Clustering of SARS-CoV-2 Infections in Households of Patients Diagnosed in the Outpatient Setting in Baltimore, Maryland

Demko, Zoe O; Antar, Annukka A.R.; Blair, Paul W; Lambrou, Anastasia S.; Yu, Tong; Brown, Diane; Walch, Samantha N; Armstrong, Derek T; Mostafa, Heba H.; Keruly, Jeanne C.; Thomas, David L.; Manabe, Yukari C.; Mehta, Shruti H.; Reuland, Carolyn; Azamfirei, Răzvan; Hardick, Justin; Church, Taylor R.; Sewell, Thelio T; Keller, Sara C.; Sauer, Lauren; Tornheim, Jeffrey A.; Townsend, Jennifer; Bachu, Vismaya S; Barnaba, Brittany; Charles, Curtisha; Dai, Weiwei; Payton, Christine; Fuchs, Joelle; Holden, Jeffrey; Jang, Minyoung; Johnstone, J; Kruczynski, Kate; Kusemiju, Oyinkansola; Li, Lucy; Tuchler, Amanda; Montana, Manuela Plazas; Prizzi, Michelle; Ursin, Rebecca L.

doi:10.1093/ofid/ofab121

Cited by 5 publications

(11 citation statements)

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“…The estimated overall household SAR for all 87 studies was 18.9% (95% CI, 16.2%-22.0%), with significant heterogeneity ( I 2 = 99.4%; P < .001) ( Figure 2 ). Excluding studies with only asymptomatic 85 or pediatric 36 , 66 index cases, studies that tested only 7 , 9 , 15 , 17 , 19 , 24 , 26 , 29 , 30 , 31 , 35 , 37 , 45 , 47 , 61 , 65 , 68 , 69 , 71 , 77 , 79 , 81 , 82 , 86 , 87 , 90 , 92 , 94 or asymptomatic 78 contacts, studies with long follow-up periods (≥21 days), 5 , 8 , 9 , 23 , 46 , 92 and studies published as preprints, 8 , 23 , 24 , 29 , 45 , 79 , 88 , 89 , 90 , 92 the overall SAR among the 47 remaining studies 4 , 6 , 10 , 11 , 12 , 13 , 14 , …”

Section: Resultsmentioning

confidence: 99%

“…This updated systematic review and meta-analysis found that, with the addition of 37 studies, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 the estimated overall household SAR of SARS-CoV-2 was 18.9%, which is similar to the estimate in the previous review. 1 Nonetheless, when analyzing SAR by study period, we observed an increase in household transmission over time.…”

Section: Discussionmentioning

confidence: 99%

“…Characteristics of Studies Included in Analysis of Household Secondary Attack Rates for SARS-CoV-2 (continued) ,23,24,29,37,40,45,79,[88][89][90]92 21.0(13.8-30.6) No 75[4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20][21][22][25][26][27][28][30][31][32][33][34][35][36][37][38][39][74][75][76][77][78][80][81][82][83][84]…”

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confidence: 99%

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Factors Associated With Household Transmission of SARS-CoV-2

et al. 2021

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IMPORTANCE A previous systematic review and meta-analysis of household transmission of SARS-CoV-2 that summarized 54 published studies through October 19, 2020, found an overall secondary attack rate (SAR) of 16.6% (95% CI, 14.0%-19.3%). However, the understanding of household secondary attack rates for SARS-CoV-2 is still evolving, and updated analysis is needed.OBJECTIVE To use newly published data to further the understanding of SARS-CoV-2 transmission in the household.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors Associated With Household Transmission of SARS-CoV-2

et al. 2021

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“…To our knowledge, there are no fit-for-purpose PROs available. Although the Flu-PRO has been used as a PRO to measure COVID-19, 8,9 it has not been validated in outpatients with the disease. The development of the SE-C19 addresses the important unmet need for a standardized method for evaluating COVID-19 symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…6 Currently, there are no existing patient-reported outcome measures (PROs) specific to COVID-19 symptoms. Other PROs specific to influenza and influenza-like illnesses (eg, Flu-PRO 7 ) have been used in COVID-19, 8,9 but have not been developed for or validated in this population. A targeted PRO is needed to support accurate measurement of COVID-19 symptoms, document their severity, and assess resolution.…”

Section: Introductionmentioning

confidence: 99%

Development and Content Validation of the Symptoms Evolution of COVID-19: A Patient-Reported Electronic Daily Diary in Clinical and Real-World Studies

Rofail

McGale²,

Rams³

et al. 2021

Preprint

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Importance: At the onset of the COVID-19 pandemic, there was limited understanding of symptom experience and disease progression. Objective: We developed and validated a fit-for-purpose, disease-specific instrument to assess symptoms in patients with COVID-19 to inform endpoints in an interventional trial for non-hospitalized patients. Design: The initial drafting of the 23-item Symptoms Evolution of COVID-19 (SE-C19) Instrument was developed based on the Centers for Disease Control and Prevention symptom list and available published literature specific to patients with COVID-19 as of Spring 2020. The measurement principles in the Food and Drug Administration patient-reported outcomes guidance and the four methodological Patient-Focused Drug Development Guidances were also considered. Setting: Interviews were conducted virtually with patients recruited through a healthcare research firm. Participants: Semi-structured qualitative interviews were conducted with a purposive sample of 30 non-hospitalized patients with COVID-19 Intervention: Interviews involved two stages: (1) concept elicitation, to obtain information about the symptoms experienced as a result of COVID-19 in patients' own words, and (2) cognitive debriefing, for patients to describe their understanding of the SE-C19 instructions, specific symptoms, response options, and recall period to ensure the content of the SE-C19 is relevant and comprehensive. Five clinicians treating COVID-19 outpatients were interviewed to obtain their insights on symptoms experienced by patients and provide input on the SE-C19. Main Outcome and Measure: Patients reported no issues regarding the relevance or appropriateness of the SE-C19 instructions, including the recall period. The comprehensiveness of the SE-C19 was confirmed against the conceptual model developed in the qualitative research. Minor conceptual gaps were revealed to capture nuances in the experience of nasal and gustatory symptoms, and systemic manifestations of sickness. Almost all items were endorsed by patients as being appropriate and well understood. The clinicians largely approved all items, response options, and recall period. Conclusions and Relevance: The qualitative research provided supportive evidence of the content validity of the SE-C19 instrument to assess the symptoms of outpatients with COVID-19 and its use in clinical trials to evaluate the benefit of treatment. Minor changes may be considered to improve conceptual clarity and ease of responding. Trial Registration: R10933-10987-COV-2067 (https://clinicaltrials.gov/ct2/show/NCT04425629)

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Emergency Myelopoiesis Distinguishes Multisystem Inflammatory Syndrome in Children From Pediatric Severe Coronavirus Disease 2019

Roznik,

Andargie,

Johnston

et al. 2024

The Journal of Infectious Diseases

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Background Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition caused by recent SARS-CoV-2 infection, but the underlying immunological mechanisms driving this distinct syndrome are unknown. Methods We utilized high dimensional flow cytometry, cell-free (cf) DNA, and cytokine and chemokine profiling to identify mechanisms of critical illness distinguishing MIS-C from severe acute COVID-19 (SAC). Results Compared to SAC, MIS-C patients demonstrated profound innate immune cell death and features of emergency myelopoiesis (EM), an understudied phenomenon observed in severe inflammation. EM signatures were characterized by fewer mature myeloid cells in the periphery and decreased expression of HLA-DR and CD86 on antigen presenting cells. IL-27, a cytokine known to drive hematopoietic stem cells towards EM, was increased in MIS-C, and correlated with immature cell signatures in MIS-C. Upon recovery, EM signatures decreased, and IL-27 plasma levels returned to normal levels. Despite profound lymphopenia, we report a lack of cfDNA released by adaptive immune cells and increased CCR7 expression on T cells indicative of egress out of peripheral blood. Conclusions Immune cell signatures of EM combined with elevated innate immune cell-derived cfDNA levels distinguish MIS-C from SAC in children and provide mechanistic insight into dysregulated immunity contributing towards MIS-C, offering potential diagnostic and therapeutic targets.

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Clustering of SARS-CoV-2 Infections in Households of Patients Diagnosed in the Outpatient Setting in Baltimore, Maryland

Cited by 5 publications

References 9 publications

Factors Associated With Household Transmission of SARS-CoV-2

Factors Associated With Household Transmission of SARS-CoV-2

Development and Content Validation of the Symptoms Evolution of COVID-19: A Patient-Reported Electronic Daily Diary in Clinical and Real-World Studies

Emergency Myelopoiesis Distinguishes Multisystem Inflammatory Syndrome in Children From Pediatric Severe Coronavirus Disease 2019

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