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Energetic Monitoring of Individuals Uncovered to Sufferers with Confirmed…


On March 3, 2020, this report was posted on-line as an MMWR Early Launch.

Rachel M. Burke, PhD1; Claire M. Midgley, PhD1; Alissa Dratch, MPH2; Marty Fenstersheib, MD; Thomas Haupt, MS4; Michelle Holshue, MPH5,6; Isaac Ghinai, MBBS6,7; M. Claire Jarashow, PhD8; Jennifer Lo, MD9; Tristan D. McPherson, MD6,10; Sara Rudman, MD; Sarah Scott, MD6,12; Aron J. Corridor, DVM1; Alicia M. Fry, MD1; Melissa A. Rolfes, PhD1 (View creator affiliations)

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In December 2019, an outbreak of coronavirus illness 2019 (COVID-19), attributable to the virus SARS-CoV-2, started in Wuhan, China (1). The illness unfold extensively in China, and, as of February 26, 2020, COVID-19 instances had been recognized in 36 different nations and territories, together with america. Individual-to-person transmission has been extensively documented, and a restricted variety of nations have reported sustained person-to-person unfold.* On January 20, state and native well being departments in america, in collaboration with groups deployed from CDC, started figuring out and monitoring all individuals thought-about to have had shut contact with sufferers with confirmed COVID-19 (2). The goals of those efforts have been to make sure speedy analysis and care of sufferers, restrict additional transmission, and higher perceive danger components for transmission.

As of February 26, 12 travel-related COVID-19 instances had been identified in america, along with three COVID-19 instances in sufferers with no journey historical past (together with two instances in shut family contacts) and 46 instances reported amongst repatriated U.S. residents.§ Following confirmed analysis, the 12 sufferers with travel-related COVID-19 have been remoted within the hospital if medically needed, or at house as soon as house care was deemed clinically adequate. Among the many first 10 sufferers with travel-related confirmed COVID-19 reported in america, a complete of 445 individuals (vary = 1–201 individuals per case) who had shut contact with one of many 10 sufferers on or after the date of the affected person’s symptom onset have been recognized. Nineteen (4%) of the 445 contacts have been members of a affected person’s family, and 5 of those 19 contacts continued to have family publicity to the affected person with confirmed COVID-19 in the course of the affected person’s isolation interval; 104 (23%) have been group members who spent no less than 10 minutes inside 6 toes of a affected person with confirmed illness; 100 (22%) have been group members who have been uncovered** to a affected person in a well being care setting; and 222 (50%) have been well being care personnel.††

Energetic symptom monitoring of the 445 shut contacts, consisting of every day phone, textual content, or in-person inquiries about fever or different signs for 14 days following the final identified publicity to an individual with confirmed COVID-19, was carried out by native well being jurisdictions. In the course of the 14 days of lively symptom monitoring, 54 (12%) shut contacts developed new or worsening signs deemed by native public well being authorities to be regarding for COVID-19 and have been thus thought-about individuals beneath investigation (PUIs)§§ and subsequently have been examined for SARS-CoV-2. Two individuals who have been family members of sufferers with confirmed COVID-19 examined constructive for SARS-CoV-2. This yielded a symptomatic secondary assault price of 0.45% (95% confidence interval [CI] = 0.12%–1.6%) amongst all shut contacts,¶¶ and a symptomatic secondary assault price of 10.5% (95% CI = 2.9%–31.4%) amongst family members. Each individuals with confirmed secondary transmission had shut contact with the respective supply affected person earlier than COVID-19 was confirmed and have been remoted from the supply affected person after the affected person’s COVID-19 analysis.

No different shut contacts who have been examined for SARS-CoV-2 had a constructive take a look at, together with the 5 family members who have been constantly uncovered in the course of the interval of isolation of their family member with confirmed COVID-19. A further 146 individuals uncovered to the 2 sufferers with secondary COVID-19 transmission underwent 14 days of lively monitoring. Amongst these, 18 (12%) developed signs suitable with COVID-19 and have been thought-about PUIs. All examined detrimental, and no additional symptomatic COVID-19 instances (representing tertiary transmission) have been recognized.

In america, two situations of person-to-person transmission of SARS-CoV-2 have been documented from individuals with travel-related COVID-19 to their family contacts. Since February 28, an growing variety of newly identified confirmed and presumptive COVID-19 instances have been in sufferers with neither a related journey historical past nor clear epidemiologic hyperlinks to different confirmed COVID-19 sufferers. Nevertheless, regardless of intensive follow-up, no sustained person-to-person transmission of symptomatic SARS-CoV-2 was noticed in america among the many shut contacts of the primary 10 individuals with identified travel-related COVID-19. Analyses of timing of publicity throughout every affected person’s sickness in addition to the sort and period of exposures will present data on potential danger components for transmission. An infection management and prevention efforts by sufferers with COVID-19, their family members, and their well being care suppliers,*** together with contact tracing actions, are essential to mitigate group unfold of the illness.

Acknowledgments

Maricopa County Division of Public Well being; Arizona Division of Well being Providers; Lynn Mello, Mary White, Cynthia Marttila, Patricia Mottu-Monteon, Anthony Aguiar, Anita Alvarez, Veronica Guerra, San Benito County Public Well being Providers; Sara Cody, George Han, Shanon Smith, Elsa Villarino, Santa Clara County Public Well being Division; Scott Lindquist, Washington State Division of Well being; Hollianne Bruce, Snohomish Well being District, Everett, Washington; Jeff Duchin, Vance Kawakami, Shauna Clark, Public Well being Seattle-King County; Boston Public Well being Fee; Sharon Balter, Daybreak Terashita, Prabhu Gounder, Zach Rubin, Rebecca Fisher, Chelsea Foo, Meredith Haddix, Elizabeth Traub, Rebecca Lee, Kelsey Oyong, Christina Eclarino, Keith Gurtzweiler, Jennifer Kilburn, Jan King, Lucille Rayford, Ashley Griffin, Los Angeles County Division of Public Well being; Howard Chiou, Los Angeles County of Public Well being and COVID-19 Response Workforce, CDC; Rebecca Sunenshine, Maricopa County Division of Public Well being and COVID-19 Response Workforce, CDC. Olivia Almendares, Miwako Kobayashi, Olivia McGovern, Heather Reese, Anna Yousaf, Vaughn Barry, Karlyn Beer, Erin Conners, Connor Hoff, Allison Miller, Isaac Benowitz, Nora Chea, Cheri Grigg, Jennifer Hunter, Shannon Novosad, Amy Valderrama, Matthew Westercamp, Katie Wilson, Matthew Biggerstaff, Leora Feldstein, Pamela Kennedy, Archana Kumar, Holly Biggs, Jordan Cates, Victoria Chu, Nakia Clemmons, Brandi Freeman, Amber Haynes, Anita Kambhampati, Hannah Kirking, Stephen Lindstrom, Ruth Hyperlink-Gelles, Joana Full of life, Mariel Marlow, Claire Mattison, Nancy McClung, Manisha Patel, Brian Rha, Janell Routh, Megan Wallace, John Watson, Kevin Chatham-Stephens, Max Cohen, Vishal Dasari, Matthew Donahue, Max Jacobs, Heather Rhodes, Varun Shetty, Amy Xie, Patrick Dawson, Jonathan Dyal, Mary Evans, Marc Fischer, Grace Vahey, Marie Killerby, Jennifer Verani, Kristen Pettrone, Satish Pillai, Sarah Elizabeth Smith-Jeffcoat, Bryan Stierman, Florence Whitehill, Jonathan Wortham, COVID-19 Response Workforce, CDC.

Corresponding creator: Rachel M. Burke, lxx8@cdc.gov, 404-718-1016.



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