36092825 PMCID: PMC9452155 DOI: 10.1093/ofid/ofac438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Limited descriptive data exist regarding the clinical characteristics of hospitalizations due to the severe acute respiratory syndrome coronavirus 2 Omicron variant based on vaccination status. Methods This was a retrospective cohort study of all patients hospitalized with a diagnosis of coronavirus disease 2019 (COVID-19) between 15 January 2022 and 15 February 2022 across 9 hospitals in a large health network. Data were extracted by manual records review. Results A total of 351 of 452 (77.7%) unvaccinated, 209 of 331 (63.1%) fully vaccinated, and 107 of 163 (65.6%) boosted patients hospitalized with a COVID-19 diagnosis were determined to be admitted specifically due to COVID-19 (P < .001). Most (85%) boosted patients admitted due to COVID-19 were at least 65 years old and/or had severe immunosuppression, compared to 72.2% of fully vaccinated and 60.7% of unvaccinated patients (P < .001). Significantly more unvaccinated patients (34.2%) required >6 L/minute of supplemental oxygen compared to fully vaccinated (24.4%) and boosted (25.2%) patients (P = .027). The age-adjusted vaccine effectiveness (VE) against hospitalization due to COVID-19 was estimated to be 81.1% and 94.1% for full vaccination and boosted status, respectively, whereas VE against mortality related to COVID-19 was estimated to be 84.7% and 94.8%, respectively. Conclusions During the Omicron BA.1 sublineage wave, unvaccinated patients hospitalized with a COVID-19 diagnosis were more likely than vaccinated patients to be admitted specifically due to COVID-19. Despite being younger with fewer comorbidities, unvaccinated patients required higher levels of care. Vaccination with a booster provides the greatest protection against hospitalization and death from COVID-19.
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Affiliation(s)
- Matthew A Moffa
- Medicine Institute and Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Nathan R Shively
- Medicine Institute and Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Dustin R Carr
- Department of Pharmacy, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Derek N Bremmer
- Department of Pharmacy, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Carley Buchanan
- Department of Pharmacy, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Tamara L Trienski
- Department of Pharmacy, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Max W Jacobs
- Medicine Institute, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Vikram Saini
- Medicine Institute and Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, PA , United States of America
| | - Thomas L Walsh
- Medicine Institute and Division of Infectious Diseases, Allegheny Health Network , Pittsburgh, PA , United States of America
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7
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McPherson TD, Ghinai I, Binder AM, Freeman BD, Hoskin Snelling C, Hunter JC, Anderson KM, Davenport P, Rudd DL, Zafer M, Christiansen D, Joshi K, Rubin R, Black SR, Fricchione MJ, Pacilli M, Walblay KA, Korpics J, Moeller D, Quartey-Kumapley P, Wang C, Charles EM, Kauerauf J, Patel MT, Disari VS, Fischer M, Jacobs MW, Lester SN, Midgley CM, Rasheed MAU, Reese HE, Verani JR, Wallace M, Watson JT, Thornburg NJ, Layden JE, Kirking HL. Lack of Serologic Evidence of Infection Among Health Care Personnel and Other Contacts of First 2 Confirmed Patients With COVID-19 in Illinois, 2020. Public Health Rep 2020; 136:88-96. [PMID: 33108976 DOI: 10.1177/0033354920966064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Widespread global transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), continues. Many questions remain about asymptomatic or atypical infections and transmission dynamics. We used comprehensive contact tracing of the first 2 confirmed patients in Illinois with COVID-19 and serologic SARS-CoV-2 antibody testing to determine whether contacts had evidence of undetected COVID-19. METHODS Contacts were eligible for serologic follow-up if previously tested for COVID-19 during an initial investigation or had greater-risk exposures. Contacts completed a standardized questionnaire during the initial investigation. We classified exposure risk as high, medium, or low based on interactions with 2 index patients and use of personal protective equipment (PPE). Serologic testing used a SARS-CoV-2 spike enzyme-linked immunosorbent assay on serum specimens collected from participants approximately 6 weeks after initial exposure to either index patient. The 2 index patients provided serum specimens throughout their illness. We collected data on demographic, exposure, and epidemiologic characteristics. RESULTS Of 347 contacts, 110 were eligible for serologic follow-up; 59 (17% of all contacts) enrolled. Of these, 53 (90%) were health care personnel and 6 (10%) were community contacts. Seventeen (29%) reported high-risk exposures, 15 (25%) medium-risk, and 27 (46%) low-risk. No participant had evidence of SARS-CoV-2 antibodies. The 2 index patients had antibodies detected at dilutions >1:6400 within 4 weeks after symptom onset. CONCLUSIONS In serologic follow-up of the first 2 known patients in Illinois with COVID-19, we found no secondary transmission among tested contacts. Lack of seroconversion among these contacts adds to our understanding of conditions (ie, use of PPE) under which SARS-CoV-2 infections might not result in transmission and demonstrates that SARS-CoV-2 antibody testing is a useful tool to verify epidemiologic findings.
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Affiliation(s)
- Tristan D McPherson
- 1242 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,11056 Chicago Department of Public Health, Chicago, IL, USA
| | - Isaac Ghinai
- 1242 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,11056 Chicago Department of Public Health, Chicago, IL, USA.,7455 Illinois Department of Public Health, Springfield, IL, USA
| | - Alison M Binder
- 1242 National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brandi D Freeman
- 1242 Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jennifer C Hunter
- 1242 National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristin M Anderson
- 21862 AMITA Health, St. Alexius Medical Center, Hoffman Estates, IL, USA
| | - Polly Davenport
- 21862 AMITA Health, St. Alexius Medical Center, Hoffman Estates, IL, USA
| | - Deborah L Rudd
- 21862 AMITA Health, St. Alexius Medical Center, Hoffman Estates, IL, USA
| | - Mujeeb Zafer
- 21862 AMITA Health, St. Alexius Medical Center, Hoffman Estates, IL, USA
| | | | - Kiran Joshi
- 6144 Cook County Department of Public Health, Oak Forest, IL, USA
| | - Rachel Rubin
- 6144 Cook County Department of Public Health, Oak Forest, IL, USA
| | | | | | | | | | - Jacqueline Korpics
- 6144 Cook County Health, Chicago, IL, USA.,Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Darcie Moeller
- 6144 Cook County Health, Chicago, IL, USA.,Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | | | - Chen Wang
- 6144 Cook County Health, Chicago, IL, USA.,Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - E Matt Charles
- 7455 Illinois Department of Public Health, Springfield, IL, USA
| | - Judy Kauerauf
- 7455 Illinois Department of Public Health, Springfield, IL, USA
| | - Megan T Patel
- 7455 Illinois Department of Public Health, Springfield, IL, USA
| | - Vishal S Disari
- 1242 National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Marc Fischer
- 1242 National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Max W Jacobs
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Sandra N Lester
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Synergy America, Inc, Duluth, GA, USA
| | - Claire M Midgley
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohammed Ata Ur Rasheed
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Synergy America, Inc, Duluth, GA, USA
| | - Heather E Reese
- 1242 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer R Verani
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan Wallace
- 1242 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John T Watson
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natalie J Thornburg
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Hannah L Kirking
- 1242 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Burke RM, Balter S, Barnes E, Barry V, Bartlett K, Beer KD, Benowitz I, Biggs HM, Bruce H, Bryant-Genevier J, Cates J, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu VT, Clark S, Cody SH, Cohen M, Conners EE, Dasari V, Dawson P, DeSalvo T, Donahue M, Dratch A, Duca L, Duchin J, Dyal JW, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Freeman-Ponder B, Fry AM, Gant J, Gautom R, Ghinai I, Gounder P, Grigg CT, Gunzenhauser J, Hall AJ, Han GS, Haupt T, Holshue M, Hunter J, Ibrahim MB, Jacobs MW, Jarashow MC, Joshi K, Kamali T, Kawakami V, Kim M, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Lang M, Layden J, Leidman E, Lindquist S, Lindstrom S, Link-Gelles R, Marlow M, Mattison CP, McClung N, McPherson TD, Mello L, Midgley CM, Novosad S, Patel MT, Pettrone K, Pillai SK, Pray IW, Reese HE, Rhodes H, Robinson S, Rolfes M, Routh J, Rubin R, Rudman SL, Russell D, Scott S, Shetty V, Smith-Jeffcoat SE, Soda EA, Spitters C, Stierman B, Sunenshine R, Terashita D, Traub E, Vahey GM, Verani JR, Wallace M, Westercamp M, Wortham J, Xie A, Yousaf A, Zahn M. Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS One 2020; 15:e0238342. [PMID: 32877446 DOI: 10.1101/2020.04.27.20081901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/15/2020] [Indexed: 05/24/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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Affiliation(s)
- Rachel M Burke
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon Balter
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Emily Barnes
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vaughn Barry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karri Bartlett
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Karlyn D Beer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaac Benowitz
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Holly M Biggs
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollianne Bruce
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Jonathan Bryant-Genevier
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jordan Cates
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Chatham-Stephens
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nora Chea
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Howard Chiou
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Demian Christiansen
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Victoria T Chu
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shauna Clark
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Sara H Cody
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Max Cohen
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Erin E Conners
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vishal Dasari
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick Dawson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Traci DeSalvo
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Matthew Donahue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alissa Dratch
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
| | - Lindsey Duca
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Duchin
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Jonathan W Dyal
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R Feldstein
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marty Fenstersheib
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Marc Fischer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Fisher
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Chelsea Foo
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Brandi Freeman-Ponder
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia M Fry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Gant
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Romesh Gautom
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Isaac Ghinai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Prabhu Gounder
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Cheri T Grigg
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Gunzenhauser
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Aron J Hall
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - George S Han
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Thomas Haupt
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Michelle Holshue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Jennifer Hunter
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mireille B Ibrahim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Max W Jacobs
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - M Claire Jarashow
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Kiran Joshi
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Talar Kamali
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vance Kawakami
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle-King County, Seattle, Washington, United States of America
| | - Moon Kim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Hannah L Kirking
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda Kita-Yarbro
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Rachel Klos
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Miwako Kobayashi
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Kocharian
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Misty Lang
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Jennifer Layden
- The COVID-19 Close Contact Investigation Team, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Eva Leidman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Lindquist
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Stephen Lindstrom
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Link-Gelles
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mariel Marlow
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claire P Mattison
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Nancy McClung
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tristan D McPherson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Lynn Mello
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Claire M Midgley
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Novosad
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan T Patel
- The COVID-19 Close Contact Investigation Team, United States of America
- Illinois Department of Public Health, Chicago, Illinois, United States of America
| | - Kristen Pettrone
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Satish K Pillai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ian W Pray
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Heather E Reese
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather Rhodes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wyoming Department of Health, Cheyenne, Wyoming, United States of America
| | - Susan Robinson
- The COVID-19 Close Contact Investigation Team, United States of America
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Melissa Rolfes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Janell Routh
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Rubin
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Sarah L Rudman
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Denny Russell
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Sarah Scott
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Varun Shetty
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah E Smith-Jeffcoat
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth A Soda
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher Spitters
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Bryan Stierman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Sunenshine
- The COVID-19 Close Contact Investigation Team, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Dawn Terashita
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Elizabeth Traub
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Grace M Vahey
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer R Verani
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan Wallace
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Westercamp
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Wortham
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy Xie
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Yousaf
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Zahn
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
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9
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Burke RM, Balter S, Barnes E, Barry V, Bartlett K, Beer KD, Benowitz I, Biggs HM, Bruce H, Bryant-Genevier J, Cates J, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu VT, Clark S, Cody SH, Cohen M, Conners EE, Dasari V, Dawson P, DeSalvo T, Donahue M, Dratch A, Duca L, Duchin J, Dyal JW, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Freeman-Ponder B, Fry AM, Gant J, Gautom R, Ghinai I, Gounder P, Grigg CT, Gunzenhauser J, Hall AJ, Han GS, Haupt T, Holshue M, Hunter J, Ibrahim MB, Jacobs MW, Jarashow MC, Joshi K, Kamali T, Kawakami V, Kim M, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Lang M, Layden J, Leidman E, Lindquist S, Lindstrom S, Link-Gelles R, Marlow M, Mattison CP, McClung N, McPherson TD, Mello L, Midgley CM, Novosad S, Patel MT, Pettrone K, Pillai SK, Pray IW, Reese HE, Rhodes H, Robinson S, Rolfes M, Routh J, Rubin R, Rudman SL, Russell D, Scott S, Shetty V, Smith-Jeffcoat SE, Soda EA, Spitters C, Stierman B, Sunenshine R, Terashita D, Traub E, Vahey GM, Verani JR, Wallace M, Westercamp M, Wortham J, Xie A, Yousaf A, Zahn M. Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS One 2020; 15:e0238342. [PMID: 32877446 PMCID: PMC7467265 DOI: 10.1371/journal.pone.0238342] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/15/2020] [Indexed: 12/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.
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Affiliation(s)
- Rachel M. Burke
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon Balter
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Emily Barnes
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vaughn Barry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karri Bartlett
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Karlyn D. Beer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isaac Benowitz
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Holly M. Biggs
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollianne Bruce
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Jonathan Bryant-Genevier
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jordan Cates
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Chatham-Stephens
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nora Chea
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Howard Chiou
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Demian Christiansen
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Victoria T. Chu
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shauna Clark
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Sara H. Cody
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Max Cohen
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Erin E. Conners
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vishal Dasari
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick Dawson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Traci DeSalvo
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Matthew Donahue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alissa Dratch
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
| | - Lindsey Duca
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Duchin
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Jonathan W. Dyal
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R. Feldstein
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marty Fenstersheib
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Marc Fischer
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Fisher
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Chelsea Foo
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Brandi Freeman-Ponder
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alicia M. Fry
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Gant
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Romesh Gautom
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Isaac Ghinai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Prabhu Gounder
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Cheri T. Grigg
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeffrey Gunzenhauser
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Aron J. Hall
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - George S. Han
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Thomas Haupt
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Michelle Holshue
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Jennifer Hunter
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mireille B. Ibrahim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Max W. Jacobs
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - M. Claire Jarashow
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Kiran Joshi
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Talar Kamali
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Vance Kawakami
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Seattle–King County, Seattle, Washington, United States of America
| | - Moon Kim
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Hannah L. Kirking
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda Kita-Yarbro
- The COVID-19 Close Contact Investigation Team, United States of America
- Public Health Madison & Dane County, Madison, Wisconsin, United States of America
| | - Rachel Klos
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Miwako Kobayashi
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Kocharian
- The COVID-19 Close Contact Investigation Team, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Misty Lang
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Jennifer Layden
- The COVID-19 Close Contact Investigation Team, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Eva Leidman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Scott Lindquist
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Department of Health, Shoreline, Washington, United States of America
| | - Stephen Lindstrom
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Link-Gelles
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mariel Marlow
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claire P. Mattison
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Nancy McClung
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tristan D. McPherson
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Chicago Department of Public Health, Chicago, Illinois, United States of America
| | - Lynn Mello
- The COVID-19 Close Contact Investigation Team, United States of America
- San Benito County Public Health Services, Hollister, California, United States of America
| | - Claire M. Midgley
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Novosad
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan T. Patel
- The COVID-19 Close Contact Investigation Team, United States of America
- Illinois Department of Public Health, Chicago, Illinois, United States of America
| | - Kristen Pettrone
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Satish K. Pillai
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ian W. Pray
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - Heather E. Reese
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heather Rhodes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Wyoming Department of Health, Cheyenne, Wyoming, United States of America
| | - Susan Robinson
- The COVID-19 Close Contact Investigation Team, United States of America
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Melissa Rolfes
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Janell Routh
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Rubin
- The COVID-19 Close Contact Investigation Team, United States of America
- Cook County Department of Public Health, Oak Forest, Illinois, United States of America
| | - Sarah L. Rudman
- The COVID-19 Close Contact Investigation Team, United States of America
- County of Santa Clara, Public Health Department, San Jose, California, United States of America
| | - Denny Russell
- The COVID-19 Close Contact Investigation Team, United States of America
- Washington State Public Health Laboratories, Shoreline, Washington, United States of America
| | - Sarah Scott
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Varun Shetty
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah E. Smith-Jeffcoat
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth A. Soda
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher Spitters
- The COVID-19 Close Contact Investigation Team, United States of America
- Snohomish Health District, Everett, Washington, United States of America
| | - Bryan Stierman
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rebecca Sunenshine
- The COVID-19 Close Contact Investigation Team, United States of America
- Maricopa County Department of Public Health, Phoenix, Arizona, United States of America
| | - Dawn Terashita
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Elizabeth Traub
- The COVID-19 Close Contact Investigation Team, United States of America
- Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - Grace M. Vahey
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer R. Verani
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan Wallace
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Westercamp
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Wortham
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy Xie
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Yousaf
- The COVID-19 Close Contact Investigation Team, United States of America
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Zahn
- The COVID-19 Close Contact Investigation Team, United States of America
- Orange County Healthcare Agency, Santa Ana, California, United States of America
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Kujawski SA, Wong KK, Collins JP, Epstein L, Killerby ME, Midgley CM, Abedi GR, Ahmed NS, Almendares O, Alvarez FN, Anderson KN, Balter S, Barry V, Bartlett K, Beer K, Ben-Aderet MA, Benowitz I, Biggs H, Binder AM, Black SR, Bonin B, Brown CM, Bruce H, Bryant-Genevier J, Budd A, Buell D, Bystritsky R, Cates J, Charles EM, Chatham-Stephens K, Chea N, Chiou H, Christiansen D, Chu V, Cody S, Cohen M, Conners E, Curns A, Dasari V, Dawson P, DeSalvo T, Diaz G, Donahue M, Donovan S, Duca LM, Erickson K, Esona MD, Evans S, Falk J, Feldstein LR, Fenstersheib M, Fischer M, Fisher R, Foo C, Fricchione MJ, Friedman O, Fry AM, Galang RR, Garcia MM, Gerber SI, Gerrard G, Ghinai I, Gounder P, Grein J, Grigg C, Gunzenhauser JD, Gutkin GI, Haddix M, Hall AJ, Han G, Harcourt J, Harriman K, Haupt T, Haynes A, Holshue M, Hoover C, Hunter JC, Jacobs MW, Jarashow C, Jhung MA, Joshi K, Kamali T, Kamili S, Kim L, Kim M, King J, Kirking HL, Kita-Yarbro A, Klos R, Kobayashi M, Kocharian A, Komatsu KK, Koppaka R, Layden JE, Li Y, Lindquist S, Lindstrom S, Link-Gelles R, Lively J, Livingston M, Lo K, Lo J, Lu X, Lynch B, Madoff L, Malapati L, Marks G, Marlow M, Mathisen GE, McClung N, McGovern O, McPherson TD, Mehta M, Meier A, Mello L, Moon SS, Morgan M, Moro RN, Murray J, Murthy R, Novosad S, Oliver SE, O'Shea J, Pacilli M, Paden CR, Pallansch MA, Patel M, Patel S, Pedraza I, Pillai SK, Pindyck T, Pray I, Queen K, Quick N, Reese H, Rha B, Rhodes H, Robinson S, Robinson P, Rolfes M, Routh J, Rubin R, Rudman SL, Sakthivel SK, Scott S, Shepherd C, Shetty V, Smith EA, Smith S, Stierman B, Stoecker W, Sunenshine R, Sy-Santos R, Tamin A, Tao Y, Terashita D, Thornburg NJ, Tong S, Traub E, Tural A, Uehara A, Uyeki TM, Vahey G, Verani JR, Villarino E, Wallace M, Wang L, Watson JT, Westercamp M, Whitaker B, Wilkerson S, Woodruff RC, Wortham JM, Wu T, Xie A, Yousaf A, Zahn M, Zhang J. Clinical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nat Med 2020; 26:861-868. [PMID: 32327757 DOI: 10.1101/2020.03.09.20032896] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/06/2020] [Indexed: 05/28/2023]
Abstract
Data on the detailed clinical progression of COVID-19 in conjunction with epidemiological and virological characteristics are limited. In this case series, we describe the first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020, including 4 patients described previously1-3. Respiratory, stool, serum and urine specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing, viral culture and whole genome sequencing. Median age was 53 years (range: 21-68); 8 patients were male. Common symptoms at illness onset were cough (n = 8) and fever (n = 7). Patients had mild to moderately severe illness; seven were hospitalized and demonstrated clinical or laboratory signs of worsening during the second week of illness. No patients required mechanical ventilation and all recovered. All had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset. Lowest real-time PCR with reverse transcription cycle threshold values in the upper respiratory tract were often detected in the first week and SARS-CoV-2 was cultured from early respiratory specimens. These data provide insight into the natural history of SARS-CoV-2. Although infectiousness is unclear, highest viral RNA levels were identified in the first week of illness. Clinicians should anticipate that some patients may worsen in the second week of illness.
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11
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Ghinai I, McPherson TD, Hunter JC, Kirking HL, Christiansen D, Joshi K, Rubin R, Morales-Estrada S, Black SR, Pacilli M, Fricchione MJ, Chugh RK, Walblay KA, Ahmed NS, Stoecker WC, Hasan NF, Burdsall DP, Reese HE, Wallace M, Wang C, Moeller D, Korpics J, Novosad SA, Benowitz I, Jacobs MW, Dasari VS, Patel MT, Kauerauf J, Charles EM, Ezike NO, Chu V, Midgley CM, Rolfes MA, Gerber SI, Lu X, Lindstrom S, Verani JR, Layden JE. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet 2020; 395:1137-1144. [PMID: 32178768 PMCID: PMC7158585 DOI: 10.1016/s0140-6736(20)30607-3] [Citation(s) in RCA: 328] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December, 2019. In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA. METHODS Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test. Contacts were people with exposure to a patient with COVID-19 on or after the patient's symptom onset date. Contacts underwent active symptom monitoring for 14 days following their last exposure. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2. A convenience sample of 32 asymptomatic health-care personnel contacts were also tested. FINDINGS Patient 1-a woman in her 60s-returned from China in mid-January, 2020. One week later, she was hospitalised with pneumonia and tested positive for SARS-CoV-2. Her husband (Patient 2) did not travel but had frequent close contact with his wife. He was admitted 8 days later and tested positive for SARS-CoV-2. Overall, 372 contacts of both cases were identified; 347 underwent active symptom monitoring, including 152 community contacts and 195 health-care personnel. Of monitored contacts, 43 became persons under investigation, in addition to Patient 2. These 43 persons under investigation and all 32 asymptomatic health-care personnel tested negative for SARS-CoV-2. INTERPRETATION Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected. FUNDING None.
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Affiliation(s)
- Isaac Ghinai
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Illinois Department of Public Health, Springfield, IL, USA
| | - Tristan D McPherson
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Chicago Department of Public Health, Chicago, IL, USA.
| | - Jennifer C Hunter
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah L Kirking
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kiran Joshi
- Cook County Department of Public Health, Oak Forest, IL, USA
| | - Rachel Rubin
- Cook County Department of Public Health, Oak Forest, IL, USA
| | | | | | | | | | | | | | - N Seema Ahmed
- Metro Infectious Disease Consultants, Burr Ridge, IL, USA
| | | | | | | | - Heather E Reese
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan Wallace
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chen Wang
- Cook County Health, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Darcie Moeller
- Cook County Health, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jacqueline Korpics
- Cook County Health, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shannon A Novosad
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isaac Benowitz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Max W Jacobs
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Vishal S Dasari
- One Health Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Megan T Patel
- Illinois Department of Public Health, Springfield, IL, USA
| | - Judy Kauerauf
- Illinois Department of Public Health, Springfield, IL, USA
| | - E Matt Charles
- Illinois Department of Public Health, Springfield, IL, USA
| | - Ngozi O Ezike
- Illinois Department of Public Health, Springfield, IL, USA
| | - Victoria Chu
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claire M Midgley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiaoyan Lu
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Lindstrom
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer R Verani
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
An in vitro model was developed and validated in vivo to quantify the attenuation of impact vibrations, transmitted through the lower equine forelimb and to assess the effects of horseshoeing on this attenuation. The transsected forelimbs of 13 horses were equipped with custom-made hollow bone screws in the 4 distal bones, on each of which a tri-axial accelerometer could be mounted. The limbs were then preloaded while the impact was simulated by dropping a weight on the steel plate on which the hoof was resting. At the hoof wall, the distal, middle and proximal phalanx and at the metacarpal bone, the shock waves resulting from this impact were quantified. To assess the damping effects of shoeing, measurements were performed with unshod hooves, hooves shod with a normal flat shoe and hooves shod with an equisoft pad and a silicone packing between hoof and pad. The in vitro model was validated by performing in vivo measurements using one horse, and subjecting the limb of this horse to the same in vitro measurements after death. Approximately 67% of the damping of impact vibrations took place at the interface between the hoof wall and the distal phalanx. The attenuation of impact vibrations at the distal and proximal interphalangeal joints was considerably less (both 6%), while at the metacarpophalangeal joint 9% of the amplitude of that at the hoof wall was absorbed, leaving approximately 13% of the initial amplitude at the hoof wall detectable at the metacarpus. Compared to unshod hooves the amplitude at the hoof wall is 15% higher in shod hooves. No differences could be observed between shoe types. At the level of the first phalanx and metacarpus the difference between shod and unshod vanished; it was therefore concluded that, although shoeing might influence the amplitude of impact vibrations at the hoof wall, the effect of shoeing on the amplitude at the level of the metacarpophalangeal joint is minimal.
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Affiliation(s)
- M A Willemen
- Equine Biomechanics Research Group, Utrecht University, The Netherlands
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13
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Jacobs MW, Linder EV, Wagoner RV. Green function for metric perturbations due to cosmological density fluctuations. Phys Rev D Part Fields 1993; 48:4623-4629. [PMID: 10016114 DOI: 10.1103/physrevd.48.4623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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14
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Wilkins D, Jacobs MW. Gödel's gravitomagnet. Phys Rev D Part Fields 1992; 46:3395-3402. [PMID: 10015286 DOI: 10.1103/physrevd.46.3395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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