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Article ; Online: HIV Recent Infection and Past HIV Testing History Among Newly HIV-Diagnosed 15-24-Year-Olds in Malawi: An Analysis of 2019-2022 HIV Recent Infection Surveillance Data.

Kabaghe, Alinune N / Stephens, Reno / Payne, Danielle / Theu, Joe / Luhanga, Misheck / Chalira, Davie / Arons, Melissa M / O'Malley, Gabrielle / Thomson, Kerry A / Nyangulu, Mtemwa / Nyirenda, Rose / Patel, Pragna / Wadonda-Kabondo, Nellie

AIDS education and prevention : official publication of the International Society for AIDS Education

2023 Volume 35, Page(s) 4–19

Abstract: Awareness of HIV status in Malawi is 88.3% and lowest among 15-24-year-olds (76.2%). There is a need to understand HIV testing history and transmission in this age group. We analyzed pooled HIV surveillance data to describe testing history and HIV recent ...

Abstract	Awareness of HIV status in Malawi is 88.3% and lowest among 15-24-year-olds (76.2%). There is a need to understand HIV testing history and transmission in this age group. We analyzed pooled HIV surveillance data to describe testing history and HIV recent infection among 8,389 HIV-positive 15-24-year-olds from 251 sites in Malawi between 2019 and 2022. Most HIV-positive 15-24-year-olds were female; aged 23-24 years; rural residents; and diagnosed at voluntary counseling and testing. No prior HIV testing was reported in 43.5% and 32.9% of 15-19-year-olds and males, respectively. Overall, 4.9% of HIV-positive diagnoses were classified as recent HIV infections, with the highest proportions among breastfeeding women (8.2%); persons tested at sexually transmitted infection clinics (9.0%); persons with a prior negative test within 6 months (13.0%); and 17-18-year-olds (7.3%). Tailored and innovative HIV prevention and testing strategies for young adolescents, young males, and pregnant and breastfeeding women are needed for HIV epidemic control.
MeSH term(s)	Male ; Pregnancy ; Adolescent ; Female ; Humans ; HIV Infections/prevention & control ; Malawi/epidemiology ; HIV Testing ; Counseling ; Acquired Immunodeficiency Syndrome
Language	English
Publishing date	2023-07-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1075448-9
ISSN	1943-2755 ; 0899-9546
ISSN (online)	1943-2755
ISSN	0899-9546
DOI	10.1521/aeap.2023.35.suppA.4
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Article ; Online: Correction: Acceptability and feasibility of HIV recent infection surveillance by healthcare workers using a rapid test for recent infection at HIV testing sites - Malawi, 2019.

Arons, Melissa M / Curran, Kathryn G / Msukwa, Malango / Theu, Joe / O'Malley, Gabrielle / Ernst, Alexandra / Namakhoma, Ireen / Bello, George / Telford, Carson / Shanmugam, Vedapuri / Parekh, Bharat / Kim, Evelyn / Dobbs, Trudy / Payne, Danielle / Gugsa, Salem

BMC health services research

2022 Volume 22, Issue 1, Page(s) 917

Language	English
Publishing date	2022-07-15
Publishing country	England
Document type	Published Erratum
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-08303-9
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Article ; Online: Acceptability and feasibility of HIV recent infection surveillance by healthcare workers using a rapid test for recent infection at HIV testing sites - Malawi, 2019.

BMC health services research

2022 Volume 22, Issue 1, Page(s) 341

Abstract: Background: The Malawi Ministry of Health implemented a new surveillance activity in April 2019 to detect recent HIV infections using a rapid test for recent infection (RTRI) to identify areas of ongoing transmission and guide response activities.: ... ...

Abstract	Background: The Malawi Ministry of Health implemented a new surveillance activity in April 2019 to detect recent HIV infections using a rapid test for recent infection (RTRI) to identify areas of ongoing transmission and guide response activities. Setting: At 23 health facilities in Blantyre District, healthcare workers (HCWs) were trained to conduct recent infection testing. In September 2019, we conducted a cross-sectional survey at these sites to explore the acceptability and feasibility of integrating this activity into routine HIV testing services (HTS). Methods: Research assistants interviewed HCWs using a semi-structured survey. Descriptive statistics were used to summarize quantitative responses and thematic analysis was used to group open-ended text. Results: We interviewed 119 HCWs. Eighty-two percent of participants reported the RTRI was easy-to-use. HCWs perceived high client acceptability; 100% reported clients as 'somewhat' or 'very accepting'. Challenges included 68% of HCWs estimating they spend ≥20 min beyond routine HTS per client for this activity and 51% performing at least two additional finger pricks to complete the testing algorithm. HCWs differed in their perceptions of whether results should be returned to clients. Conclusion: This study assessed HCW experiences using point-of-care RTRIs for HIV recent infection surveillance. Overall, HCWs perceived RTRIs to be acceptable, easy-to-use, and valuable. Though only clients with new HIV diagnoses are tested for recent infection, additional time may be substantial at high-volume health service delivery points. Providing response plans or aggregated recent infection results to HCWs and/or clients may support motivation and sustainability of this novel surveillance activity.
MeSH term(s)	Cross-Sectional Studies ; Feasibility Studies ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Testing ; Health Personnel ; Humans ; Malawi
Language	English
Publishing date	2022-03-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07600-7
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Article ; Online: Immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination among nursing home residents-Georgia, October 2020-July 2022.

Chisty, Zeshan A / Li, Deana D / Haile, Melia / Houston, Hollis / DaSilva, Juliana / Overton, Rahsaan / Schuh, Amy J / Haynie, Jenn / Clemente, Jacob / Branch, Alicia G / Arons, Melissa M / Tsang, Clarisse A / Pellegrini, Gerald J / Bugrysheva, Julia / Ilutsik, Justina / Mohelsky, Romy / Comer, Patricia / Hundia, Solomon B / Oh, Hyungseok /

Stuckey, Matthew J / Bohannon, Caitlin D / Rasheed, Mohammed Ata Ur / Epperson, Monica / Thornburg, Natalie J / McDonald, L Clifford / Brown, Allison C / Kutty, Preeta K

PloS one

2024 Volume 19, Issue 4, Page(s) e0301367

Abstract: Background: Understanding the immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination is important in nursing home (NH) residents, a high-risk population.: Methods: An observational longitudinal evaluation of 37 consenting ... ...

Abstract	Background: Understanding the immune response kinetics to SARS-CoV-2 infection and COVID-19 vaccination is important in nursing home (NH) residents, a high-risk population. Methods: An observational longitudinal evaluation of 37 consenting vaccinated NH residents with/without SARS-CoV-2 infection from October 2020 to July 2022 was conducted to characterize the immune response to spike protein due to infection and/or mRNA COVID-19 vaccine. Antibodies (IgG) to SARS-CoV-2 full-length spike, nucleocapsid, and receptor binding domain protein antigens were measured, and surrogate virus neutralization capacity was assessed using Meso Scale Discovery immunoassays. The participant's spike exposure status varied depending on the acquisition of infection or receipt of a vaccine dose. Longitudinal linear mixed effects modeling was used to describe trajectories based on the participant's last infection or vaccination; the primary series mRNA COVID-19 vaccine was considered two spike exposures. Mean antibody titer values from participants who developed an infection post receipt of mRNA COVID-19 vaccine were compared with those who did not. In a subset of participants (n = 15), memory B cell (MBC) S-specific IgG (%S IgG) responses were assessed using an ELISPOT assay. Results: The median age of the 37 participants at enrollment was 70.5 years; 30 (81%) had prior SARS-CoV-2 infection, and 76% received Pfizer-BioNTech and 24% Moderna homologous vaccines. After an observed augmented effect with each spike exposure, a decline in the immune response, including %S IgG MBCs, was observed over time; the percent decline decreased with increasing spike exposures. Participants who developed an infection at least two weeks post-receipt of a vaccine were observed to have lower humoral antibody levels than those who did not develop an infection post-receipt. Conclusions: These findings suggest that understanding the durability of immune responses in this vulnerable NH population can help inform public health policy regarding the timing of booster vaccinations as new variants display immune escape.
MeSH term(s)	Humans ; Aged ; COVID-19/prevention & control ; COVID-19 Vaccines ; Georgia ; SARS-CoV-2 ; Vaccination ; Immunity ; Nursing Homes ; RNA, Messenger ; Immunoglobulin G ; Antibodies, Viral
Chemical Substances	COVID-19 Vaccines ; RNA, Messenger ; Immunoglobulin G ; Antibodies, Viral
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0301367
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Article ; Online: Acceptability and feasibility of HIV recent infection surveillance by healthcare workers using a rapid test for recent infection at HIV testing sites — Malawi, 2019

Melissa M. Arons / Kathryn G. Curran / Malango Msukwa / Joe Theu / Gabrielle O’Malley / Alexandra Ernst / Ireen Namakhoma / George Bello / Carson Telford / Vedapuri Shanmugam / Bharat Parekh / Evelyn Kim / Trudy Dobbs / Danielle Payne / Salem Gugsa

BMC Health Services Research, Vol 22, Iss 1, Pp 1-

2022 Volume 8

Abstract: Abstract Background The Malawi Ministry of Health implemented a new surveillance activity in April 2019 to detect recent HIV infections using a rapid test for recent infection (RTRI) to identify areas of ongoing transmission and guide response activities. ...

Abstract	Abstract Background The Malawi Ministry of Health implemented a new surveillance activity in April 2019 to detect recent HIV infections using a rapid test for recent infection (RTRI) to identify areas of ongoing transmission and guide response activities. Setting At 23 health facilities in Blantyre District, healthcare workers (HCWs) were trained to conduct recent infection testing. In September 2019, we conducted a cross-sectional survey at these sites to explore the acceptability and feasibility of integrating this activity into routine HIV testing services (HTS). Methods Research assistants interviewed HCWs using a semi-structured survey. Descriptive statistics were used to summarize quantitative responses and thematic analysis was used to group open-ended text. Results We interviewed 119 HCWs. Eighty-two percent of participants reported the RTRI was easy-to-use. HCWs perceived high client acceptability; 100% reported clients as ‘somewhat’ or ‘very accepting’. Challenges included 68% of HCWs estimating they spend ≥20 min beyond routine HTS per client for this activity and 51% performing at least two additional finger pricks to complete the testing algorithm. HCWs differed in their perceptions of whether results should be returned to clients. Conclusion This study assessed HCW experiences using point-of-care RTRIs for HIV recent infection surveillance. Overall, HCWs perceived RTRIs to be acceptable, easy-to-use, and valuable. Though only clients with new HIV diagnoses are tested for recent infection, additional time may be substantial at high-volume health service delivery points. Providing response plans or aggregated recent infection results to HCWs and/or clients may support motivation and sustainability of this novel surveillance activity.
Keywords	HIV ; Surveillance systems ; Healthcare workers ; Acceptability ; Feasibility ; Point-of-care test ; recent infection surveillance ; RTRIs ; Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Examining the temporality of vitamin E acetate in illicit THC-containing e-cigarette, or vaping, products from a public health and law enforcement response to EVALI - Utah, 2018-2020.

Arons, Melissa M / Barnes, Stephen R / Cheng, Rita / Whittle, Kelly / Elsholz, Christopher / Bui, David / Gilley, Stephen / Maldonado, Alejandra / LaCross, Nathan / Sage, Kylie / Lewis, Nathaniel / McCaffrey, Keegan / Green, Jordan / Duncan, Janae / Dunn, Angela C

The International journal on drug policy

2020 Volume 88, Page(s) 103026

Abstract: Background: In the summer of 2019, e-cigarette, or vaping, product use-associated lung injury (EVALI) was detected in the United States. Multiple agencies reported illicit tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products containing ...

Abstract	Background: In the summer of 2019, e-cigarette, or vaping, product use-associated lung injury (EVALI) was detected in the United States. Multiple agencies reported illicit tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products containing vitamin E acetate (VEA) as a substance of concern. Methods: As an expansion of the Utah Department of Health's response to EVALI, the Utah Public Health Laboratory and the Utah Department of Public Safety screened 170 products from 96 seizures between October 2018 and January 2020. Using Pearson's correlation coefficient, we analyzed the temporal correlation of national, and Utah specific case counts, and the percentage of seizures indicating VEA by month. Results: The findings indicate strong and significant correlations between seizures indicating VEA and both the national (r = 0.70, p = 0.002) and Utah specific (r = 0.78, p < 0.001) case counts. Conclusion: These findings underscore that VEA should not be added to e-cigarettes, or vaping, products and the importance of collaboration with law enforcement when responding to outbreaks associated with illicit substances.
MeSH term(s)	Acetates ; Dronabinol ; Electronic Nicotine Delivery Systems ; Humans ; Law Enforcement ; Public Health ; United States/epidemiology ; Utah/epidemiology ; Vaping ; Vitamin E
Chemical Substances	Acetates ; Vitamin E (1406-18-4) ; Dronabinol (7J8897W37S)
Language	English
Publishing date	2020-11-24
Publishing country	Netherlands
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2010000-0
ISSN	1873-4758 ; 0955-3959
ISSN (online)	1873-4758
ISSN	0955-3959
DOI	10.1016/j.drugpo.2020.103026
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Article ; Online: Geospatial Transmission Hotspots of Recent HIV Infection - Malawi, October 2019-March 2020.

Telford, Carson T / Tessema, Zaena / Msukwa, Malango / Arons, Melissa M / Theu, Joe / Bangara, Fred Fredrick / Ernst, Alexandra / Welty, Susie / O'Malley, Gabrielle / Dobbs, Trudy / Shanmugam, Vedapuri / Kabaghe, Alinune / Dale, Helen / Wadonda-Kabondo, Nellie / Gugsa, Salem / Kim, Andrea / Bello, George / Eaton, Jeffrey W / Jahn, Andreas /

Nyirenda, Rose / Parekh, Bharat S / Shiraishi, Ray W / Kim, Evelyn / Tobias, James L / Curran, Kathryn G / Payne, Danielle / Auld, Andrew F

MMWR. Morbidity and mortality weekly report

2022 Volume 71, Issue 9, Page(s) 329–334

Abstract: Persons infected with HIV are more likely to transmit the virus during the early stages (acute and recent) of infection, when viral load is elevated and opportunities to implement risk reduction are limited because persons are typically unaware of their ... ...

Abstract	Persons infected with HIV are more likely to transmit the virus during the early stages (acute and recent) of infection, when viral load is elevated and opportunities to implement risk reduction are limited because persons are typically unaware of their status (1,2). Identifying recent HIV infections (acquired within the preceding 12 months)* is critical to understanding the factors and geographic areas associated with transmission to strengthen program intervention, including treatment and prevention (2). During June 2019, a novel recent infection surveillance initiative was integrated into routine HIV testing services in Malawi, a landlocked country in southeastern Africa with one of the world's highest prevalences of HIV infection.
MeSH term(s)	Adult ; Disease Hotspot ; Female ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Infections/transmission ; HIV Testing/methods ; Humans ; Malawi/epidemiology ; Male ; Public Health ; Sentinel Surveillance ; Software ; Spatial Analysis ; Young Adult
Language	English
Publishing date	2022-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm7109a1
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Article ; Online: Identification of Presymptomatic and Asymptomatic Cases Using Cohort-Based Testing Approaches at a Large Correctional Facility-Chicago, Illinois, USA, May 2020.

Wadhwa, Ashutosh / Fisher, Kiva A / Silver, Rachel / Koh, Mitsuki / Arons, Melissa M / Miller, David A / McIntyre, Anne F / Vuong, Jeni T / Kim, Kaylee / Takamiya, Mayuko / Binder, Alison M / Tate, Jacqueline E / Armstrong, Paige A / Black, Stephanie R / Mennella, Connie C / Levin, Rebecca / Gubser, Jane / Jones, Bridgette / Welbel, Sharon F /

Moonan, Patrick K / Curran, Kathryn / Ghinai, Isaac / Doshi, Reena / Zawitz, Chad J

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2020 Volume 72, Issue 5, Page(s) e128–e135

Abstract: Background: Coronavirus disease 2019 (COVID-19) continues to cause significant morbidity and mortality worldwide. Correctional and detention facilities are at high risk of experiencing outbreaks. We aimed to evaluate cohort-based testing among detained ... ...

Abstract	Background: Coronavirus disease 2019 (COVID-19) continues to cause significant morbidity and mortality worldwide. Correctional and detention facilities are at high risk of experiencing outbreaks. We aimed to evaluate cohort-based testing among detained persons exposed to laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to identify presymptomatic and asymptomatic cases. Methods: During 1-19 May 2020, 2 testing strategies were implemented in 12 tiers or housing units of the Cook County Jail, Chicago, Illinois. Detained persons were approached to participate in serial testing (n = 137) and offered tests at 3 time points over 14 days (day 1, days 3-5, and days 13-14). The second group was offered a single test and interview at the end of a 14-day quarantine period (day 14 group) (n = 87). Results: 224 detained persons were approached for participation and, of these, 194 (87%) participated in ≥1 interview and 172 (77%) had ≥1 test. Of the 172 tested, 19 were positive for SARS-CoV-2. In the serial testing group, 17 (89%) new cases were detected, 16 (84%) on day 1, 1 (5%) on days 3-5, and none on days 13-14; in the day 14 group, 2 (11%) cases were identified. More than half (12/19; 63%) of the newly identified cases were presymptomatic or asymptomatic. Conclusions: Our findings highlight the utility of cohort-based testing promptly after initiating quarantine within a housing tier. Cohort-based testing efforts identified new SARS-CoV-2 asymptomatic and presymptomatic infections that may have been missed by symptom screening alone.
MeSH term(s)	COVID-19 ; Chicago/epidemiology ; Correctional Facilities ; Humans ; Illinois/epidemiology ; Minnesota ; SARS-CoV-2
Language	English
Publishing date	2020-12-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciaa1802
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Article ; Online: Investigation of a Severe Acute Respiratory Syndrome Coronavirus 2 Delta (B.1.617.2) Variant Outbreak Among Residents of a Skilled Nursing Facility and Vaccine Effectiveness Analysis: Maricopa County, Arizona, June-July 2021.

Dale, Ariella P / Almendares, Olivia / Howard, Brandon J / Burnett, Eleanor / Prasai, Siru / Arons, Melissa / Collins, Jennifer / Duffy, Nadezdha / Pandit, Urvashi / Brady, Shane / White, Jessica R / Garrett, Brenna / Kirking, Hannah L / Sunenshine, Rebecca / Tate, Jacqueline E / Scott, Sarah E

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2022 Volume 75, Issue 1, Page(s) e20–e26

Abstract: Background: Short-term rehabilitation units present unique infection control challenges because of high turnover and medically complex residents. In June 2021, the Maricopa County Department of Public Health was notified of a severe acute respiratory ... ...

Abstract	Background: Short-term rehabilitation units present unique infection control challenges because of high turnover and medically complex residents. In June 2021, the Maricopa County Department of Public Health was notified of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta outbreak in a skilled nursing facility short-term rehabilitation unit. We describe the outbreak and assess vaccine effectiveness (VE). Methods: Facility electronic medical records were reviewed for residents who spent > 1 night on the affected unit between June 10 and July 23, 2021, to collect demographics, SARS-CoV-2 test results, underlying medical conditions, vaccination status, and clinical outcomes. Coronavirus disease 2019 VE estimates using Cox proportional hazards models were calculated. Results: Forty (37%) of 109 short-stay rehabilitation unit residents who met inclusion criteria tested positive for SARS-CoV-2. SARS-CoV-2-positive case-patients were mostly male (58%) and White (78%) with a median age of 65 (range, 27-92) years; 11 (27%) were immunocompromised. Of residents, 39% (10 cases, 32 noncases) received 2 doses and 9% (4 cases, 6 noncases) received 1 dose of messenger RNA (mRNA) vaccine. Among nonimmunocompromised residents, adjusted 2-dose primary-series mRNA VE against symptomatic infection was 80% (95% confidence interval, 15-95). More cases were hospitalized (33%) or died (38%) than noncases (10% hospitalized; 16% died). Conclusions: In this large SARS-CoV-2 Delta outbreak in a high-turnover short-term rehabilitation unit, a low vaccination rate and medically complex resident population were noted alongside severe outcomes. VE of 2-dose primary-series mRNA vaccine against symptomatic infection was the highest in nonimmunocompromised residents. Health departments can use vaccine coverage data to prioritize facilities for assistance in preventing outbreaks.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Arizona ; COVID-19/epidemiology ; COVID-19/prevention & control ; Disease Outbreaks/prevention & control ; Female ; Humans ; Male ; Middle Aged ; RNA, Messenger ; SARS-CoV-2/genetics ; Skilled Nursing Facilities ; Vaccine Efficacy ; Vaccines, Synthetic ; mRNA Vaccines
Chemical Substances	RNA, Messenger ; Vaccines, Synthetic ; mRNA Vaccines
Language	English
Publishing date	2022-04-12
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciac240
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Article ; Online: Outbreak Investigation of COVID-19 Among Residents and Staff of an Independent and Assisted Living Community for Older Adults in Seattle, Washington.

Roxby, Alison C / Greninger, Alexander L / Hatfield, Kelly M / Lynch, John B / Dellit, Timothy H / James, Allison / Taylor, Joanne / Page, Libby C / Kimball, Anne / Arons, Melissa / Munanga, Albert / Stone, Nimalie / Jernigan, John A / Reddy, Sujan C / Lewis, James / Cohen, Seth A / Jerome, Keith R / Duchin, Jeffrey S / Neme, Santiago

JAMA internal medicine

2020 Volume 180, Issue 8, Page(s) 1101–1105

Abstract: Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused epidemic spread of coronavirus disease 2019 (COVID-19) in the Seattle, Washington, metropolitan area, with morbidity and mortality concentrated among residents of ... ...

Abstract	Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused epidemic spread of coronavirus disease 2019 (COVID-19) in the Seattle, Washington, metropolitan area, with morbidity and mortality concentrated among residents of skilled nursing facilities. The prevalence of COVID-19 among older adults in independent/assisted living is not understood. Objectives: To conduct surveillance for SARS-CoV-2 and describe symptoms of COVID-19 among residents and staff of an independent/assisted living community. Design, setting, and participants: In March 2020, public health surveillance of staff and residents was conducted on site at an assisted and independent living residence for older adults in Seattle, Washington, after exposure to 2 residents who were hospitalized with COVID-19. Exposures: Surveillance for SARS-CoV-2 infection in a congregate setting implementing social isolation and infection prevention protocols. Main outcomes and measures: SARS-CoV-2 real-time polymerase chain reaction was performed on nasopharyngeal swabs from residents and staff; a symptom questionnaire was completed assessing fever, cough, and other symptoms for the preceding 14 days. Residents were retested for SARS-CoV-2 7 days after initial screening. Results: Testing was performed on 80 residents; 62 were women (77%), with mean age of 86 (range, 69-102) years. SARS-CoV-2 was detected in 3 of 80 residents (3.8%); none felt ill, 1 male resident reported resolved cough and 1 loose stool during the preceding 14 days. Virus was also detected in 2 of 62 staff (3.2%); both were symptomatic. One week later, resident SARS-CoV-2 testing was repeated and 1 new infection detected (asymptomatic). All residents remained in isolation and were clinically stable 14 days after the second test. Conclusions and relevance: Detection of SARS-CoV-2 in asymptomatic residents highlights challenges in protecting older adults living in congregate settings. In this study, symptom screening failed to identify residents with infections and all 4 residents with SARS-CoV-2 remained asymptomatic after 14 days. Although 1 asymptomatic infection was found on retesting, a widespread facility outbreak was avoided. Compared with skilled nursing settings, in assisted/independent living communities, early surveillance to identify asymptomatic persons among residents and staff, in combination with adherence to recommended preventive strategies, may reduce viral spread.
MeSH term(s)	Aged ; Aged, 80 and over ; Assisted Living Facilities/organization & administration ; Betacoronavirus ; COVID-19 ; COVID-19 Testing ; Clinical Laboratory Techniques/methods ; Coronavirus Infections/diagnosis ; Female ; Housing for the Elderly ; Humans ; Male ; Pandemics ; Pneumonia, Viral/diagnosis ; Prevalence ; SARS-CoV-2 ; Washington/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-05-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2020.2233
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