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Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States.
PLoS One. 2020; 15(9):e0238342.Plos

Abstract

Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19.

Authors+Show Affiliations

The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Public Health Madison & Dane County, Madison, Wisconsin, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Snohomish Health District, Everett, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Cook County Department of Public Health, Oak Forest, Illinois, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Public Health Seattle-King County, Seattle, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. County of Santa Clara, Public Health Department, San Jose, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Wisconsin Department of Health Services, Madison, Wisconsin, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Orange County Healthcare Agency, Santa Ana, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Public Health Seattle-King County, Seattle, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. San Benito County Public Health Services, Hollister, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Washington State Public Health Laboratories, Shoreline, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Washington State Department of Health, Shoreline, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Chicago Department of Public Health, Chicago, Illinois, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. County of Santa Clara, Public Health Department, San Jose, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Wisconsin Department of Health Services, Madison, Wisconsin, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Washington State Department of Health, Shoreline, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Cook County Department of Public Health, Oak Forest, Illinois, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Public Health Seattle-King County, Seattle, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Public Health Madison & Dane County, Madison, Wisconsin, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Wisconsin Department of Health Services, Madison, Wisconsin, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Wisconsin Department of Health Services, Madison, Wisconsin, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Washington State Public Health Laboratories, Shoreline, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Chicago Department of Public Health, Chicago, Illinois, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Washington State Department of Health, Shoreline, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Chicago Department of Public Health, Chicago, Illinois, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. San Benito County Public Health Services, Hollister, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Illinois Department of Public Health, Chicago, Illinois, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Wisconsin Department of Health Services, Madison, Wisconsin, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Wyoming Department of Health, Cheyenne, Wyoming, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Arizona Department of Health Services, Phoenix, Arizona, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Cook County Department of Public Health, Oak Forest, Illinois, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. County of Santa Clara, Public Health Department, San Jose, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Washington State Public Health Laboratories, Shoreline, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. Maricopa County Department of Public Health, Phoenix, Arizona, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Snohomish Health District, Everett, Washington, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Maricopa County Department of Public Health, Phoenix, Arizona, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Los Angeles County Department of Public Health, Los Angeles, California, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.The COVID-19 Close Contact Investigation Team, United States of America. Orange County Healthcare Agency, Santa Ana, California, United States of America.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32877446

Citation

Burke, Rachel M., et al. "Enhanced Contact Investigations for Nine Early Travel-related Cases of SARS-CoV-2 in the United States." PloS One, vol. 15, no. 9, 2020, pp. e0238342.
Burke RM, Balter S, Barnes E, et al. Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS One. 2020;15(9):e0238342.
Burke, R. M., Balter, S., Barnes, E., Barry, V., Bartlett, K., Beer, K. D., Benowitz, I., Biggs, H. M., Bruce, H., Bryant-Genevier, J., Cates, J., Chatham-Stephens, K., Chea, N., Chiou, H., Christiansen, D., Chu, V. T., Clark, S., Cody, S. H., Cohen, M., ... Zahn, M. (2020). Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PloS One, 15(9), e0238342. https://doi.org/10.1371/journal.pone.0238342
Burke RM, et al. Enhanced Contact Investigations for Nine Early Travel-related Cases of SARS-CoV-2 in the United States. PLoS One. 2020;15(9):e0238342. PubMed PMID: 32877446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. AU - Burke,Rachel M, AU - Balter,Sharon, AU - Barnes,Emily, AU - Barry,Vaughn, AU - Bartlett,Karri, AU - Beer,Karlyn D, AU - Benowitz,Isaac, AU - Biggs,Holly M, AU - Bruce,Hollianne, AU - Bryant-Genevier,Jonathan, AU - Cates,Jordan, AU - Chatham-Stephens,Kevin, AU - Chea,Nora, AU - Chiou,Howard, AU - Christiansen,Demian, AU - Chu,Victoria T, AU - Clark,Shauna, AU - Cody,Sara H, AU - Cohen,Max, AU - Conners,Erin E, AU - Dasari,Vishal, AU - Dawson,Patrick, AU - DeSalvo,Traci, AU - Donahue,Matthew, AU - Dratch,Alissa, AU - Duca,Lindsey, AU - Duchin,Jeffrey, AU - Dyal,Jonathan W, AU - Feldstein,Leora R, AU - Fenstersheib,Marty, AU - Fischer,Marc, AU - Fisher,Rebecca, AU - Foo,Chelsea, AU - Freeman-Ponder,Brandi, AU - Fry,Alicia M, AU - Gant,Jessica, AU - Gautom,Romesh, AU - Ghinai,Isaac, AU - Gounder,Prabhu, AU - Grigg,Cheri T, AU - Gunzenhauser,Jeffrey, AU - Hall,Aron J, AU - Han,George S, AU - Haupt,Thomas, AU - Holshue,Michelle, AU - Hunter,Jennifer, AU - Ibrahim,Mireille B, AU - Jacobs,Max W, AU - Jarashow,M Claire, AU - Joshi,Kiran, AU - Kamali,Talar, AU - Kawakami,Vance, AU - Kim,Moon, AU - Kirking,Hannah L, AU - Kita-Yarbro,Amanda, AU - Klos,Rachel, AU - Kobayashi,Miwako, AU - Kocharian,Anna, AU - Lang,Misty, AU - Layden,Jennifer, AU - Leidman,Eva, AU - Lindquist,Scott, AU - Lindstrom,Stephen, AU - Link-Gelles,Ruth, AU - Marlow,Mariel, AU - Mattison,Claire P, AU - McClung,Nancy, AU - McPherson,Tristan D, AU - Mello,Lynn, AU - Midgley,Claire M, AU - Novosad,Shannon, AU - Patel,Megan T, AU - Pettrone,Kristen, AU - Pillai,Satish K, AU - Pray,Ian W, AU - Reese,Heather E, AU - Rhodes,Heather, AU - Robinson,Susan, AU - Rolfes,Melissa, AU - Routh,Janell, AU - Rubin,Rachel, AU - Rudman,Sarah L, AU - Russell,Denny, AU - Scott,Sarah, AU - Shetty,Varun, AU - Smith-Jeffcoat,Sarah E, AU - Soda,Elizabeth A, AU - Spitters,Christopher, AU - Stierman,Bryan, AU - Sunenshine,Rebecca, AU - Terashita,Dawn, AU - Traub,Elizabeth, AU - Vahey,Grace M, AU - Verani,Jennifer R, AU - Wallace,Megan, AU - Westercamp,Matthew, AU - Wortham,Jonathan, AU - Xie,Amy, AU - Yousaf,Anna, AU - Zahn,Matthew, Y1 - 2020/09/02/ PY - 2020/05/19/received PY - 2020/08/15/accepted PY - 2020/9/3/entrez PY - 2020/9/3/pubmed PY - 2020/9/17/medline SP - e0238342 EP - e0238342 JF - PloS one JO - PLoS One VL - 15 IS - 9 N2 - Coronavirus disease 2019 (COVID-19), the respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. In response to the first cases identified in the United States, close contacts of confirmed COVID-19 cases were investigated to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Close contacts of nine early travel-related cases in the United States were identified and monitored daily for development of symptoms (active monitoring). Selected close contacts (including those with exposures categorized as higher risk) were targeted for collection of additional exposure information and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction at the Centers for Disease Control and Prevention. Four hundred four close contacts were actively monitored in the jurisdictions that managed the travel-related cases. Three hundred thirty-eight of the 404 close contacts provided at least basic exposure information, of whom 159 close contacts had ≥1 set of respiratory samples collected and tested. Across all actively monitored close contacts, two additional symptomatic COVID-19 cases (i.e., secondary cases) were identified; both secondary cases were in spouses of travel-associated case patients. When considering only household members, all of whom had ≥1 respiratory sample tested for SARS-CoV-2, the secondary attack rate (i.e., the number of secondary cases as a proportion of total close contacts) was 13% (95% CI: 4-38%). The results from these contact tracing investigations suggest that household members, especially significant others, of COVID-19 cases are at highest risk of becoming infected. The importance of personal protective equipment for healthcare workers is also underlined. Isolation of persons with COVID-19, in combination with quarantine of exposed close contacts and practice of everyday preventive behaviors, is important to mitigate spread of COVID-19. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/32877446/Enhanced_contact_investigations_for_nine_early_travel_related_cases_of_SARS_CoV_2_in_the_United_States_ L2 - https://dx.plos.org/10.1371/journal.pone.0238342 DB - PRIME DP - Unbound Medicine ER -