On June 9, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Compared with the volume of data on coronavirus disease 2019 (COVID-19) outbreaks among older adults, relatively few data are available concerning COVID-19 in younger, healthy persons in the United States (1,2). In late March 2020, the aircraft carrier USS Theodore Roosevelt arrived at port in Guam after numerous U.S. service members onboard developed COVID-19. In April, the U.S. Navy and CDC investigated this outbreak, and the demographic, epidemiologic, and laboratory findings among a convenience sample of 382 service members serving aboard the aircraft carrier are reported in this study. The outbreak was characterized by widespread transmission with relatively mild symptoms and asymptomatic infection among this sample of mostly young, healthy adults with close, congregate exposures. Service members who reported taking preventive measures had a lower infection rate than did those who did not report taking these measures (e.g., wearing a face covering, 55.8% versus 80.8%; avoiding common areas, 53.8% versus 67.5%; and observing social distancing, 54.7% versus 70.0%, respectively). The presence of neutralizing antibodies, which represent antibodies that inhibit SARS-CoV-2, among the majority (59.2%) of those with antibody responses is a promising indicator of at least short-term immunity. This report improves the understanding of COVID-19 in the U.S. military and among young adults in congregate settings and reinforces the importance of preventive measures to lower risk for infection in similar environments. In mid-January, the USS Theodore Roosevelt was deployed to the western Pacific. An outbreak of COVID-19 occurred during deployment, which resulted in the aircraft carrier stopping in Guam at the end of March. During this time, approximately 1,000 service members were determined to be infected with SARS-CoV-2, the virus that causes COVID-19. The United States Navy and CDC investigated this ongoing outbreak during April 20-24; 382 service members voluntarily completed questionnaires and provided serum specimens (a convenience sample comprising 27% of 1,417 service members staying at the base on Guam or on the ship). The 1,417 included persons who were previously infected, currently infected, or never infected. Among these 382 service members,

, et al. (2020) Enhanced contact investigations for nine early travel-related cases of SARS-CoV-2 in the United States. PLoS ONE 15(9): e0238342.

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the CDC COVID-19 Response Team 1We evaluated the performance of self-collected anterior nasal swab (ANS) and saliva samples compared with healthcare worker-collected nasopharyngeal swab specimens used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used the same PCR diagnostic panel to test all self-collected and healthcare worker-collected samples from participants at a public hospital in Atlanta, Georgia, USA. Among 1,076 participants, 51.9% were men, 57.1% were >50 years of age, 81.2% were Black (non-Hispanic), and 74.9% reported >1 chronic medical condition. In total, 8.0% tested positive for SARS-CoV-2. Compared with nasopharyngeal swab samples, ANS samples had a sensitivity of 59% and saliva samples a sensitivity of 68%. Among participants tested 3-7 days after symptom onset, ANS samples had a sensitivity of 80% and saliva samples a sensitivity of 85%. Sensitivity varied by specimen type and patient characteristics. These fi ndings can help physicians interpret PCR results for SARS-CoV-2. 1 Members are listed at the end of this article.

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.

Global progress and gaps in tuberculosis screening and treatment among people with HIV: experience from 32 countries Tuberculosis (TB) is responsible for roughly one-third of HIV-associated deaths among people with HIV (PWH). Despite the known risk among this population, only 56% (456 385) of an estimated 815 000 people with TB/HIV globally received a TB diagnosis and were reported in 2019 [1]. To close this gap, the WHO recommends screening PWH at every clinical encounter for cough of any duration, fever, weight loss and night sweats, followed by sputum testing with a WHO-recommended rapid diagnostic test when symptoms are present. Ruling out active disease is also crucial for safely initiating TB preventive treatment (TPT), which is a critical component of care for PWH. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the world's largest HIV programme that provides antiretroviral therapy (ART) to 17Á4 million people (roughly 65% of all PWH receiving ART), aligns with WHO guidance regarding TB screening [1,2]. We assess TB screening among ART patients in PEPFAR-supported sites and review existing literature on TB screening among PWH.

Background The natural history and clinical progression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can be better understood using combined serological and reverse transcription polymerase chain reaction (RT-PCR) testing. Methods Nasopharyngeal swabs and serum were collected at a single time-point from patients at an urban, public hospital August – November 2020 and tested for SARS-CoV-2 using RT-PCR, viral culture, and anti-Spike pan-Ig antibody testing. Participant demographics and symptoms were collected through interview. Chi-squared and Fisher’s exact tests were used to identify associations between RT-PCR and serology results with presence of viable virus and frequency of symptoms. Results Among 592 participants, 129 (21.8%) had evidence of SARS-CoV-2 infection by RT-PCR or serology. Presence of SARS-CoV-2 antibodies was strongly associated with lack of viable virus (p-value=0.016). COVID-19 symptom frequency was similar for patients testing RT-PCR positive/seronegative and patients testing RT-PCR positive/seropositive. Patients testing RT-PCR positive/seronegative reported headaches, fatigue, diarrhea and vomiting at rates not statistically significantly different from those testing RT-PCR negative/seropositive. Conclusions While patients testing SARS-CoV-2 seropositive were unlikely to test positive for viable virus and were therefore low-risk for forward transmission, COVID-19 symptoms were common. Paired SARS-CoV-2 RT-PCR and antibody testing provides more nuanced understanding of patients’ COVID-19 status.