Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Tobolowsky FA[original query] |
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Novel oral poliovirus vaccine 2 safety evaluation during nationwide supplemental immunization activity, Uganda, 2022
Tobolowsky FA , Nsubuga F , Gilani Z , Kisakye A , Ndagije H , Kyabayinze D , Gidudu JF . Emerg Infect Dis 2024 30 (4) 775-778 Given its enhanced genetic stability, novel oral poliovirus vaccine type 2 was deployed for type 2 poliovirus outbreak responses under World Health Organization Emergency Use Listing. We evaluated the safety profile of this vaccine. No safety signals were identified using a multipronged approach of passive and active surveillance. |
Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19 (preprint)
Rao CY , Robinson T , Huster K , Laws RL , Keating R , Tobolowsky FA , McMichael TM , Gonzales E , Mosites E . medRxiv 2021 2021.02.22.21251646 Objective To describe the work environment and COVID-19 mitigation measures for homeless shelter workers and assess occupational risk factors for COVID-19 infectionMethods Between June 9-August 10, 2020, we conducted a self-administered survey among homeless shelter workers in Washington, Massachusetts, Utah, Maryland, and Georgia. We calculated frequencies for work environment, personal protective equipment use, and SARS-CoV-2 testing history. We used generalized linear models to produce unadjusted prevalence ratios (PR) to assess risk factors for SARS-CoV-2 infection.Results Of the 106 respondents, 43.4% reported frequent close contact with clients; 75% were worried about work-related SARS-CoV-2 infections; 15% reported testing positive. Close contact with clients was associated with testing positive for SARS-CoV-2 (PR 3.97, 95%CI 1.06, 14.93).Conclusions Homeless shelter workers may be at higher risk of being infected with SARS-CoV-2 during the course of their work. Protecting these critical essential workers by implementing mitigation measures and prioritizing for COVID-19 vaccination, is imperative during the pandemic.Competing Interest StatementThe authors have declared no competing interest.Funding StatementNo external funding was receivedAuthor DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This project was reviewed by the Centers for Disease Control and Prevention (CDC) COVID-19 Response Human Subject Review panel. The project was determined to meet the requirements of public health surveillance covered by the U.S. Department of Health and Human Services Policy for the Protection of Human Research Subjects as defined in 45 CFR 46.102, and the decision was made that this project was nonresearch and did not require ethical review by the CDC Human Research Protection Office. Ethical approval was waived and informed consent was not required.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData are not available. |
Longitudinal serologic and viral testing post-SARS-CoV-2 infection and post-receipt of mRNA COVID-19 vaccine in a nursing home cohort-Georgia, October 2020-April 2021 (preprint)
Tobolowsky FA , Waltenburg MA , Moritz ED , Haile M , DaSilva JC , Schuh AJ , Thornburg NJ , Westbrook A , McKay SL , LaVoie SP , Folster JM , Harcourt JL , Tamin A , Stumpf MM , Mills L , Freeman B , Lester S , Beshearse E , Lecy KD , Brown LG , Fajardo G , Negley J , McDonald LC , Kutty PK , Brown AC , Bhatnagar A , Bryant-Genevier J , Currie DW , Campbell D , Gilbert SE , Hatfield KM , Jackson DA , Jernigan JA , Dawson JL , Hudson MJ , Joseph K , Reddy SC , Wilson MM . medRxiv 2022 01 (10) e0275718 Importance: There are limited data describing SARS-CoV-2-specific immune responses and their durability following infection and vaccination in nursing home residents. Objective(s): To evaluate the quantitative titers and durability of binding antibodies detected after SARSCoV-2 infection and subsequent COVID-19 vaccination. Design(s): A prospective longitudinal evaluation included nine visits over 150 days; visits included questionnaire administration, blood collection for serology, and paired anterior nasal specimen collection for testing by BinaxNOWTM COVID-19 Ag Card (BinaxNOW), reverse transcription polymerase chain reaction (RT-PCR), and viral culture. Setting(s): A nursing home during and after a SARS-CoV-2 outbreak. Participant(s): 11 consenting SARS-CoV-2-positive nursing home residents. Main Outcomes and Measures: SARS-CoV-2 testing (BinaxNOWTM, RT-PCR, viral culture); quantitative titers of binding SARS-CoV-2 antibodies post-infection and post-vaccination (beginning after the first dose of the primary series). Result(s): Of 10 participants with post-infection serology results, 9 (90%) had detectable Pan-Ig, IgG, and IgA antibodies and 8 (80%) had detectable IgM antibodies. At first antibody detection post-infection, two-thirds (6/9, 67%) of participants were RT-PCR-positive but none were culture positive. Ten participants received vaccination; all had detectable Pan-Ig, IgG, and IgA antibodies through their final observation <=90 days post-first dose. Post-vaccination geometric means of IgG titers were 10-200-fold higher than post-infection. Conclusions and Relevance: Nursing home residents in this cohort mounted robust immune responses to SARS-CoV-2 post-infection and post-vaccination. The augmented antibody responses post-vaccination are potential indicators of enhanced protection that vaccination may confer on previously infected nursing home residents. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Update on wild poliovirus type 1 outbreak - Southeastern Africa, 2021-2022
Davlantes E , Greene SA , Tobolowsky FA , Biya O , Wiesen E , Abebe F , Weldetsadik MB , Eboh VA , Chisema MN , da Conceição Mário B , Tinuga F , Bobo PM , Chigodo CK , Sethy G , Hellström JM , Goundara AM , Burny ME , Mwale JC , Jorba J , Makua KS , Howard W , Seakamela L , Okiror S , Thompson A , Ali A , Samba D , Agbo C , Kabamba L , Kazoka A , Zomahoun DL , Manneh F , Abdelrahim K , Kamugisha C , Umar AS . MMWR Morb Mortal Wkly Rep 2023 72 (15) 391-397 ![]() ![]() Since the Global Polio Eradication Initiative (GPEI) began in 1988, the number of wild poliovirus (WPV) cases has declined by >99.99%. Five of the six World Health Organization (WHO) regions have been certified free of indigenous WPV, and WPV serotypes 2 and 3 have been declared eradicated globally (1). WPV type 1 (WPV1) remains endemic only in Afghanistan and Pakistan (2,3). Before the outbreak described in this report, WPV1 had not been detected in southeastern Africa since the 1990s, and on August 25, 2020, the WHO African Region was certified free of indigenous WPV (4). On February 16, 2022, WPV1 infection was confirmed in one child living in Malawi, with onset of paralysis on November 19, 2021. Genomic sequence analysis of the isolated poliovirus indicated that it originated in Pakistan (5). Cases were subsequently identified in Mozambique. This report summarizes progress in the outbreak response since the initial report (5). During November 2021-December 2022, nine children and adolescents with paralytic polio caused by WPV1 were identified in southeastern Africa: one in Malawi and eight in Mozambique. Malawi, Mozambique, and three neighboring countries at high risk for WPV1 importation (Tanzania, Zambia, and Zimbabwe) responded by increasing surveillance and organizing up to six rounds of national and subnational polio supplementary immunization activities (SIAs).* Although no cases of paralytic WPV1 infection have been reported in Malawi since November 2021 or in Mozambique since August 2022, undetected transmission might be ongoing because of poliovirus surveillance gaps and testing delays. Efforts to further enhance poliovirus surveillance sensitivity, improve SIA quality, and strengthen routine immunization are needed to ensure that WPV1 transmission has been interrupted within 12 months of the first case, thereby preserving the WHO African Region's WPV-free status. |
Longitudinal serologic and viral testing post-SARS-CoV-2 infection and post-receipt of mRNA COVID-19 vaccine in a nursing home cohort-Georgia, October 2020‒April 2021.
Tobolowsky FA , Waltenburg MA , Moritz ED , Haile M , DaSilva JC , Schuh AJ , Thornburg NJ , Westbrook A , McKay SL , LaVoie SP , Folster JM , Harcourt JL , Tamin A , Stumpf MM , Mills L , Freeman B , Lester S , Beshearse E , Lecy KD , Brown LG , Fajardo G , Negley J , McDonald LC , Kutty PK , Brown AC , Bhatnagar A , Bryant-Genevier J , Currie DW , Campbell D , Gilbert SE , Hatfield KM , Jackson DA , Jernigan JA , Dawson JL , Hudson MJ , Joseph K , Reddy SC , Wilson MM . PLoS One 2022 17 (10) e0275718 ![]() There are limited data describing SARS-CoV-2-specific immune responses and their durability following infection and vaccination in nursing home residents. We conducted a prospective longitudinal evaluation of 11 consenting SARS-CoV-2-positive nursing home residents to evaluate the quantitative titers and durability of binding antibodies detected after SARS-CoV-2 infection and subsequent COVID-19 vaccination. The evaluation included nine visits over 150 days from October 25, 2020, through April 1, 2021. Visits included questionnaire administration, blood collection for serology, and paired anterior nasal specimen collection for testing by BinaxNOW™ COVID-19 Ag Card (BinaxNOW), reverse transcription polymerase chain reaction (RT-PCR), and viral culture. We evaluated quantitative titers of binding SARS-CoV-2 antibodies post-infection and post-vaccination (beginning after the first dose of the primary series). The median age among participants was 74 years; one participant was immunocompromised. Of 10 participants with post-infection serology results, 9 (90%) had detectable Pan-Ig, IgG, and IgA antibodies, and 8 (80%) had detectable IgM antibodies. At first antibody detection post-infection, two-thirds (6/9, 67%) of participants were RT-PCR-positive, but none were culture- positive. Ten participants received vaccination; all had detectable Pan-Ig, IgG, and IgA antibodies through their final observation ≤90 days post-first dose. Post-vaccination geometric means of IgG titers were 10-200-fold higher than post-infection. Nursing home residents in this cohort mounted robust immune responses to SARS-CoV-2 post-infection and post-vaccination. The augmented antibody responses post-vaccination are potential indicators of enhanced protection that vaccination may confer on previously infected nursing home residents. |
Clinical use of tecovirimat (Tpoxx) for treatment of monkeypox under an investigational new drug protocol - United States, May-August 2022
O'Laughlin K , Tobolowsky FA , Elmor R , Overton R , O'Connor SM , Damon IK , Petersen BW , Rao AK , Chatham-Stephens K , Yu P , Yu Y . MMWR Morb Mortal Wkly Rep 2022 71 (37) 1190-1195 Currently, no Food and Drug Administration (FDA)-approved treatments for human monkeypox are available. Tecovirimat (Tpoxx), however, is an antiviral drug that has demonstrated efficacy in animal studies and is FDA-approved for treating smallpox. Use of tecovirimat for treatment of monkeypox in the United States is permitted only through an FDA-regulated Expanded Access Investigational New Drug (EA-IND) mechanism. CDC holds a nonresearch EA-IND protocol that facilitates access to and use of tecovirimat for treatment of monkeypox.() The protocol includes patient treatment and adverse event reporting forms to monitor safety and ensure intended clinical use in accordance with FDA EA-IND requirements. The current multinational monkeypox outbreak, first detected in a country where Monkeypox virus infection is not endemic in May 2022, has predominantly affected gay, bisexual, and other men who have sex with men (MSM) (1,2). To describe characteristics of persons treated with tecovirimat for Monkeypox virus infection, demographic and clinical data abstracted from available tecovirimat EA-IND treatment forms were analyzed. As of August 20, 2022, intake and outcome forms were available for 549 and 369 patients, respectively; 97.7% of patients were men, with a median age of 36.5 years. Among patients with available data, 38.8% were reported to be non-Hispanic White (White) persons, 99.8% were prescribed oral tecovirimat, and 93.1% were not hospitalized. Approximately one half of patients with Monkeypox virus infection who received tecovirimat were living with HIV infection. The median interval from initiation of tecovirimat to subjective improvement was 3 days and did not differ by HIV infection status. Adverse events were reported in 3.5% of patients; all but one adverse event were nonserious. These data support the continued access to and treatment with tecovirimat for patients with or at risk for severe disease in the ongoing monkeypox outbreak. |
Notes from the field: Wound botulism outbreak among a group of persons who inject drugs - Dallas, Texas, 2020
Edwards LD , Gomez I , Wada S , Swaney EM , Caruthers MB , Cody I , Tobolowsky FA , Dykes J , Ford L , Davis KR , Griffin CT , Chung W . MMWR Morb Mortal Wkly Rep 2022 71 (15) 556-557 On December 9, 2020, Dallas County Health and Human Services (DCHHS) was notified of a hospitalized male, aged 33 years (patient A), who was experiencing homelessness and had bilateral ptosis, upper and lower extremity weakness, and respiratory failure requiring intubation. The patient reported injecting methamphetamines, and physical examination noted track marks but no overt skin wounds or abscesses. Patient A was treated with naloxone. Heroin and methamphetamines were detected in the patient’s urine. Myasthenia gravis was initially suspected; however, botulism was considered when the patient did not respond to treatment with pyridostigmine and steroids and the patient’s weakness continued to progress. DCHHS contacted the Texas Department of State Health Services (DSHS) and CDC’s botulism clinical consultation service.* Heptavalent botulinum antitoxin (BAT) was released by CDC on December 9, 2020, and administered to the patient on December 10. Botulism testing results were not available before treatment with BAT. Botulism neurotoxin (BoNT) types A and B were detected in the patient’s serum specimen using the BoNT Endopep-MS assay (1). |
Salmonella Serotypes Associated with Illnesses after Thanksgiving Holiday, United States, 1998-2018
Tobolowsky FA , Cui Z , Hoekstra RM , Bruce BB . Emerg Infect Dis 2022 28 (1) 210-213 We sought to determine which Salmonella serotypes cause illness related to the Thanksgiving holiday in the United States and to foods disproportionately eaten then (e.g., turkey). Using routine surveillance for 1998-2018 and a case-crossover design, we found serotype Reading to be most strongly associated with Thanksgiving. |
Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19.
Rao CY , Robinson T , Huster K , Laws RL , Keating R , Tobolowsky FA , McMichael TM , Gonzales E , Mosites E . PLoS One 2021 16 (11) e0253108 OBJECTIVE: To describe the work environment and COVID-19 mitigation measures for homeless shelter workers and assess occupational risk factors for COVID-19. METHODS: Between June 9-August 10, 2020, we conducted a self-administered survey among homeless shelter workers in Washington, Massachusetts, Utah, Maryland, and Georgia. We calculated frequencies for work environment, personal protective equipment use, and SARS-CoV-2 testing history. We used generalized linear models to produce unadjusted prevalence ratios (PR) to assess risk factors for SARS-CoV-2 infection. RESULTS: Of the 106 respondents, 43.4% reported frequent close contact with clients; 75% were worried about work-related SARS-CoV-2 infections; 15% reported testing positive. Close contact with clients was associated with testing positive for SARS-CoV-2 (PR 3.97, 95%CI 1.06, 14.93). CONCLUSIONS: Homeless shelter workers may be at risk of being exposed to individuals with COVID-19 during the course of their work. Frequent close contact with clients was associated with SARS-CoV-2 infection. Protecting these critical essential workers by implementing mitigation measures and prioritizing for COVID-19 vaccination is imperative during the pandemic. |
Repeated Antigen Testing Among SARS-CoV-2-Positive Nursing Home Residents.
Moritz ED , McKay SL , Tobolowsky FA , LaVoie SP , Waltenburg MA , Lecy KD , Thornburg NJ , Harcourt JL , Tamin A , Folster JM , Negley J , Brown AC , McDonald LC , Kutty PK . Infect Control Hosp Epidemiol 2021 43 (12) 1-10 Repeated antigen testing of 12 SARS-CoV-2-positive nursing home residents using Abbott BinaxNOW™ identified 9/9 (100%) culture-positive specimens up to 6 days after initial positive test. Antigen positivity lasted 2-24 days. Antigen positivity might last beyond the infectious period, but was reliable in residents with evidence of early infection. |
Evaluating the Presence of Replication-Competent SARS-CoV-2 from Nursing Home Residents with Persistently Positive RT-PCR Results.
Lutgring JD , Tobolowsky FA , Hatfield KM , Lehnertz NB , Sullivan MM , Martin KG , Keaton A , Sexton DJ , Tamin A , Harcourt JL , Thornburg NJ , Reddy SC , Jernigan JA . Clin Infect Dis 2021 74 (3) 525-528 ![]() ![]() Replication-competent virus has not been detected in individuals with mild to moderate COVID-19 more than 10 days after symptom onset. It is unknown whether these findings apply to nursing home residents. Of 273 specimens collected from nursing home residents >10 days from the initial positive test, none were culture positive. |
Performance Evaluation of Serial SARS-CoV-2 Rapid Antigen Testing During a Nursing Home Outbreak.
McKay 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 174 (7) 945-951 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. |
Signs, Symptoms, and Comorbidities Associated With Onset and Prognosis of COVID-19 in a Nursing Home.
Tobolowsky FA , Bardossy AC , Currie DW , Schwartz NG , Zacks RLT , Chow EJ , Dyal JW , Ali H , Kay M , Duchin JS , Brostrom-Smith C , Clark S , Sykes K , Jernigan JA , Honein MA , Clark TA , Stone ND , Reddy SC , Rao AK . J Am Med Dir Assoc 2021 22 (3) 498-503 BACKGROUND: Effective halting of outbreaks in skilled nursing facilities (SNFs) depends on the earliest recognition of cases. We assessed confirmed COVID-19 cases at an SNF impacted by COVID-19 in the United States to identify early indications of COVID-19 infection. METHODS: We performed retrospective reviews of electronic health records for residents with laboratory-confirmed SARS-CoV-2 during February 28-March 16, 2020. Records were abstracted for comorbidities, signs and symptoms, and illness outcomes during the 2 weeks before and after the date of positive specimen collection. Relative risks (RRs) of hospitalization and death were calculated. RESULTS: Of the 118 residents tested among approximately 130 residents from Facility A during February 28-March 16, 2020, 101 (86%) were found to test positive for SARS-CoV-2. At initial presentation, about two-thirds of SARS-CoV-2-positive residents had an abnormal vital sign or change in oxygen status. Most (90.2%) symptomatic residents had elevated temperature, change in mental status, lethargy, change in oxygen status, or cough; 9 (11.0%) did not have fever, cough, or shortness of breath during their clinical course. Those with change in oxygen status had an increased relative risk (RR) of 30-day mortality [51.1% vs 29.7%, RR 1.7, 95% confidence interval (CI) 1.0-3.0]. RR of hospitalization was higher for residents with underlying hepatic disease (1.6, 95% CI 1.1-2.2) or obesity (1.5, 95% CI 1.1-2.1); RR of death was not statistically significant. CONCLUSIONS AND IMPLICATIONS: Our findings reinforce the critical role that monitoring of signs and symptoms can have in identifying COVID-19 cases early. SNFs should ensure they have a systematic approach for responding to abnormal vital signs and oxygen saturation and consider ensuring common signs and symptoms identified in Facility A are among those they monitor. |
Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May-June, 2020.
Wallace M , James AE , Silver R , Koh M , Tobolowsky FA , Simonson S , Gold JAW , Fukunaga R , Njuguna H , Bordelon K , Wortham J , Coughlin M , Harcourt JL , Tamin A , Whitaker B , Thornburg NJ , Tao Y , Queen K , Uehara A , Paden CR , Zhang J , Tong S , Haydel D , Tran H , Kim K , Fisher KA , Marlow M , Tate JE , Doshi RH , Sokol T , Curran KG . Emerg Infect Dis 2021 27 (2) 421-429 To assess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a detention facility experiencing a coronavirus disease outbreak and evaluate testing strategies, we conducted a prospective cohort investigation in a facility in Louisiana, USA. We conducted SARS-CoV-2 testing for detained persons in 6 quarantined dormitories at various time points. Of 143 persons, 53 were positive at the initial test, and an additional 58 persons were positive at later time points (cumulative incidence 78%). In 1 dormitory, all 45 detained persons initially were negative; 18 days later, 40 (89%) were positive. Among persons who were SARS-CoV-2 positive, 47% (52/111) were asymptomatic at the time of specimen collection; 14 had replication-competent virus isolated. Serial SARS-CoV-2 testing might help interrupt transmission through medical isolation and quarantine. Testing in correctional and detention facilities will be most effective when initiated early in an outbreak, inclusive of all exposed persons, and paired with infection prevention and control. |
COVID-19 in Americans aboard the Diamond Princess cruise ship.
Plucinski MM , Wallace M , Uehara A , Kurbatova EV , Tobolowsky FA , Schneider ZD , Ishizumi A , Bozio CH , Kobayashi M , Toda M , Stewart A , Wagner RL , Moriarty LF , Murray R , Queen K , Tao Y , Paden C , Mauldin MR , Zhang J , Li Y , Elkins CA , Lu X , Herzig CTA , Novak R , Bower W , Medley AM , Acosta AM , Knust B , Cantey PT , Pesik NT , Halsey ES , Cetron MS , Tong S , Marston BJ , Friedman CR . Clin Infect Dis 2020 72 (10) e448-e457 ![]() ![]() BACKGROUND: The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship. RESULTS: The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years. CONCLUSION: Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in U.S. waters in March 2020. |
Serial Laboratory Testing for SARS-CoV-2 Infection Among Incarcerated and Detained Persons in a Correctional and Detention Facility - Louisiana, April-May 2020.
Njuguna H , Wallace M , Simonson S , Tobolowsky FA , James AE , Bordelon K , Fukunaga R , Gold JAW , Wortham J , Sokol T , Haydel D , Tran H , Kim K , Fisher KA , Marlow M , Tate JE , Doshi RH , Curran KG . MMWR Morb Mortal Wkly Rep 2020 69 (26) 836-840 Transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), by asymptomatic and presymptomatic persons poses important challenges to controlling spread of the disease, particularly in congregate settings such as correctional and detention facilities (1). On March 29, 2020, a staff member in a correctional and detention facility in Louisiana developed symptoms(dagger) and later had a positive test result for SARS-CoV-2. During April 2-May 7, two additional cases were detected among staff members, and 36 cases were detected among incarcerated and detained persons at the facility; these persons were removed from dormitories and isolated, and the five dormitories that they had resided in before diagnosis were quarantined. On May 7, CDC and the Louisiana Department of Health initiated an investigation to assess the prevalence of SARS-CoV-2 infection among incarcerated and detained persons residing in quarantined dormitories. Goals of this investigation included evaluating COVID-19 symptoms in this setting and assessing the effectiveness of serial testing to identify additional persons with SARS-CoV-2 infection as part of efforts to mitigate transmission. During May 7-21, testing of 98 incarcerated and detained persons residing in the five quarantined dormitories (A-E) identified an additional 71 cases of SARS-CoV-2 infection; 32 (45%) were among persons who reported no symptoms at the time of testing, including three who were presymptomatic. Eighteen cases (25%) were identified in persons who had received negative test results during previous testing rounds. Serial testing of contacts from shared living quarters identified persons with SARS-CoV-2 infection who would not have been detected by symptom screening alone or by testing at a single time point. Prompt identification and isolation of infected persons is important to reduce further transmission in congregate settings such as correctional and detention facilities and the communities to which persons return when released. |
COVID-19 Outbreak Among Three Affiliated Homeless Service Sites - King County, Washington, 2020.
Tobolowsky FA , Gonzales E , Self JL , Rao CY , Keating R , Marx GE , McMichael TM , Lukoff MD , Duchin JS , Huster K , Rauch J , McLendon H , Hanson M , Nichols D , Pogosjans S , Fagalde M , Lenahan J , Maier E , Whitney H , Sugg N , Chu H , Rogers J , Mosites E , Kay M . MMWR Morb Mortal Wkly Rep 2020 69 (17) 523-526 On March 30, 2020, Public Health - Seattle and King County (PHSKC) was notified of a confirmed case of coronavirus disease 2019 (COVID-19) in a resident of a homeless shelter and day center (shelter A). Residents from two other homeless shelters (B and C) used shelter A's day center services. Testing for SARS-CoV-2, the virus that causes COVID-19, was offered to available residents and staff members at the three shelters during March 30-April 1, 2020. Among the 181 persons tested, 19 (10.5%) had positive test results (15 residents and four staff members). On April 1, PHSKC and CDC collaborated to conduct site assessments and symptom screening, isolate ill residents and staff members, reinforce infection prevention and control practices, provide face masks, and advise on sheltering-in-place. Repeat testing was offered April 7-8 to all residents and staff members who were not tested initially or who had negative test results. Among the 118 persons tested in the second round of testing, 18 (15.3%) had positive test results (16 residents and two staff members). In addition to the 31 residents and six staff members identified through testing at the shelters, two additional cases in residents were identified during separate symptom screening events, and four were identified after two residents and two staff members independently sought health care. In total, COVID-19 was diagnosed in 35 of 195 (18%) residents and eight of 38 (21%) staff members who received testing at the shelter or were evaluated elsewhere. COVID-19 can spread quickly in homeless shelters; rapid interventions including testing and isolation to identify cases and minimize transmission are necessary. CDC recommends that homeless service providers implement appropriate infection control practices, apply physical distancing measures including ensuring resident's heads are at least 6 feet (2 meters) apart while sleeping, and promote use of cloth face coverings among all residents (1). |
Symptom Screening at Illness Onset of Health Care Personnel With SARS-CoV-2 Infection in King County, Washington.
Chow EJ , Schwartz NG , Tobolowsky FA , Zacks RLT , Huntington-Frazier M , Reddy SC , Rao AK . JAMA 2020 323 (20) 2087-2089 This study assessed the spectrum of initial symptoms at the onset of polymerase chain reaction-confirmed coronavirus disease 2019 (COVID-19) among health care personnel in King County, Washington. |
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