SARS-CoV-2 infection of BNT162b2(mRNA)-vaccinated individuals is not restricted to variants of concern or high-risk exposure environments

The emergence of SARS-CoV-2 variants of concern (VOC) has raised questions regarding the extent of protection of currently implemented vaccines. Ten "vaccination breakthrough" infections were identified in Alachua County, Florida, among individuals fully vaccinated with the BNT162b2 mRNA vaccine as a result of social or household transmission. Eight individuals presented mild symptoms in the absence of infection with other common respiratory viruses, confirmed using viral genetic sequencing. SARS-CoV-2 genomes were successfully generated for five of the vaccine breakthroughs and 399 individuals in the surrounding area and were included for reference-based phylogenetic investigation. These five individuals were characterized by infection with both VOCs and low-frequency variants present within the surrounding population. Mutations in the Spike protein were consistent with their respective circulating lineages, with the exception of a viable, low-frequency (approximately 1%) B.1.1.7 mutation, which we describe as a mutation of potential concern. The findings indicate that in cases of limited vaccine protection, infection is not restricted to VOCs or high-risk settings, highlighting the critical need for continued testing and monitoring of infection among individuals regardless of vaccination status.

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Evaluation of a home-based 7-day infection control strategy for healthcare workers following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2): A cohort study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1389 ◽

2020 ◽

pp. 1-4

Author(s):

Carla Benea ◽

Laura Rendon ◽

Jesse Papenburg ◽

Charles Frenette ◽

Ahmed Imacoudene ◽

...

Keyword(s):

High Risk ◽

Infection Control ◽

Control Strategy ◽

Healthcare Workers ◽

Control Strategies ◽

Risk Exposure ◽

Nasopharyngeal Swab ◽

Home Based ◽

Respiratory Coronavirus ◽

Second Wave

Abstract Objective: Evidence-based infection control strategies are needed for healthcare workers (HCWs) following high-risk exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). In this study, we evaluated the negative predictive value (NPV) of a home-based 7-day infection control strategy. Methods: HCWs advised by their infection control or occupational health officer to self-isolate due to a high-risk SARS-CoV-2 exposure were enrolled between May and October 2020. The strategy consisted of symptom-triggered nasopharyngeal SARS-CoV-2 RNA testing from day 0 to day 7 after exposure and standardized home-based nasopharyngeal swab and saliva testing on day 7. The NPV of this strategy was calculated for (1) clinical coronavirus disease 2019 (COVID-19) diagnosis from day 8–14 after exposure, and for (2) asymptomatic SARS-CoV-2 detected by standardized nasopharyngeal swab and saliva specimens collected at days 9, 10, and 14 after exposure. Interim results are reported in the context of a second wave threatening this essential workforce. Results: Among 30 HCWs enrolled, the mean age was 31 years (SD, ±9), and 24 (80%) were female. Moreover, 3 were diagnosed with COVID-19 by day 14 after exposure (secondary attack rate, 10.0%), and all cases were detected using the 7-day infection control strategy: the NPV for subsequent clinical COVID-19 or asymptomatic SARS-CoV-2 detection by day 14 was 100.0% (95% CI, 93.1%–100.0%). Conclusions: Among HCWs with high-risk exposure to SARS-CoV-2, a home-based 7-day infection control strategy may have a high NPV for subsequent COVID-19 and asymptomatic SARS-CoV-2 detection. Ongoing data collection and data sharing are needed to improve the precision of the estimated NPV, and here we report interim results to inform infection control strategies in light of a second wave threatening this essential workforce.

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451. Evaluation of Exposure History in Healthcare Personnel with Coronavirus 2019 Disease

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.644 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S293-S293

Author(s):

Sandra Silva ◽

Thriveen Mana ◽

Davinder Bhullar ◽

Beatrice Tabor ◽

Curtis Donskey

Keyword(s):

High Risk ◽

Risk Exposure ◽

Healthcare Personnel ◽

Administrative Personnel ◽

Asymptomatic Carriage ◽

Moderate Disease ◽

Control And Prevention ◽

History Of ◽

Exposure History ◽

Atypical Presentations

Abstract Background During the Coronavirus Disease 2019 (COVID-19) pandemic, many healthcare personnel (HCP) have developed COVID-19. However, there is uncertainty regarding whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was acquired at work versus in the community. Methods We conducted a cohort study to examine exposure history of personnel with COVID-19 infection or asymptomatic carriage in a VA healthcare system. High-risk exposures were classified based Centers for Disease Control and Prevention criteria. Results Of 578 personnel tested, 49 (8%) had nasopharyngeal swabs with positive PCR results, including 45 (92%) with and 4 (8%) without COVID-19 symptoms. Of the 49 cases, 21 (43%) had a documented high-risk exposure at work, including 14 exposures to COVID-19 patients and 7 exposures to colonized or infected personnel. Exposures to infected patients most often were a result of delays in recognition of COVID-19 due to atypical presentations. Exposures to personnel with COVID-19 most often involved activities such as meals when facemasks were not worn. Most cases occurred among nurses (26, 53%) and administrative personnel (10, 20%); only 3 physicians developed COVID-19. No cases occurred in personnel working on COVID-19 wards. All personnel had mild or moderate disease. Conclusion Forty-three percent of healthcare personnel with COVID-19 had prior high-risk exposures at work. Improved detection of patients with atypical presentations and efforts to reduce high-risk contacts among personnel may reduce the risk for acquisition of SARS-CoV-2. Disclosures All Authors: No reported disclosures

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High risk exposure to HIV among sexually active individuals who tested negative on rapid HIV Tests in the Tshwane District of South Africa—The importance of behavioural prevention measures

PLoS ONE ◽

10.1371/journal.pone.0192357 ◽

2018 ◽

Vol 13 (2) ◽

pp. e0192357 ◽

Cited By ~ 1

Author(s):

Simnikiwe H. Mayaphi ◽

Desmond J. Martin ◽

Steve A. S. Olorunju ◽

Brian G. Williams ◽

Thomas C. Quinn ◽

...

Keyword(s):

South Africa ◽

High Risk ◽

Risk Exposure ◽

Sexually Active ◽

Prevention Measures

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Current practices for treatment of respiratory syncytial virus and other non-influenza respiratory viruses in high-risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative

Transplant Infectious Disease ◽

10.1111/tid.12510 ◽

2016 ◽

Vol 18 (2) ◽

pp. 210-215 ◽

Cited By ~ 32

Author(s):

O.E. Beaird ◽

A. Freifeld ◽

M.G. Ison ◽

S.J. Lawrence ◽

N. Theodoropoulos ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

High Risk ◽

Respiratory Virus ◽

High Risk Patient ◽

Respiratory Viruses ◽

Risk Patient ◽

Syncytial Virus ◽

Current Practices

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Hepatitis B Awareness Among Medical Students And Their Vaccination Status In A Medical College In Western UP.

10.36106/ijsr/0601604 ◽

2019 ◽

pp. 57-59

Author(s):

Rajni Dawar ◽

Tabassum Yasmin ◽

Ajay Kumar Jha

Keyword(s):

Medical Students ◽

High Risk ◽

Data Collection ◽

Hepatitis B ◽

Health Care Professionals ◽

Hepatitis B Surface Antigen ◽

Vaccination Status ◽

Hepatitis B Vaccination ◽

Universal Precautions ◽

Medical College

Background: India is in the intermediate hepatitis B virus endemicity zone with hepatitis B surface antigen prevalence among the general population ranging from 2% to 8%.Health care professionals are at a high risk of getting .Hep B infection which can be prevented by strategies like vaccination, increasing awareness and following universal precautions. The present study was conducted on medical students (3rd Semester) to evaluate their knowledge regarding HBV and to know their vaccination status. Also along with data collection, students were educated about hepatitis B vaccine and about universal precautions before they start with their clinical postings. Methods: Cross sectional study was carried out on 3rd semester MBBS students (batch 2012-2013). All the students present on the day of data collection were included in the study and interviewed using pretested questionnaire. Data was analyzed using percentages. Results: Most of the students had good knowledge about disease and modes of transmission & prevention. Surprisingly only 56.6 percent were aware of high risk of transmission to health professional and doctors. Main source of information was media (85.4percent).Nearly 82% of the students were immunized and main reason among those unimmunized was unawareness about vaccine availability. Conclusions: It is recommended that Hepatitis B vaccination should be made available for all unimmunized students who enter medical profession. The orientation and sensitization programm should be held to create awareness regarding HBV infection preferably at the time of admission into medical college ,else no later than start of their clinical posting.

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Predicting SARS-CoV-2 infections for children and youth with single symptom screening

10.1101/2021.08.19.21262310 ◽

2021 ◽

Author(s):

Richard J. Webster ◽

Deepti Reddy ◽

Mary-Ann Harrison ◽

Ken J. Farion ◽

Jacqueline Wilmore ◽

...

Keyword(s):

High Risk ◽

Predictive Value ◽

Relative Frequency ◽

Respiratory Viruses ◽

Children And Youth ◽

Age Group ◽

Local Factors ◽

Cough Headache ◽

Symptom Screening ◽

Assessment Centre

AbstractSymptom-based SARS-CoV-2 screening and testing decisions in children have important implications on daycare and school exclusion policies. Single symptoms account for a substantial volume of testing and disruption to in-person learning and childcare, yet their predictive value is unclear, given the clinical overlap with other circulating respiratory viruses and non-infectious etiologies. We aimed to determine the relative frequency and predictive value of single symptoms for paediatric SARS-CoV-2 infections from an Ottawa COVID-19 assessment centre from October 2020 through April 2021.Overall, 46.3% (n=10,688) of pediatric encounters were for single symptoms, and 2.7% of these tested positive. The most common presenting single symptoms were rhinorrhea (31.8%), cough (17.4%) and fever (14.0%). Among children with high-risk exposures children in each age group, the following single symptoms had a higher proportion of positive SARS-CoV-2 cases compared to no symptoms; fever and fatigue (0-4 years); fever, cough, headache, and rhinorrhea (5-12 years); fever, loss of taste or smell, headache, rhinorrhea, sore throat, and cough (13-17 years). There was no evidence that the single symptom of either rhinorrhea or cough predicted SARS-CoV-2 infections among 0-4 year olds, despite accounting for a large volume (61.1%) of single symptom presentations in the absence of high-risk exposures.Symptom-based screening needs to be responsive to changes in evidence and local factors, including the expected resurgence of other respiratory viruses following relaxation of social distancing/masking, to reduce infection-related risks in schools and daycare settings.

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First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States—Maricopa County, Arizona, 2020

Clinical Infectious Diseases ◽

10.1093/cid/ciaa374 ◽

2020 ◽

Vol 71 (15) ◽

pp. 807-812 ◽

Cited By ~ 13

Author(s):

Sarah E Scott ◽

Karen Zabel ◽

Jennifer Collins ◽

Katherine C Hobbs ◽

Melissa J Kretschmer ◽

...

Keyword(s):

Public Health ◽

High Risk ◽

The United States ◽

Asymptomatic Infection ◽

Illness Severity ◽

Risk Exposure ◽

Intimate Contact ◽

Maricopa County ◽

Medium Risk ◽

County Resident

Abstract Background Coronavirus disease 2019 (COVID-19) causes a range of illness severity. Mild illness has been reported, but whether illness severity correlates with infectivity is unknown. We describe the public health investigation of a mildly ill, nonhospitalized COVID-19 case who traveled to China. Methods The case was a Maricopa County resident with multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–positive specimens collected on 22 January 2020. Contacts were persons exposed to the case on or after the day before case diagnostic specimen collection. Contacts were monitored for 14 days after last known exposure. High-risk contacts had close, prolonged case contact (≥ 10 minutes within 2 m). Medium-risk contacts wore all US Centers for Disease Control and Prevention–recommended personal protective equipment during interactions. Nasopharyngeal and oropharyngeal (NP/OP) specimens were collected from the case and high-risk contacts and tested for SARS-CoV-2. Results Paired case NP/OP specimens were collected for SARS-CoV-2 testing at 11 time points. In 8 pairs (73%), ≥ 1 specimen tested positive or indeterminate, and in 3 pairs (27%) both tested negative. Specimens collected 18 days after diagnosis tested positive. Sixteen contacts were identified; 11 (69%) had high-risk exposure, including 1 intimate contact, and 5 (31%) had medium-risk exposure. In total, 35 high-risk contact NP/OP specimens were collected for SARS-CoV-2 testing; all 35 pairs (100%) tested negative. Conclusions This report demonstrates that SARS-CoV-2 infection can cause mild illness and result in positive tests for up to 18 days after diagnosis, without evidence of transmission to close contacts. These data might inform public health strategies to manage individuals with asymptomatic infection or mild illness.

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Risk-adapted screening in bladder cancer with the open-access tool RiskCheck Bladder Cancer: Proof of principle by the health service research foundation IQUO.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1571 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1571-1571

Author(s):

Goetz Geiges ◽

Frank Koenig ◽

Gerson Lüdecke ◽

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Open Access ◽

Classification Tree ◽

False Negative ◽

Risk Exposure ◽

Service Research ◽

Daily Routine ◽

Risk Population ◽

Asymptomatic Patients

1571 Background: The open-access questionnaire RiskCheck Bladder Cancer (RCBC) was proven in daily routine work from German urologists organized in the health services research foundation IQUO on asymptomatic patients to identify BC risk exposure and its relation to detectable tumors. Methods: The open-access RCBC questionnaire checked asymptomatic patients for their BC risk exposure in relation to personal-, smoking-, occupation- and medical induced risk. This resulted in a risk stratification with low- intermediate- and high risk. The intermediate and high risk subjects were checked for tumor presence by routine diagnostics. IBM-SPSS 20 was used for descriptive statistics and effectiveness was proven by classification tree analysis and cross-table analysis with Chi-square test. Results: Out of 303 checked asymptomatic persons 274 (90.4%) were negative for tumor and 29 (9.6%) had a detectable tumor. In the group of NED 176 (68.1%) persons were classified as low risk, and 98 (16.2%) with tumor risk. Out of the 29 detected tumors 20 were at intermediate or high risk (68.9%). This resulted in an over all detection rate of 6.6% and focused on the risk population of 16.9%. The RCBC risk assessment was significant (p < 0.01). Sensitivity 69.0%, specificity 64.2%, NPV 95.1%, PPV 16.9%, false positive cases 35.8%, false negative cases 31.0%, accuracy 64.7%. Compared to the common incidence (35/100,000) this is an increase in effectiveness of 188.6 in the screened population and 482.8 in relation to the risk population alone. Conclusions: Preventive medical care becomes effective because RCBC is able to condense a population with focusing investigations on people living under risk. A reasonable preventive care by a yearly recall control in urological offices for the risk population (32.3%) can be organized. In consequence the assessment is work effective, aim achieving and in result cost effective. The questionnaire RCBC integrates evidence based bladder cancer inductors, is easy in use and as a open-access tool available in 10 languages via internet to all medical services. www.riskcheck-bladder-cancer.info.

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