-
Early introductions and transmission of SARS-CoV-2 variant
B.1.1.7 in the United Statesexternal iconAlpert T, Brito AF, Lasek-Nesselquist
E, Rothman J, Valesano AL, MacKay MJ, Petrone ME, Breban MI, Watkins AE,
Vogels CB, Kalinich CC, Dellicour S, Russell A, Kelly JP, Shudt M,
Plitnick J, Schneider E, Fitzsimmons WJ, Khullar G, Metti J, Dudley JT,
Nash M, Beaubier N, Wang J, Liu C, Hui P, Muyombwe A, Downing R, Razeq J,
Bart SM,
Grills A,
Morrison
SM, Murphy S, Neal C, Laszlo E, Rennert H, Cushing M, Westblade
L, Velu P, Craney A, Cong L, Peaper DR, Landry ML,
Cook
PW, Fauver JR, Mason CE, Lauring AS, St George K,
MacCannell DR, Grubaugh ND.
Cell. 2021 Apr 3.
The
emergence and spread of SARS-CoV-2 lineage B.1.1.7, first detected in the
United Kingdom, has become a global public health concern because of its
increased transmissibility. Over 2,500 COVID-19 cases associated with this
variant have been detected in the United States (US) since December 2020,
but the extent of establishment is relatively unknown. Using travel,
genomic, and diagnostic data, we highlight that the primary ports of entry
for B.1.1.7 in the US were in New York, California, and Florida.
Furthermore, we found evidence for many independent B.1.1.7 establishments
starting in early December 2020, followed by interstate spread by the end
of the month. Finally, we project that B.1.1.7 will be the dominant
lineage in many states by mid- to late March. Thus, genomic surveillance
for B.1.1.7 and other variants urgently needs to be enhanced to better
inform the public health response.
-
COVID-19 Outbreaks at Two Construction Sites - New York
City, October-November 2020external iconBushman D, Sekaran J,
Jeffery N, Rath C, Ackelsberg J, Weiss D, Wu W, Van Oss K, Johnston K,
Huang J, Khatun U, Sheikh T, Sutcliff J, Tsoi B.
Clin Infect Dis. 2021
Apr 29.
During
October 23-November 16, 2020, the New York City Department of Health and
Mental Hygiene investigated COVID-19 outbreaks at two construction sites.
Challenges in adhering to the New York State Department of Health "Interim
COVID-19 Guidance for Construction" were reported. To minimize outbreaks,
jurisdictions should increase tailored outreach to the construction
industry emphasizing infection prevention.
-
COVID-19 Outbreak Associated with a SARS-CoV-2 R.1 Lineage
Variant in a Skilled Nursing Facility After Vaccination Program -
Kentucky, March 2021external iconCavanaugh AM, Fortier S,
Lewis P, Arora V, Johnson M, George K, Tobias J, Lunn S, Miller T,
Thoroughman D,
Spicer KB.
MMWR Morb
Mortal Wkly Rep. 2021 Apr 30;70(17):639-643.
Although
COVID-19 mRNA vaccines demonstrated high efficacy in clinical trials (1),
they were not 100% efficacious. Thus, some infections postvaccination are
expected. Limited data are available on effectiveness in skilled nursing
facilities (SNFs) and against emerging variants. The Kentucky Department
for Public Health (KDPH) and a local health department investigated a
COVID-19 outbreak in a SNF that occurred after all residents and health
care personnel (HCP) had been offered vaccination. Among 83 residents and
116 HCP, 75 (90.4%) and 61 (52.6%), respectively, received 2 vaccine
doses. Twenty-six residents and 20 HCP received positive test results for
SARS-CoV-2, the virus that causes COVID-19, including 18 residents and
four HCP who had received their second vaccine dose >14 days before the
outbreak began. An R.1 lineage variant was detected with whole genome
sequencing (WGS). Although the R.1 variant has multiple spike protein
mutations, vaccinated residents and HCP were 87% less likely to have
symptomatic COVID-19 compared with those who were unvaccinated.
Vaccination of SNF populations, including HCP, is critical to reduce the
risk for SARS-CoV-2 introduction, transmission, and severe outcomes in
SNFs. An ongoing focus on infection prevention and control practices is
also essential.
-
Late conditions diagnosed 1-4 months following an initial
COVID-19 encounter: a matched cohort study using inpatient and outpatient
administrative data - United States, March 1-June 30,
2020external iconChevinsky JR,
Tao G,
Lavery AM,
Kukielka EA,
Click
ES,
Malec D,
Kompaniyets L,
Bruce BB,
Yusuf H,
Goodman
AB,
Dixon MG,
Nakao JH,
Datta SD,
Mac Kenzie WR, Kadri S,
Saydah S,
Giovanni JE,
Gundlapalli AV.
Clin Infect Dis. 2021 Apr 28.
BACKGROUND:
Late sequelae of COVID-19 have been reported; however, few studies have
investigated the time-course or incidence of late new COVID-19-related
health conditions (post-COVID conditions) after COVID-19 diagnosis.
Studies distinguishing post-COVID conditions from late conditions caused
by other etiologies are lacking. Using data from a large administrative
all-payer database, we assessed the type, association, and timing of
post-COVID conditions following COVID-19 diagnosis. METHODS: Using the
Premier Healthcare Database Special COVID-19 Release (PHD-SR) (release
date, October 20, 2020) data, during March-June 2020, 27,589 inpatients
and 46,857 outpatients diagnosed with COVID-19 (case-patients) were 1:1
matched with patients without COVID-19 through the 4-month follow-up
period (control-patients) by using propensity score matching. In this
matched-cohort study, adjusted odds ratios were calculated to assess for
late conditions that were more common in case-patients compared with
control-patients. Incidence proportion was calculated for conditions that
were more common in case-patients than control-patients during 31-120 days
following a COVID-19 encounter. RESULTS: During 31-120 days after an
initial COVID-19 inpatient hospitalization, 7.0% of adults experienced at
least one of five post-COVID conditions. Among adult outpatients with
COVID-19, 7.7% experienced at least one of ten post-COVID conditions.
During 31-60 days after an initial outpatient encounter, adults with
COVID-19 were 2.8 times as likely to experience acute pulmonary embolism
as outpatient control-patients and were also more likely to experience a
range of conditions affecting multiple body systems (e.g. nonspecific
chest pain, fatigue, headache, and respiratory, nervous, circulatory, and
gastrointestinal system symptoms) than outpatient control-patients.
Children with COVID-19 were not more likely to experience late conditions
than children without COVID-19. CONCLUSIONS: These findings add to the
evidence of late health conditions possibly related to COVID-19 in adults
following COVID-19 diagnosis and can inform health care practice and
resource planning for follow-up COVID-19 care.
-
INTRODUCTION:
Sexually transmitted infections (STIs) are common during pregnancy and can
result in adverse delivery and birth outcomes. The purpose of this study
was to estimate the prevalence of STIs; Chlamydia trachomatis (CT),
Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Trichomonas
vaginalis (trichomoniasis), and Human Immunodeficiency Virus (HIV) among
pregnant women visiting an antenatal care center in Nepal. MATERIALS AND
METHODS: We adapted and piloted the WHO standard protocol for conducting a
prevalence survey of STIs among pregnant women visiting antenatal care
center of Dhulikhel Hospital, Nepal. Patient recruitment, data collection,
and specimen testing took place between November 2019-March 2020. First
catch urine sample was collected from each eligible woman. GeneXpert
platform was used for CT and NG testing. Wet-mount microscopy of urine
sample was used for detection of trichomoniasis. Serological test for HIV
was done by rapid and enzyme-linked immunosorbent assay tests. Serological
test for syphilis was done using "nonspecific non-treponemal" and
"specific treponemal" antibody tests. Tests for CT, NG and trichomoniasis
were done as part of the prevalence study while tests for syphilis and HIV
were done as part of the routine antenatal testing. RESULTS: 672 women
were approached to participate in the study, out of which 591 (87.9%) met
the eligibility criteria and consented to participate. The overall
prevalence of any STIs was 8.6% (51/591, 95% CI: 6.3-10.8); 1.5% (95% CI:
0.5-2.5) for CT and 7.1% (95% CI: 5.0-9.2) for trichomoniasis infection.
None of the samples tested positive for NG, HIV or syphilis. Prevalence of
any STI was not significantly different among women, age ≤ 24 years (10%,
25/229) compared to women age ≥25 years (7.1%, 26/362) (p = 0.08).
CONCLUSIONS: The prevalence of trichomoniasis among pregnant women in this
sub-urban population of Nepal was high compared to few cases of CT and no
cases of NG, syphilis, and HIV. The WHO standard protocol provided a
valuable framework for conducting STI surveillance that can be adapted for
other countries and populations.
-
Linked Clusters of SARS-CoV-2 Variant B.1.351 - Maryland,
January-February 2021external iconFeder KA, Pearlowitz M,
Goode A, Duwell M, Williams TW, Chen-Carrington PA, Patel A, Dominguez C,
Keller EN, Klein L, Rivera-Colon A, Mostafa HH, Morris CP, Patel N,
Schauer AM, Myers R, Blythe D, Feldman KA.
MMWR Morb Mortal Wkly Rep.
2021 Apr 30;70(17):627-631.
In
late January 2021, a clinical laboratory notified the Maryland Department
of Health (MDH) that the SARS-CoV-2 variant of concern B.1.351 had been
identified in a specimen collected from a Maryland resident with COVID-19
(1). The SARS-CoV-2 B.1.351 lineage was first identified in South Africa
(2) and might be neutralized less effectively by antibodies produced after
vaccination or natural infection with other strains (3-6). To limit
SARS-CoV-2 chains of transmission associated with this index patient, MDH
used contact tracing to identify the source of infection and any linked
infections among other persons. The investigation identified two linked
clusters of SARS-CoV-2 infection that included 17 patients. Three
additional specimens from these clusters were sequenced; all three had the
B.1.351 variant and all sequences were closely related to the sequence
from the index patient's specimen. Among the 17 patients identified, none
reported recent international travel or contact with international
travelers. Two patients, including the index patient, had received the
first of a 2-dose COVID-19 vaccination series in the 2 weeks before their
likely exposure; one additional patient had a confirmed SARS-CoV-2
infection 5 months before exposure. Two patients were hospitalized with
COVID-19, and one died. These first identified linked clusters of B.1.351
infections in the United States with no apparent link to international
travel highlight the importance of expanding the scope and volume of
genetic surveillance programs to identify variants, completing contact
investigations for SARS-CoV-2 infections, and using universal prevention
strategies, including vaccination, masking, and physical distancing, to
control the spread of variants of concern.
-
Assessment of Contact Tracing for COVID-19 among People
Experiencing Homelessness, Salt Lake County Health Department, March-May
2020external iconFields VL, Kiphibane T, Eason JT, Hafoka SF,
Lopez AS,
Schwartz A,
Henry
A,
Tran CH,
Tate JE,
Kirking HL,
Laws RL,
Venkatappa
T,
Mosites E,
Montgomery
MP.
Ann Epidemiol. 2021 Apr 21.
PURPOSE:
Contact tracing is intended to reduce the spread of coronavirus disease
2019 (COVID-19), but it is difficult to conduct among people who live in
congregate settings, including people experiencing homelessness (PEH).
This analysis compares person-based contact tracing among two populations
in Salt Lake County, Utah, from March-May 2020. METHODS: All
laboratory-confirmed positive cases among PEH (n=169) and documented in
Utah's surveillance system were included in this analysis. The general
population comparison group (n=163) were systematically selected from all
laboratory-confirmed cases identified during the same period. RESULTS:
Ninety-three PEH cases (55%) were interviewed compared to 163 (100%) cases
among the general population (p<0.0001). PEH were more likely to be
lost to follow-up at end of isolation (14.2%) versus the general
population (0%; p-value<0.0001) and provided fewer contacts per case
(0.31) than the general population (4.7) (p-value<0.0001). Contacts of
PEH were more often unreachable (13.0% vs. 7.1%; p-value<0.0001).
CONCLUSIONS: These findings suggest that contact tracing among PEH should
include a location-based approach, along with a person-based approach when
resources allow, due to challenges in identifying, locating, and reaching
cases among PEH and their contacts through person-based contact tracing
efforts alone.
-
A Comparison of Less Invasive SARS-CoV-2 Diagnostic
Specimens in Nursing Home Residents - Arkansas, June-August
2020external iconGable P,
Huang JY,
Gilbert SE,
Bollinger S,
Lyons
AK,
Sabour S,
Surie D,
Biedron C, Haney T,
Beshearse E,
Gregory CJ, Seely KA,
Clemmons NS, Patil
N, Kothari A, Gulley T, Garner K,
Anderson K,
Thornburg NJ,
Halpin AL,
McDonald LC,
Kutty PK,
Brown
AC.
Clin Infect Dis. 2021 Apr 28.
BACKGROUND:
SARS-CoV-2 testing remains essential for early identification and clinical
management of cases. We compared the diagnostic performance of three
specimen types for characterizing SARS-CoV-2 in infected nursing home
residents. METHODS: A convenience sample of 17 residents were enrolled
within 15 days of first positive SARS-CoV-2 result by real-time reverse
transcription polymerase chain reaction (RT-PCR) and prospectively
followed for 42 days. Anterior nasal swabs (AN), oropharyngeal swabs (OP),
and saliva specimens (SA) were collected on the day of enrollment, every 3
days for the first 21 days, then weekly for 21 days. Specimens were tested
for presence of SARS-CoV-2 RNA using RT-PCR and replication-competent
virus by viral culture. RESULTS: Comparing the three specimen types
collected from each participant at each time point, the concordance of
paired RT-PCR results ranged from 80-88%. After the first positive result,
SA and OP were RT-PCR-positive for ≤48 days; AN were RT-PCR-positive for
≤33 days. AN had the highest percentage of RT-PCR-positive results (81%;
21/26) when collected ≤10 days of participants' first positive result.
Eleven specimens were positive by viral culture: nine AN collected ≤19
days following first positive result and two OP collected ≤5 days
following first positive result. CONCLUSIONS: AN, OP, and SA were
effective methods for repeated testing in this population. More AN than OP
were positive by viral culture. SA and OP remained RT-PCR-positive longer
than AN, which could lead to unnecessary interventions if RT-PCR detection
occurred after viral shedding has likely ceased.
-
-
Health Care Utilization and Clinical Characteristics of
Nonhospitalized Adults in an Integrated Health Care System 28-180 Days
After COVID-19 Diagnosis - Georgia, May 2020-March
2021external iconHernandez-Romieu AC, Leung S, Mbanya A,
Jackson BR,
Cope JR,
Bushman
D,
Dixon M,
Brown J,
McLeod T,
Saydah S,
Datta
D,
Koplan K,
Lobelo F.
MMWR
Morb Mortal Wkly Rep. 2021 Apr 30;70(17):644-650.
As
of April 19, 2021, 21.6 million COVID-19 cases had been reported among
U.S. adults, most of whom had mild or moderate disease that did not
require hospitalization (1). Health care needs in the months after
COVID-19 diagnosis among nonhospitalized adults have not been well
studied. To better understand longer-term health care utilization and
clinical characteristics of nonhospitalized adults after COVID-19
diagnosis, CDC and Kaiser Permanente Georgia (KPGA) analyzed electronic
health record (EHR) data from health care visits in the 28-180 days after
a diagnosis of COVID-19 at an integrated health care system. Among 3,171
nonhospitalized adults who had COVID-19, 69% had one or more outpatient
visits during the follow-up period of 28-180-days. Compared with patients
without an outpatient visit, a higher percentage of those who did have an
outpatient visit were aged ≥50 years, were women, were non-Hispanic Black,
and had underlying health conditions. Among adults with outpatient visits,
68% had a visit for a new primary diagnosis, and 38% had a new specialist
visit. Active COVID-19 diagnoses* (10%) and symptoms potentially related
to COVID-19 (3%-7%) were among the top 20 new visit diagnoses; rates of
visits for these diagnoses declined from 2-24 visits per 10,000
person-days 28-59 days after COVID-19 diagnosis to 1-4 visits per 10,000
person-days 120-180 days after diagnosis. The presence of diagnoses of
COVID-19 and related symptoms in the 28-180 days following acute illness
suggests that some nonhospitalized adults, including those with
asymptomatic or mild acute illness, likely have continued health care
needs months after diagnosis. Clinicians and health systems should be
aware of post-COVID conditions among patients who are not initially
hospitalized for acute COVID-19 disease.
-
BACKGROUND:
While researchers seek to use administrative health data to examine
outcomes for individuals with sexually transmitted infections (STIs), the
International Classification of Diseases, Tenth Revision, Clinical
Modification (ICD-10-CM) codes used to identify persons with chlamydia and
gonorrhea have not been validated. Objectives were to determine the
validity of using ICD-10-CM codes to identify individuals with chlamydia
and gonorrhea. METHODS: We used data from electronic health records
gathered from public and private health systems from October 1, 2015, to
December 31, 2016. Patients were included if they were aged 13 to 44 years
and received either (1) laboratory testing for chlamydia or gonorrhea or
(2) an ICD-10-CM diagnosis of chlamydia, gonorrhea, or an unspecified STI.
To validate ICD-10-CM codes, we calculated positive and negative
predictive values, sensitivity, and specificity based on the presence of a
laboratory test result. We further examined the timing of clinical
diagnosis relative to laboratory testing. RESULTS: The positive predictive
values for chlamydia, gonorrhea, and unspecified STI ICD-10-CM codes were
87.6%, 85.0%, and 32.0%, respectively. Negative predictive values were
high (>92%). Sensitivity for chlamydia diagnostic codes was 10.6%, and
gonorrhea was 9.7%. Specificity was 99.9% for both chlamydia and
gonorrhea. The date of diagnosis occurred on or after the date of the
laboratory result for 84.8% of persons with chlamydia, 91.9% for
gonorrhea, and 23.5% for unspecified STI. CONCLUSIONS: Disease-specific
ICD-10-CM codes accurately identify persons with chlamydia and gonorrhea.
However, low sensitivities suggest that most individuals could not be
identified in administrative data alone without laboratory test
results.
-
BACKGROUND:
Handwashing and surface cleaning and disinfection are two hygiene
behaviors promoted to prevent the spread of COVID-19. Persons with
disabilities may be at increased risk for severe COVID-19 illness due to
underlying medical conditions that have been associated with COVID-19.
OBJECTIVE: This study aims to describe self-reported hygiene behaviors
among U.S. adults with disabilities to prevent transmission of COVID-19.
METHODS: Data were obtained from the March 2020 Porter Novelli
ConsumerStyles survey. This study includes 6463 U.S. adults (≥18 years)
who participated in the survey (58.2% response rate). Participants were
asked about frequent handwashing and surface disinfection. Participants
were also asked six questions to assess disability status and disability
type. Prevalence estimates with 95% confidence intervals were calculated;
chi-square tests were conducted. RESULTS: A total of 1295 (20.3%) of
survey participants reported at least one disability and their
hygiene-related behavior. Overall, 91.3% of respondents with disabilities
reported frequent handwashing; only 72% reported frequent surface
disinfection. Those with hearing, vision, cognition, mobility, self-care,
and independent living disabilities (range: 77.9%-90.6%) were
significantly less likely than those without any disability (94.0%) to
report frequent handwashing. People with vision (62.2%) and independent
living (66.8%) disabilities were less likely to report frequent surface
disinfection than those without any disability (74.6%). CONCLUSIONS:
Practices such as handwashing and disinfecting surfaces are effective for
reducing and preventing the spread of COVID-19. Promotion of
hygiene-related practices among people with disabilities is essential.
Tailored communications and implementation of evidence-based strategies
are needed to address hygiene-related behaviors among the subgroups of
people with disabilities most affected.
-
Mortality, neurodevelopmental impairments, and economic
outcomes after invasive group B streptococcal disease in early infancy in
Denmark and the Netherlands: a national matched cohort
studyexternal iconHorváth-Puhó E, van Kassel MN, Gonçalves BP, de Gier B,
Procter SR, Paul P, van der Ende A, Søgaard KK, Hahné SJ, Chandna J,
Schrag SJ, van de Beek D, Jit M, Sørensen HT, Bijlsma MW,
Lawn JE.
Lancet Child Adolesc Health. 2021 Apr 21.
BACKGROUND:
Group B Streptococcus (GBS) disease is a leading cause of neonatal death,
but its long-term effects have not been studied after early childhood. The
aim of this study was to assess long-term mortality, neurodevelopmental
impairments (NDIs), and economic outcomes after infant invasive GBS (iGBS)
disease up to adolescence in Denmark and the Netherlands. METHODS: For
this cohort study, children with iGBS disease were identified in Denmark
and the Netherlands using national medical and administrative databases
and culture results that confirmed their diagnoses. Exposed children were
defined as having a history of iGBS disease (sepsis, meningitis, or
pneumonia) by the age of 89 days. For each exposed child, ten unexposed
children were randomly selected and matched by sex, year and month of
birth, and gestational age. Mortality data were analysed with the use of
Cox proportional hazards models. NDI data up to adolescence were captured
from discharge diagnoses in the National Patient Registry (Denmark) and
special educational support records (the Netherlands). Health care use and
household income were also compared between the exposed and unexposed
cohorts. FINDINGS: 2258 children-1561 in Denmark (born from Jan 1, 1997 to
Dec 31, 2017) and 697 in the Netherlands (born from Jan 1, 2000 to Dec 31,
2017)-were identified to have iGBS disease and followed up for a median of
14 years (IQR 7-18) in Denmark and 9 years (6-11) in the Netherlands. 366
children had meningitis, 1763 had sepsis, and 129 had pneumonia (in
Denmark only). These children were matched with 22 462 children with no
history of iGBS disease. iGBS meningitis was associated with an increased
mortality at age 5 years (adjusted hazard ratio 4·08 [95% CI 1·78-9·35]
for Denmark and 6·73 [3·76-12·06] for the Netherlands). Any iGBS disease
was associated with an increased risk of NDI at 10 years of age, both in
Denmark (risk ratio 1·77 [95% CI 1·44-2·18]) and the Netherlands (2·28
[1·64-3·17]). A history of iGBS disease was associated with more frequent
outpatient clinic visits (incidence rate ratio 1·93 [95% CI 1·79-2·09],
p<0·0001) and hospital admissions (1·33 [1·27-1·38], p<0·0001) in
children 5 years or younger. No differences in household income were
observed between the exposed and unexposed cohorts. INTERPRETATION: iGBS
disease, especially meningitis, was associated with increased mortality
and a higher risk of NDIs in later childhood. This previously unquantified
burden underlines the case for a maternal GBS vaccine, and the need to
track and provide care for affected survivors of iGBS disease. FUNDING:
The Bill & Melinda Gates Foundation. TRANSLATIONS: For the Dutch and
Danish translations of the abstract see Supplementary Materials
section.
-
Factors Associated with Loss to Follow-up among Patients
Receiving HIV Treatment in Nairobi, Kenyaexternal iconKoech E, Stafford KA,
Mutysia I,
Katana A, Jumbe M, Awuor P,
Lavoie MC, Ngunu C, Riedel DJ, Ojoo S.
AIDS Res Hum Retroviruses. 2021
Apr 29.
OBJECTIVE:
We investigated factors associated with loss to follow-up in 24 urban
health facilities in Nairobi, Kenya. MATERIALS AND METHODS: We conducted a
retrospective analysis of routinely collected data to assess factors
associated with lost to follow-up (LTFU) in the period October 1, 2016 to
June 30, 2017. LTFU was defined as no antiretroviral therapy (ART) refill
for ≥90 days and no documentation of transfer, death, or treatment
cessation in the patient chart, and if no lapse of ≥90 days between ART
refills, patients were considered retained in care. Multivariable logistic
regression modeling was used to compute odds ratios and 95% CI for LTFU.
RESULTS: Our analysis included 633 individuals who were LTFU and 13,098
individuals retained in care. Most participants (69.6%) were women, and
median age was 33.0 years (interquartile range, 27.2-38.3 years). Median
ART duration was shorter among those LTFU (0.4 years) compared to retained
patients (2.5 years, p<0.0001). Being male (adjusted odds ratio (aOR)
1.30; 95% confidence interval (CI) 1.04, 1.63, P=0.02), transferring into
facilities while already receiving ART (aOR 11.58; 95% CI 8.23, 16.29,
P<0.0001), and having a shorter ART duration (<6 months) were
associated with increased odds of LTFU. Patients who transferred into a
facility while already receiving ART had the highest adjusted odds of
being LTFU compared to those retained in care. CONCLUSIONS: In this urban
and highly mobile population, transferring into facilities while already
receiving ART was strongly associated with LTFU. Focusing programming
efforts on patients transferring between urban clinics to identify reasons
for transfer and potential barriers to treatment adherence could help
improve patient outcomes. Supplementary case management and support may be
needed to promote a seamless transition and ensure uninterrupted
engagement in HIV care and treatment.
-
HIV
pre-exposure prophylaxis (PrEP) is a preventive medication that could
reduce new infections among men who have sex with men (MSM). There are
limited data on differing reasons for PrEP nonuse by condomless anal sex
(CAS). We examined demographic and behavioral variables associated with
PrEP use and reasons for PrEP nonuse by CAS. Data are from the M-cubed
Study, collected in a 2018 baseline assessment of MSM (n = 798) in
Atlanta, Detroit, and New York City. Participants reported current PrEP
use (31%), previous use (8%), and never use (61%). MSM reporting CAS
(adjusted odds ratio [aOR] = 2.60, confidence interval [95%
CI] = 1.73-3.91), age 18-29 (aOR = 2.11, 95% CI = 1.26-3.52), 30-39
(aOR = 2.12, 95% CI = 1.25-3.59), with a college degree (aOR = 1.96, 95%
CI = 1.20-3.21), or postgraduate education (aOR = 2.58, 95%
CI = 1.51-4.40) had greater odds of current (vs. never) use; uninsured
(aOR = 0.30, 95% CI = 0.16-0.57) men had lower odds of current (vs. never)
use. For never use, more MSM who reported CAS (vs. did not) endorsed the
following reasons (p's < 0.05): Insurance wouldn't cover PrEP (20% vs.
12%), Didn't know where to get it (33% vs. 24%) and fewer reported Didn't
need PrEP (23% vs. 39%) and Started a committed relationship (7% vs. 25%).
For discontinuation, more MSM who reported CAS (vs. did not) endorsed
Worry about the safety of PrEP (19% vs. 3%). Efforts are needed to enhance
PrEP as an option among older, less educated, and uninsured MSM. These
findings may inform how providers can facilitate PrEP use by messaging on
access and safety for MSM who reported CAS.
-
COVID-19 Mitigation Efforts and Testing During an
In-Person Training Event - Uganda, October 12-29, 2020external iconLaws
RL, Biraro S, Kirungi W,
Gianetti B, Aibo D,
Awor AC,
West C, Sachathep KK,
Kiyingi H,
Ward J,
Mwangi
C, Nkurunziza P, Okimait D,
Currie D,
Ajiboye A,
Moore CS,
Patel
H,
Sendagala S,
Naluguza M,
Mugisha V, Low A, Delgado S, Hoos D,
Brown K,
Galbraith JS,
Hladik W,
Nelson
L, El-Sadr W, Musinguzi J,
Voetsch AC.
Clin
Infect Dis. 2021 Apr 29.
Large
public-health training events may result in SARS-CoV-2 transmission.
Universal SARS-CoV-2 testing during trainings for the Uganda
Population-based HIV Impact Assessment identified 28/475 (5.9%)
individuals with COVID-19 among attendees; most (89.3%) were asymptomatic.
Effective COVID-19 mitigation measures, along with SARS-CoV-2 testing, are
recommended for in-person trainings, particularly when trainees will have
subsequent contact with survey participants.
-
BACKGROUND:
National guidelines recommend that sexually active people with human
immunodeficiency virus (PWH) who are men who have sex with men (MSM) be
tested for hepatitis C virus (HCV) infection at least annually. Hepatitis
C virus testing rates vary by race/ethnicity in the general population,
but limited data are available for PWH. METHODS: We analyzed medical
records data from MSM in the HIV Outpatient Study at 9 human
immunodeficiency virus (HIV) clinics from January 1, 2011 through December
31, 2019. We excluded observation time after documented past or current
HCV infection. We evaluated HCV antibody testing in each calendar year
among HCV-seronegative MSM, and we assessed testing correlates by
generalized estimating equation analyses. RESULTS: Of 1829 eligible MSM
who were PWH, 1174 (64.2%) were non-Hispanic/Latino white (NHW), 402
(22.0%) non-Hispanic black (NHB), 187 (10.2%) Hispanic/Latino, and 66
(3.6%) of other race/ethnicity. Most were ≥40 years old (68.9%), privately
insured (64.5%), with CD4 cell count/mm(3) (CD4) ≥350 (77.0%), and with
HIV viral load <200 copies/mL (76.9%). During 2011-2019, 1205 (65.9%)
had ≥1 HCV antibody test and average annual HCV percentage tested was
30.3% (from 33.8% for NHB to 28.5% for NHW; P < .001). Multivariable
factors positively associated (P < .05) with HCV testing included more
recent HIV diagnosis, public insurance, lower CD4, prior chlamydia,
gonorrhea, syphilis, or hepatitis B virus diagnoses, and elevated liver
enzyme levels, but not race/ethnicity. CONCLUSIONS: Although we found no
disparities by race/ethnicity in HCV testing, low overall HCV testing
rates indicate suboptimal uptake of recommended HCV testing among MSM in
HIV care.
-
Human Immunodeficiency Virus Infection in Adolescents and
Mode of Transmission in Southern Africa: A Multinational Analysis of
Population-Based Survey Dataexternal iconLow A, Teasdale C,
Brown
K,
Barradas DT, Mugurungi O, Sachathep K,
Nuwagaba-Biribonwoha H,
Birhanu S, Banda A, Frederix K,
Payne D, Radin E, Wiesner L, Ginindza C, Philip N, Musuka
G, Sithole S,
Patel H, Maile L, Abrams EJ, Arpadi
S.
Clin Infect Dis. 2021 Apr 29.
BACKGROUND:
Adolescents aged 10-19 years living with human immunodeficiency virus
(HIV) (ALHIV), both perinatally infected adolescents (APHIV) and
behaviorally infected adolescents (ABHIV), are a growing population with
distinct care needs. We characterized the epidemiology of HIV in
adolescents included in Population-based HIV Impact Assessments
(2015-2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. METHODS:
Adolescents were tested for HIV using national rapid testing algorithms.
Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL,
and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within
6 months) was measured using a limiting antigen avidity assay, excluding
adolescents with VLS or with detectable antiretrovirals (ARVs) in blood.
To determine the most likely mode of infection, we used a risk algorithm
incorporating recency, maternal HIV and vital status, history of sexual
activity, and age at diagnosis. RESULTS: HIV prevalence ranged from 1.6%
in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence
interval, 55.3%-66.6%) had HIV previously diagnosed, and 47.1%
(41.9%-52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of
707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4%
of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV
treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL.
CONCLUSIONS: These findings suggest that two-thirds of ALHIV were
perinatally infected, with many unaware of their status. The low
prevalence of VLS and UVL in those receiving treatment raises concerns
around treatment effectiveness. Expansion of opportunities for HIV
diagnoses and the optimization of treatment are
imperative.
-
BACKGROUND:
After decades of decline, US incidence of acute hepatitis B flattened
since 2010. In persons aged ≥40 years and in jurisdictions affected by the
opioid epidemic, there is an increase in new cases. Data suggest new
infections are occurring among US-born persons. METHODS: We used National
Health and Nutrition Examination Survey data during 2001-2018 to examine
trends and differences in total antibody to hepatitis B virus core antigen
(anti-HBc) prevalence in US-born persons. During 2013-2018, the
distribution of characteristics was examined. Cochran-Mantel-Haenszel test
was used to assess trends. RESULTS: During 2001-2006, 2007-2012, and
2013-2018, anti-HBc prevalence was 3.5%, 2.5%, and 2.6% among US-born
persons, respectively. This corresponded to 5.7 (range, 4.8-6.6) million
US-born persons with resolved or current HBV infection during 2013-2018,
including 347,100 persons aged 6-29 years. The most pronounced increase
and highest anti-HBc prevalence was among persons who reported injection
drug use (IDU), which increased from 35.3% during 2001-2006 to 58.4%
during 2013-2018 (P=.07). CONCLUSIONS: Anti-HBc prevalence among US-born
persons remained flat during the most recent period, coinciding with a
doubling of prevalence among persons reporting IDU. These data are
consistent with acute hepatitis B surveillance trends, showing increasing
incidence in sub-populations where prevention could be
strengthened.
-
Risk factors for measles virus infection and
susceptibility in persons aged 15 years and older in China: A multi-site
case-control study, 2012-2013external iconMa C, Hao L, Rodewald L,
An
Q,
Wannemuehler KA, Su Q, An Z,
Quick
L, Liu Y, Yan R, Liu X, Zhang Y, Yu W, Zhang X, Wang H,
Cairns L, Luo H, Gregory CJ.
Vaccine. 2020 Apr
3;38(16):3210-3217.
INTRODUCTION:
Endemic measles persists in China, despite >95% reported coverage
of two measles-containing vaccine doses and nationwide campaign that
vaccinated >100 million children in 2010. An increasing proportion of
infections now occur among adults and there is concern that persistent
susceptibility in adults is an obstacle to measles elimination in China.
We performed a case-control study in six Chinese provinces between January
2012 to June 2013 to identify risk factors for measles virus infection and
susceptibility among adults. METHODS: Persons ≥15 years old with
laboratory-confirmed measles were age and neighborhood matched with three
controls. Controls had blood specimens collected to determine their
measles IgG serostatus. We interviewed case-patients and controls about
potential risk factors for measles virus infection and susceptibility.
Unadjusted and adjusted matched odds ratios and 95% confidence intervals
(CIs) were calculated via conditional logistic regression. We calculated
attributable fractions for infection for risk factors that could be
interpreted as causal. RESULTS: 899 cases and 2498 controls were enrolled.
Among controls, 165 (6.6%) were seronegative for measles IgG indicating
persistent susceptibility to infection. In multivariable analysis,
hospital visit and travel outside the prefecture in the prior
1-3 weeks were significant risk factors for measles virus infection.
Occupation and reluctance to accept measles vaccination were significant
risk factors for measles susceptibility. The calculated attributable
fraction of measles cases from hospital visitation was 28.6% (95% CI:
20.6-38.8%). CONCLUSIONS: Exposure to a healthcare facility was the
largest risk factor for measles virus infection in adults in China.
Improved adherence to hospital infection control practices could reduce
risk of ongoing measles virus transmission and increase the likelihood of
achieving and sustaining measles elimination in China. The use of control
groups stratified by serological status identified distinct risk factors
for measles virus infection and susceptibility among
adults.
-
SARS-CoV-2 detection on self-collected saliva or anterior
nasal specimens compared with healthcare personnel-collected
nasopharyngeal specimensexternal iconMarx GE,
Biggerstaff BJ,
Nawrocki CC, Totten SE,
Travanty EA, Burakoff AW, Scott T, De Hey JC, Carlson JJ, Wendel KA,
Harcourt JL,
Tamin A,
Thomas
JD, Rowan SE.
Clin Infect Dis. 2021 Apr 29.
BACKGROUND:
Nasopharyngeal specimens (NPS) are commonly used for SARS-CoV-2 testing
but can be uncomfortable for patients. Self-collected saliva or anterior
nasal specimens (ANS) for SARS-CoV-2 detection are less invasive but the
sensitivity of these specimen types has not been thoroughly evaluated.
METHODS: During September-November 2020, 730 adults undergoing SARS-CoV-2
testing at community testing events and homeless shelters in Denver
provided self-collected saliva and ANS specimens before NPS collection and
answered a short survey about symptoms and specimen preference. Specimens
were tested for SARS-CoV-2 by rRT-PCR; viral culture was performed on a
subset of specimens positive by rRT-PCR. Sensitivity of saliva and ANS for
SARS-CoV-2 detection by rRT-PCR was measured against NPS. Subgroup
analyses included test outcomes by symptom status and culture results.
RESULTS: Sensitivity for SARS-CoV-2 detection by rRT-PCR appeared higher
for saliva than for ANS (85% vs. 80%) and among symptomatic participants
than among those without symptoms (94% vs. 29% for saliva; 87% vs. 50% for
ANS). Among participants with culture-positive SARS-CoV-2 by any specimen
type, sensitivity of saliva and ANS by rRT-PCR was 94% and 100%,
respectively. Saliva and ANS were equally preferred by participants; most
would undergo NPS again despite being least preferred. CONCLUSIONS: Saliva
was slightly more sensitive than ANS for SARS-CoV-2 detection by rRT-PCR.
Both saliva and ANS reliably detected SARS-CoV-2 among participants with
symptoms. Self-collected saliva and ANS offer practical advantages, are
preferred by patients, and might be most useful for testing people with
COVID-19 symptoms.
-
Performance Evaluation of Serial SARS-CoV-2 Rapid Antigen
Testing During a Nursing Home Outbreakexternal iconMcKay SL,
Tobolowsky FA,
Moritz ED,
Hatfield KM,
Bhatnagar A,
LaVoie
SP,
Jackson DA,
Lecy KD,
Bryant-Genevier J,
Campbell D,
Freeman B,
Gilbert SE,
Folster
JM,
Medrzycki M,
Shewmaker PL,
Bankamp B,
Radford KW,
Anderson
R,
Bowen MD, Negley J,
Reddy
SC,
Jernigan JA,
Brown AC,
McDonald LC,
Kutty PK.
Ann Intern
Med. 2021 Apr 27.
BACKGROUND:
To address high COVID-19 burden in U.S. nursing homes, rapid SARS-CoV-2
antigen tests have been widely distributed in those facilities. However,
performance data are lacking, especially in asymptomatic people.
OBJECTIVE: To evaluate the performance of SARS-CoV-2 antigen testing when
used for facility-wide testing during a nursing home outbreak. DESIGN: A
prospective evaluation involving 3 facility-wide rounds of testing where
paired respiratory specimens were collected to evaluate the performance of
the BinaxNOW antigen test compared with virus culture and real-time
reverse transcription polymerase chain reaction (RT-PCR). Early and late
infection were defined using changes in RT-PCR cycle threshold values and
prior test results. SETTING: A nursing home with an ongoing SARS-CoV-2
outbreak. PARTICIPANTS: 532 paired specimens collected from 234 available
residents and staff. MEASUREMENTS: Percentage of positive agreement (PPA)
and percentage of negative agreement (PNA) for BinaxNOW compared with
RT-PCR and virus culture. RESULTS: BinaxNOW PPA with virus culture, used
for detection of replication-competent virus, was 95%. However, the
overall PPA of antigen testing with RT-PCR was 69%, and PNA was 98%. When
only the first positive test result was analyzed for each participant, PPA
of antigen testing with RT-PCR was 82% among 45 symptomatic people and 52%
among 343 asymptomatic people. Compared with RT-PCR and virus culture, the
BinaxNOW test performed well in early infection (86% and 95%,
respectively) and poorly in late infection (51% and no recovered virus,
respectively). LIMITATION: Accurate symptom ascertainment was challenging
in nursing home residents; test performance may not be representative of
testing done by nonlaboratory staff. CONCLUSION: Despite lower positive
agreement compared with RT-PCR, antigen test positivity had higher
agreement with shedding of replication-competent virus. These results
suggest that antigen testing could be a useful tool to rapidly identify
contagious people at risk for transmitting SARS-CoV-2 during nascent
outbreaks and help reduce COVID-19 burden in nursing homes. PRIMARY
FUNDING SOURCE: None.
-
Okanogan
County, Washington, experienced increased community transmission of
SARS-CoV-2, the virus that causes COVID-19, during summer 2020 (1).
Multiple COVID-19 outbreaks occurred in agricultural settings, including a
large outbreak among employees of a fruit grower during May-August.
Because of this outbreak, Okanogan County Public Health and the Washington
State Department of Health initiated one-time, on-site screening testing
(2) of all orchard and warehouse employees in August 2020 and assessed
risk factors for SARS-CoV-2 infection. Among 3,708 known orchard
employees, a valid SARS-CoV-2 test result or information on COVID-19-like
symptoms in the absence of a test was available for 3,013 (81%).
Cumulative incidence of SARS-CoV-2 infection during approximately 3 months
among tested orchard employees was 6%. Cumulative incidence was 12% in
employees residing in the community, compared with 4% in employees
residing in farmworker housing (p<0.001); point prevalence during the
single screening testing event was 1% in both groups. Among 1,247 known
warehouse employees, a valid result was available for 726 (58%).
Cumulative incidence over approximately 3 months among tested warehouse
employees was 23%, with substantial variation across job roles. Positive
test results were received by 28% of employees who worked packing and
sorting fruit, 24% of those in other roles in the packing and sorting
area, 10% of forklift operators, 7% of employees in other warehouse roles,
and 6% of office employees. Point prevalence among all warehouse workers
was 1% at the screening testing event. Collaboration among employers,
community groups, and public health authorities can reveal risk factors
and help decrease farmworkers' risk for SARS-CoV-2 infection in the
community and the workplace. Creation of a COVID-19 assessment and control
plan by agricultural employers, with particular focus on indoor workers
whose jobs limit physical distancing, could reduce workplace
transmission.
-
Hand hygiene during the COVID-19 pandemic among people
experiencing homelessness-Atlanta, Georgia, 2020external iconMontgomery
MP,
Carry MG,
Garcia-Williams
AG,
Marshall B,
Besrat B,
Bejarano F, Carlson J, Rutledge T,
Mosites E.
J
Community Psychol. 2021 Apr 26.
People
experiencing homelessness are at risk for coronavirus disease 2019
(COVID-19) and may experience barriers to hand hygiene, a primary
recommendation for COVID-19 prevention. We conducted in-depth interviews
with 51 people experiencing sheltered and unsheltered homelessness in
Atlanta, Georgia during May 2020 to August 2020 to (1) describe challenges
and opportunities related to hand hygiene and (2) assess hand hygiene
communication preferences. The primary hand hygiene barrier reported was
limited access to facilities and supplies, which has disproportionately
impacted people experiencing unsheltered homelessness. This lack of access
has reportedly been exacerbated during COVID-19 by the closure of public
facilities and businesses. Increased access to housing and employment were
identified as long-term solutions to improving hand hygiene. Overall,
participants expressed a preference for access to facilities and supplies
over hand hygiene communication materials.
-
Large
COVID-19 outbreaks have occurred in high-density workplaces, such as food
processing facilities (1). Alaska's seafood processing industry attracts
approximately 18,000 out-of-state workers annually (2). Many of the
state's seafood processing facilities are located in remote areas with
limited health care capacity. On March 23, 2020, the governor of Alaska
issued a COVID-19 health mandate (HM10) to address health concerns related
to the impending influx of workers amid the COVID-19 pandemic (3). HM10
required employers bringing critical infrastructure (essential) workers
into Alaska to submit a Community Workforce Protective Plan.* On May 15,
2020, Appendix 1 was added to the mandate, which outlined specific
requirements for seafood processors, to reduce the risk for transmission
of SARS-CoV-2, the virus that causes COVID-19, in these high-density
workplaces (4). These requirements included measures to prevent
introduction of SARS-CoV-2 into the workplace, including testing of
incoming workers and a 14-day entry quarantine before workers could enter
nonquarantine residences. After 13 COVID-19 outbreaks in Alaska seafood
processing facilities and on processing vessels during summer and early
fall 2020, State of Alaska personnel and CDC field assignees reviewed the
state's seafood processing-associated cases. Requirements were amended in
November 2020 to address gaps in COVID-19 prevention. These revised
requirements included restricting quarantine groups to ≤10 persons,
pretransfer testing, and serial testing (5). Vaccination of this essential
workforce is important (6); until high vaccination coverage rates are
achieved, other mitigation strategies are needed in this high-risk
setting. Updating industry guidance will be important as more information
becomes available.
-
Changes in Seasonal Respiratory Illnesses in the United
States During the COVID-19 Pandemicexternal iconRodgers L,
Sheppard M,
Smith A,
Dietz
S,
Jayanthi P,
Yuan Y,
Bull L,
Wotiz S,
Schwarze
T,
Azondekon R,
Hartnett K,
Adjemian J,
Kirking HL,
Kite
Powell A.
Clin Infect Dis. 2021 Apr 29.
BACKGROUND:
Respiratory tract infections are common, often seasonal, and caused by
multiple pathogens. We assessed whether seasonal respiratory illness
patterns changed during the COVID-19 pandemic. METHODS: We categorized
emergency department (ED) visits reported to the National Syndromic
Surveillance Program according to chief complaints and diagnosis codes,
excluding visits with diagnosed SARS-CoV-2 infections. For each week
during March 1, 2020 through December 26, 2020 ("pandemic period"), we
compared the proportion of ED visits in each respiratory category with the
proportion of visits in that category during the corresponding weeks of
2017-2019 ("pre-pandemic period"). We analyzed positivity of respiratory
viral tests from two independent clinical laboratories. RESULTS: During
March 2020, cough, shortness of breath, and influenza-like illness
accounted for twice as many ED visits compared with the pre-pandemic
period. During the last four months of 2020, all respiratory conditions,
except shortness of breath, accounted for a smaller proportion of ED
visits than during the pre-pandemic period. Percent positivity for
influenza virus, respiratory syncytial virus, human parainfluenza virus,
adenoviruses, and human metapneumovirus were lower in 2020 than 2019.
Although test volume decreased, percent positivity was higher for
rhinovirus/enterovirus during the final weeks of 2020 compared with 2019;
with ED visits similar to the pre-pandemic period. DISCUSSION: Broad
reductions in respiratory test positivity and respiratory emergency
department visits (excluding COVID-19) occurred during 2020. Interventions
for mitigating spread of SARS-CoV-2 likely also reduced transmission of
other pathogens. Timely surveillance is needed to understand community
health threats, particularly when current trends deviate from seasonal
norms.
-
Tenofovir Alafenamide (TAF) for HIV Prevention: Review of
the Proceedings from the Gates Foundation Long Acting (LA) TAF Product
Development Meetingexternal iconRomano JW, Baum M, Demkovich ZR, Diana F,
Dobard C, Feldman PL,
Garcia-Lerma JG,
Grattoni A, Gunawardana M, Ho DK, Hope TJ,
Massud I,
Milad M, Moss J, Pons-Faudoa FP, Roller S, van der Straten A, Srinivasan
S, Veazey R, Zane D.
AIDS Res Hum Retroviruses. 2021 Apr 29.
The
ability to successfully develop a safe and effective vaccine for the
prevention of HIV infection has proven challenging. Consequently,
alternative approaches to HIV infection prevention have been pursued, and
there have been a number of successes with differing levels of efficacy.
Currently, only two oral pre-exposure prophylaxis (PrEP) products are
available, Truvada and Descovy. Descovy is a newer product not yet
indicated in individuals at risk of HIV-1 infection from receptive vaginal
sex, since it still needs to be evaluated in this population. A topical
dapivirine vaginal ring is currently under regulatory review, and a long
acting (LA) injectable cabotegravir product shows strong promise. Although
demonstrably effective, daily oral PrEP presents adherence challenges for
many users, particularly adolescent girls and young women, key target
populations. This limitation has triggered development efforts in LA HIV
prevention options. This article reviews efforts supported by the Bill
& Melinda Gates Foundation, as well as similar work by other groups,
to identify and develop optimal LA HIV prevention products. Specifically,
this article is a summary review of a meeting convened by the foundation
in early 2020 that focused on the development of LA products designed for
extended delivery of tenofovir alafenamide (TAF) for HIV prevention. The
review broadly serves as technical guidance for preclinical development of
LA HIV prevention products. The meeting examined the technical feasibility
of multiple delivery technologies, in vivo pharmacokinetics, and safety of
subcutaneous delivery of TAF in animal models. Ultimately, the foundation
concluded that there are technologies available for long-term delivery of
TAF. However, due to potentially limited efficacy and possible toxicity
issues with subcutaneous (SC) delivery, the foundation will not continue
investing in the development of LA, SC delivery of TAF products for HIV
prevention.
-
Performance of Repeat BinaxNOW SARS-CoV-2 Antigen Testing
in a Community Setting, Wisconsin, November-December
2020external iconShah MM,
Salvatore PP,
Ford L,
Kamitani E,
Whaley
MJ,
Kaitlin M,
Currie DW,
Morgan CN,
Segaloff HE,
Lecher
S,
Somers T,
Van Dyke ME,
Bigouette JP,
Delaney A,
DaSilva
J,
O'Hegarty M,
Boyle-Estheimer
L,
Abdirizak F,
Karpathy SE,
Meece J, Ivanic L, Goffard K, Gieryn D, Sterkel A, Bateman A, Kahrs J,
Langolf K, Zochert T,
Knight NW,
Hsu CH,
Kirking HL,
Tate JE.
Clin Infect Dis.
2021 Apr 28.
Repeating
the BinaxNOW antigen test for SARS-CoV-2 by two groups of readers within
30 minutes resulted in high concordance (98.9%) in 2,110 encounters.
BinaxNOW test sensitivity was 77.2% (258/334) compared to real-time
reverse transcription-polymerase chain reaction. Same day antigen testing
did not significantly improve test sensitivity while specificity remained
high.
-
Postvaccination SARS-CoV-2 Infections Among Skilled
Nursing Facility Residents and Staff Members - Chicago, Illinois, December
2020-March 2021external iconTeran RA, Walblay KA, Shane EL,
Xydis S, Gretsch S, Gagner A, Samala U, Choi H, Zelinski C, Black
SR.
MMWR Morb Mortal Wkly Rep. 2021 Apr 30;70(17):632-638.
Early
studies suggest that COVID-19 vaccines protect against severe illness (1);
however, postvaccination SARS-CoV-2 infections (i.e., breakthrough
infections) can occur because COVID-19 vaccines do not offer 100%
protection (2,3). Data evaluating the occurrence of breakthrough
infections and impact of vaccination in decreasing transmission in
congregate settings are limited. Skilled nursing facility (SNF) residents
and staff members have been disproportionately affected by SARS-CoV-2, the
virus that causes COVID-19 (4,5), and were prioritized for COVID-19
vaccination (6,7). Starting December 28, 2020, all 78 Chicago-based SNFs
began COVID-19 vaccination clinics over several weeks through the federal
Pharmacy Partnership for Long-Term Care Program (PPP).(†) In February
2021, through routine screening, the Chicago Department of Public Health
(CDPH) identified a SARS-CoV-2 infection in a SNF resident >14 days
after receipt of the second dose of a two-dose COVID-19 vaccination
series. SARS-CoV-2 cases, vaccination status, and possible vaccine
breakthrough infections were identified by matching facility reports with
state case and vaccination registries. Among 627 persons with SARS-CoV-2
infection across 75 SNFs since vaccination clinics began, 22 SARS-CoV-2
infections were identified among 12 residents and 10 staff members across
15 facilities ≥14 days after receiving their second vaccine dose (i.e.,
breakthrough infections in fully vaccinated persons). Nearly two thirds
(14 of 22; 64%) of persons with breakthrough infections were asymptomatic;
two residents were hospitalized because of COVID-19, and one died. No
facility-associated secondary transmission occurred. Although few
SARS-CoV-2 infections in fully vaccinated persons were observed, these
cases demonstrate the need for SNFs to follow recommended routine
infection prevention and control practices and promote high vaccination
coverage among SNF residents and staff members.
-
Introduction, Transmission Dynamics, and Fate of Early
SARS-CoV-2 Lineages in Santa Clara County, Californiaexternal iconVillarino E,
Deng X, Kemper CA, Jorden MA, Bonin B, Rudman SL, Han GS, Yu G, Wang C,
Federman S, Bushnell B, Wadford DA, Lin W,
Tao Y,
Paden CR,
Bhatnagar J, MacCannell T,
Tong S, Batson J, Chiu CY.
J Infect Dis. 2021 Apr
21.
We
combined viral genome sequencing with contact tracing to investigate
introduction and evolution of SARS-CoV-2 lineages in Santa Clara County,
California from January 27 to March 21, 2020. Of 558 persons with
COVID-19, 101 genomes from 143 available clinical samples comprised 17
different lineages including SCC1 (n=41), WA1 (n=9, including the first 2
reported deaths in the United States, diagnosed post-mortem), D614G (n=4),
ancestral Wuhan Hu-1 (n=21), and 13 others (n=26). Public health
intervention may have curtailed the persistence of lineages that appeared
transiently during February-March. By August, only D614G lineages
introduced after March 21 were circulating in SCC.
-
