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Enhanced Contact Investigations for Nine Early Travel-Related Cases of SARS-CoV-2 in the United States

By Rachel M Burke, Sharon Balter, Emily Barnes, Vaughn Barry, Karri Bartlett, Karlyn D Beer, Isaac Benowitz, Holly M Biggs, Hollianne Bruce, Jonathan Bryant-Genevier, Jordan Cates, Kevin Chatham-Stephens, Nora Chea, Howard Chiou, Demian Christiansen, Victoria Chu, Shauna Clark, Sara H. Cody, Max Cohen, Erin E Conners, Vishal Dasari, Patrick Dawson, Traci DeSalvo, Matthew Donahue, Alissa Dratch, Lindsey Duca, Jeffrey Duchin, Jonathan W Dyal, Leora R. Feldstein, Marty Fenstersheib, Marc Fischer, Rebecca Fisher, Chelsea Foo, Brandi Freeman-Ponder, Alicia M. Fry, Jessica Gant, Romesh Gautom, Isaac Ghinai, Prabhu Gounder, Cheri T Grigg, Jeffrey Gunzenhauser, Aron J Hall, George S Han, Thomas Haupt, Michelle Holshue, Jennifer Hunter, Mireille B Ibrahim, Max W. Jacobs, M. Claire Jarashow, Kiran Joshi, Talar Kamali, Vance Kawakami, Moon Kim, Hannah Kirking, Amanda Kita-Yarbro, Rachel Klos, Miwako Kobayashi, Anna Kocharian, Misty Lang, Jennifer Layden, Eva Leidman, Scott Lindquist, Stephen Lindstrom, Ruth Link-Gelles, Mariel Marlow, Claire P Mattison, Nancy McClung, Tristan McPherson, Lynn Mello, Claire M. Midgley, Shannon Novosad, Megan T Patel, Kristen Pettrone, Satish K Pillai, Ian W Pray, Heather E Reese, Heather Rhodes, Susan Robinson, Melissa Rolfes, Janell Routh, Rachel Rubin, Sarah L. Rudman, Denny Russell, Sarah Scott, Varun Shetty, Sarah E Smith-Jeffcoat, Elizabeth A Soda, Chris Spitters, Bryan Stierman, Rebecca Sunenshine, Dawn Terashita, Elizabeth Traub, Grace E Vahey, Jennifer R. Verani, Megan Wallace, Matthew Westercamp, Jonathan Wortham, Amy Xie, Anna Yousaf, Matthew Zahn

Posted 03 May 2020
medRxiv DOI: 10.1101/2020.04.27.20081901

Background Coronavirus disease 2019 (COVID-19), the respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China and has since become pandemic. As part of initial response activities in the United States, enhanced contact investigations were conducted to enable early identification and isolation of additional cases and to learn more about risk factors for transmission. Methods Close contacts of nine early travel-related cases in the United States were identified. Close contacts meeting criteria for active monitoring were followed, and selected individuals were targeted for collection of additional exposure details and respiratory samples. Respiratory samples were tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (RT-PCR) at the Centers for Disease Control and Prevention. Results There were 404 close contacts who underwent active monitoring in the response jurisdictions; 338 had at least basic exposure data, of whom 159 had at least 1 set of respiratory samples collected and tested. Across all known close contacts under monitoring, two additional cases were identified; both secondary cases were in spouses of travel-associated case patients. The secondary attack rate among household members, all of whom had at least 1 respiratory sample tested, was 13% (95% CI: 4 - 38%). Conclusions The enhanced contact tracing investigations undertaken around nine early travel-related cases of COVID-19 in the United States identified two cases of secondary transmission, both spouses. Rapid detection and isolation of the travel-associated case patients, enabled by public awareness of COVID-19 among travelers from China, may have mitigated transmission risk among close contacts of these cases.

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