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Article ; Online: Evaluating the association between in-person work and the risk of SARS-CoV-2 infection through June 2021.

Meza, Erika / Cummings, Kristin J / Vergara, Ximena P / Lai, Kristina W / Lim, Esther / Lamba, Katherine / Kamali, Amanda / Bibbins-Domingo, Kirsten / Jain, Seema / Mehrotra, Megha L

American journal of industrial medicine

2023 Volume 66, Issue 3, Page(s) 222–232

Abstract: Objectives: Recent studies have evaluated COVID-19 outbreaks and excess mortality by occupation sectors. Studies on SARS-CoV-2 infection across occupation and occupation-related factors remain lacking. In this study, we estimate the effect of in-person ... ...

Abstract	Objectives: Recent studies have evaluated COVID-19 outbreaks and excess mortality by occupation sectors. Studies on SARS-CoV-2 infection across occupation and occupation-related factors remain lacking. In this study, we estimate the effect of in-person work on SARS-CoV-2 infection risk and describe SARS-CoV-2 seroprevalence among working adults. Methods: We used Wave 1 data (May to June 2021) from CalScope, a population-based seroprevalence study in California. Occupation data were coded using the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System. Dried blood spot specimens were tested for antibodies to establish evidence of prior infection. We estimated the causal effect of in-person work on SARS-CoV-2 infection risk using the g-formula and describe SARS-CoV-2 seroprevalence across occupation-related factors. Results: Among 4335 working adults, 53% worked in person. In-person work was associated with increased risk of prior SARS-CoV-2 infection (risk difference: 0.03; [95% CI: 0.02-0.04]) compared with working remotely. Workers that reported job loss or who were without medical insurance had higher evidence of prior infection. Amongst in-person workers, evidence of prior infection was highest within farming, fishing, and forestry (55%; [95% CI: 26%-81%]); installation, maintenance, and repair (23%; [12%-39%]); building and grounds cleaning and maintenance (23%; [13%-36%]); food preparation and serving related (22% [13%-35%]); and healthcare support (22%; [13%-34%]) occupations. Workers who identified as Latino, reported a household income of <$25K, or who were without a bachelor's degree also had higher evidence of prior infection. Conclusions: SARS-CoV-2 infection risk varies by occupation. Future vaccination strategies may consider prioritizing in-person workers.
MeSH term(s)	Adult ; Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Seroepidemiologic Studies ; Industry ; Agriculture ; Health Personnel
Language	English
Publishing date	2023-01-16
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	604538-8
ISSN	1097-0274 ; 0271-3586
ISSN (online)	1097-0274
ISSN	0271-3586
DOI	10.1002/ajim.23458
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Article: SARS-CoV-2 Cumulative Incidence and Period Seroprevalence: Results From a Statewide Population-Based Serosurvey in California.

Lamba, Katherine / Bradley, Heather / Shioda, Kayoko / Sullivan, Patrick S / Luisi, Nicole / Hall, Eric W / Mehrotra, Megha L / Lim, Esther / Jain, Seema / Kamali, Amanda / Sanchez, Travis / Lopman, Benjamin A / Fahimi, Mansour / Siegler, Aaron J

Open forum infectious diseases

2021 Volume 8, Issue 8, Page(s) ofab379

Abstract: Background: California has reported the largest number of coronavirus disease 2019 (COVID-19) cases of any US state, with more than 3.5 million confirmed as of March 2021. However, the full breadth of severe acute respiratory syndrome coronavirus 2 ( ... ...

Abstract	Background: California has reported the largest number of coronavirus disease 2019 (COVID-19) cases of any US state, with more than 3.5 million confirmed as of March 2021. However, the full breadth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in California is unknown as reported cases only represent a fraction of all infections. Methods: We conducted a population-based serosurvey, utilizing mailed, home-based SARS-CoV-2 antibody testing along with a demographic and behavioral survey. We weighted data from a random sample to represent the adult California population and estimated period seroprevalence overall and by participant characteristics. Seroprevalence estimates were adjusted for waning antibodies to produce statewide estimates of cumulative incidence, the infection fatality ratio (IFR), and the reported fraction. Results: California's SARS-CoV-2 weighted seroprevalence during August-December 2020 was 4.6% (95% CI, 2.8%-7.4%). Estimated cumulative incidence as of November 2, 2020, was 8.7% (95% CrI, 6.4%-11.5%), indicating that 2 660 441 adults (95% CrI, 1 959 218-3 532 380) had been infected. The estimated IFR was 0.8% (95% CrI, 0.6%-1.0%), and the estimated percentage of infections reported to the California Department of Public Health was 31%. Disparately high risk for infection was observed among persons of Hispanic/Latinx ethnicity and people with no health insurance and who reported working outside the home. Conclusions: We present the first statewide SARS-CoV-2 cumulative incidence estimate among adults in California. As of November 2020, ~1 in 3 SARS-CoV-2 infections in California adults had been identified by public health surveillance. When accounting for unreported SARS-CoV-2 infections, disparities by race/ethnicity seen in case-based surveillance persist.
Language	English
Publishing date	2021-07-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofab379
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Article: CalScope: Monitoring Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence From Vaccination and Prior Infection in Adults and Children in California May 2021-July 2021.

Mehrotra, Megha L / Lim, Esther / Lamba, Katherine / Kamali, Amanda / Lai, Kristina W / Meza, Erika / Szeto, Irvin / Robinson, Peter / Tsai, Cheng-Ting / Gebhart, David / Fonseca, Noemi / Martin, Andrew B / Ley, Catherine / Scherf, Steve / Watt, James / Seftel, David / Parsonnet, Julie / Jain, Seema

Open forum infectious diseases

2022 Volume 9, Issue 7, Page(s) ofac246

Abstract: Background: Understanding the distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies from vaccination and/or prior infection is critical to the public health response to the pandemic. CalScope is a population-based ... ...

Abstract	Background: Understanding the distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies from vaccination and/or prior infection is critical to the public health response to the pandemic. CalScope is a population-based serosurvey in 7 counties in California. Methods: We invited 200 000 randomly sampled households to enroll up to 1 adult and 1 child between April 20, 2021 and June 16, 2021. We tested all specimens for antibodies against SARS-CoV-2 nucleocapsid and spike proteins, and each participant completed an online survey. We classified participants into categories: seronegative, antibodies from infection only, antibodies from infection and vaccination, and antibodies from vaccination only. Results: A total of 11 161 households enrolled (5.6%), with 7483 adults and 1375 children completing antibody testing. As of June 2021, 33% (95% confidence interval [CI], 28%-37%) of adults and 57% (95% CI, 48%-66%) of children were seronegative; 18% (95% CI, 14%-22%) of adults and 26% (95% CI, 19%-32%) of children had antibodies from infection alone; 9% (95% CI, 6%-11%) of adults and 5% (95% CI, 1%-8%) of children had antibodies from infection and vaccination; and 41% (95% CI, 37%-45%) of adults and 13% (95% CI, 7%-18%) of children had antibodies from vaccination alone. Conclusions: As of June 2021, one third of adults and most children in California were seronegative. Serostatus varied regionally and by demographic group.
Language	English
Publishing date	2022-05-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac246
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Article ; Online: Waning of 2-Dose BNT162b2 and mRNA-1273 Vaccine Effectiveness Against Symptomatic SARS-CoV-2 Infection Accounting for Depletion-of-Susceptibles Bias.

Andrejko, Kristin L / Pry, Jake M / Myers, Jennifer F / Mehrotra, Megha / Lamba, Katherine / Lim, Esther / Fukui, Nozomi / DeGuzman, Jennifer L / Openshaw, John / Watt, James / Jain, Seema / Lewnard, Joseph A / Covid-Case-Control Study Team, On Behalf Of The California

American journal of epidemiology

2022 Volume 192, Issue 6, Page(s) 895–907

Abstract: Concerns about the duration of protection conferred by coronavirus disease 2019 (COVID-19) vaccines have arisen in postlicensure evaluations. "Depletion of susceptibles," a bias driven by differential accrual of infection among vaccinated and ... ...

Abstract	Concerns about the duration of protection conferred by coronavirus disease 2019 (COVID-19) vaccines have arisen in postlicensure evaluations. "Depletion of susceptibles," a bias driven by differential accrual of infection among vaccinated and unvaccinated individuals, may obscure vaccine effectiveness (VE) estimates, hindering interpretation. We enrolled California residents who received molecular SARS-CoV-2 tests in a matched, test-negative design, case-control study to estimate VE of mRNA-based COVID-19 vaccines between February 23 and December 5, 2021. We analyzed waning protection following 2 vaccine doses using conditional logistic regression models. Additionally, we used data from a population-based serological study to adjust for "depletion-of-susceptibles" bias and estimated VE for 3 doses, by time since second dose receipt. Pooled VE of BNT162b2 and mRNA-1273 against symptomatic SARS-CoV-2 infection was 91.3% (95% confidence interval (CI): 83.8, 95.4) at 14 days after second-dose receipt and declined to 50.8% (95% CI: 19.7, 69.8) at 7 months. Adjusting for depletion-of-susceptibles bias, we estimated VE of 53.2% (95% CI: 23.6, 71.2) at 7 months after primary mRNA vaccination series. A booster dose of BN162b2 or mRNA-1273 increased VE to 95.0% (95% CI: 82.8, 98.6). These findings confirm that observed waning of protection is not attributable to epidemiologic bias and support ongoing efforts to administer additional vaccine doses to mitigate burden of COVID-19.
MeSH term(s)	Humans ; 2019-nCoV Vaccine mRNA-1273 ; BNT162 Vaccine ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines ; Case-Control Studies ; Vaccine Efficacy ; SARS-CoV-2/genetics ; RNA, Messenger
Chemical Substances	2019-nCoV Vaccine mRNA-1273 (EPK39PL4R4) ; BNT162 Vaccine ; COVID-19 Vaccines ; RNA, Messenger
Language	English
Publishing date	2022-04-29
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwad017
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Article ; Online: Waning of two-dose BNT162b2 and mRNA-1273 vaccine effectiveness against symptomatic SARS-CoV-2 infection is robust to depletion-of-susceptibles bias

Andrejko, Kristin L / Pry, Jake M / Myers, Jennifer F / Mehrotra, Megha / Lamba, Katherine / Lim, Esther / Fukui, Nozomi / DeGuzman, Jennifer L. / Openshaw, John / Watt, James / Jain, Seema / Lewnard, Joseph A.

medRxiv

Abstract: Concerns about the duration of protection conferred by COVID-19 vaccines have arisen in postlicensure evaluations. However, "depletion of susceptibles" bias driven by differential accrual of infection among vaccinated and unvaccinated individuals may ... ...

Abstract	Concerns about the duration of protection conferred by COVID-19 vaccines have arisen in postlicensure evaluations. However, "depletion of susceptibles" bias driven by differential accrual of infection among vaccinated and unvaccinated individuals may contribute to the appearance of waning vaccine effectiveness (VE) in epidemiologic studies, potentially hindering interpretation of estimates. We enrolled California residents who received molecular SARS-CoV-2 tests in a matched, test-negative design case-control study to estimate VE of mRNA-based COVID-19 vaccines between 23 February and 5 December 2021. We analyzed waning protection following 2 vaccine doses using conditional logistic regression models. Additionally, we used data from case-based surveillance along with estimated case-to-infection ratios from a population-based serological study to quantify the potential contribution of the "depletion-of-susceptibles" bias to time-varying VE estimates for 2 doses. We also estimated VE for 3 doses relative to 0 doses and 2 doses, by time since second dose receipt. Pooled VE of BNT162b2 and mRNA-1273 against symptomatic SARS-CoV-2 infection was 91.3% (95% confidence interval: 83.8-95.4%) at 14 days after second-dose receipt and declined to 50.8% (31.2-75.6%) at 7 months. Accounting for differential depletion-of-susceptibles among vaccinated and unvaccinated individuals, we estimated VE was 53.2% (23.6-71.2%) at 7 months among individuals who had completed the primary series (2 doses). With receipt of a third dose of BN162b2 or mRNA-1273, VE increased to 95.0% (82.8-98.6%), compared with zero doses. These findings confirm that observed waning of protection is not attributable to epidemiologic bias and support ongoing efforts to administer additional vaccine doses to mitigate burden of COVID-19.
Keywords	covid19
Language	English
Publishing date	2022-06-03
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2022.06.03.22275958
Database	COVID19

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Article ; Online: CalScope: Monitoring SARS-CoV-2 Seroprevalence from Vaccination and Prior Infection in Adults and Children in California May 2021 to July 2021

Mehrotra, Megha L. / Lim, Esther / Lamba, Katherine / Kamali, Amanda / Lai, Kristina W. / Meza, Erika / Szeto, Irvin / Robinson, Peter / Tsai, Cheng-ting / Gebhart, David / Fonseca, Noemi / Martin, Andrew B. / Ley, Catherine / Scherf, Steve / Watt, James / Seftel, David / Parsonnet, Julie / Jain, Seema

medRxiv

Abstract: Importance: Understanding how SARS-CoV-2 seroprevalence varies regionally across California is critical to the public health response to the pandemic. Objective: To estimate how many Californians have antibodies against SARS-CoV-2 from prior infection or ...

Abstract	Importance: Understanding how SARS-CoV-2 seroprevalence varies regionally across California is critical to the public health response to the pandemic. Objective: To estimate how many Californians have antibodies against SARS-CoV-2 from prior infection or vaccination. Design: Wave 1 of CalScope: a repeated cross-sectional serosurvey of adults and children enrolled between April 20, 2021 and June 16, 2021. Setting: A population-based random sample of households in seven counties in California (Alameda, El Dorado, Kern, Los Angeles, Monterey, San Diego, and Shasta) were invited to complete an at-home SARS-CoV-2 antibody test and survey instrument. Participants: Invitations were sent to 200,000 randomly selected households in the seven counties. From each household, 1 adult (18 years and older) and 1 child (aged 6 months to 17 years) could enroll in the study. There were no exclusion criteria. Main Outcome(s) and Measures: All specimens were tested for antibodies against the nucleocapsid and spike proteins of SARS-CoV-2. The primary outcome was serostatus category, which was determined based on antibody test results and self-reported vaccination status: seronegative, antibodies from infection only, antibodies from infection and vaccination, and antibodies from vaccination alone. We used inverse probability of selection weights and iterative proportional fitting to account for non-response. Results: 11,161 households enrolled in wave 1 of CalScope, with 7,483 adults and 1,375 children completing antibody testing. As of June 2021, 27% (95%CI [23%, 31%]) of adults and 30% (95%CI [24%, 36%]) of children had evidence of prior SARS-CoV-2 infection; 33% (95%CI [28%, 37%]) of adults and 57% (95%CI [48%, 66%]) of children were seronegative. Serostatus varied regionally. Californians 65 years or older were most likely to have antibodies from vaccine alone (59%; 95%CI [48%, 69%]) and children between 5-11 years old were most likely to have antibodies from prior infection alone (36%; 95%CI [21%, 52%]). Conclusions and Relevance: As of June 2021, a third of adults in California and most children under 18 remained seronegative. Seroprevalence varied regionally and by demographic group, suggesting that some regions or populations might remain more vulnerable to subsequent surges than others.
Keywords	covid19
Language	English
Publishing date	2021-12-11
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.12.09.21267565
Database	COVID19

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Article ; Online: Outbreaks Associated with Untreated Recreational Water - California, Maine, and Minnesota, 2018-2019.

Vanden Esschert, Kayla L / Mattioli, Mia C / Hilborn, Elizabeth D / Roberts, Virginia A / Yu, Alexander T / Lamba, Katherine / Arzaga, Gena / Zahn, Matthew / Marsh, Zachary / Combes, Stephen M / Smith, Emer S / Robinson, Trisha J / Gretsch, Stephanie R / Laco, Joseph P / Wikswo, Mary E / Miller, Allison D / Tack, Danielle M / Wade, Timothy J / Hlavsa, Michele C

MMWR. Morbidity and mortality weekly report

2020 Volume 69, Issue 25, Page(s) 781–783

Abstract: Outbreaks associated with fresh or marine (i.e., untreated) recreational water can be caused by pathogens or chemicals, including toxins. Voluntary reporting of these outbreaks to CDC's National Outbreak Reporting System (NORS) began in 2009. NORS data ... ...

Abstract	Outbreaks associated with fresh or marine (i.e., untreated) recreational water can be caused by pathogens or chemicals, including toxins. Voluntary reporting of these outbreaks to CDC's National Outbreak Reporting System (NORS) began in 2009. NORS data for 2009-2017 are finalized, and data for 2018-2019 are provisional. During 2009-2019 (as of May 13, 2020), public health officials from 31 states voluntarily reported 119 untreated recreational water-associated outbreaks, resulting at least 5,240 cases; 103 of the outbreaks (87%) started during June-August. Among the 119 outbreaks, 88 (74%) had confirmed etiologies. The leading etiologies were enteric pathogens: norovirus (19 [22%] outbreaks; 1,858 cases); Shiga toxin-producing Escherichia coli (STEC) (19 [22%]; 240), Cryptosporidium (17 [19%]; 237), and Shigella (14 [16%]; 713). This report highlights three examples of outbreaks that occurred during 2018-2019, were caused by leading etiologies (Shigella, norovirus, or STEC), and demonstrate the wide geographic distribution of such outbreaks across the United States. Detection and investigation of untreated recreational water-associated outbreaks are challenging, and the sources of these outbreaks often are not identified. Tools for controlling and preventing transmission of enteric pathogens through untreated recreational water include epidemiologic investigations, regular monitoring of water quality (i.e., testing for fecal indicator bacteria), microbial source tracking, and health policy and communications (e.g., observing beach closure signs and not swimming while ill with diarrhea).
MeSH term(s)	Adolescent ; Adult ; Aged ; California/epidemiology ; Child ; Child, Preschool ; Communicable Diseases/epidemiology ; Disease Outbreaks ; Female ; Humans ; Infant ; Maine/epidemiology ; Male ; Middle Aged ; Minnesota/epidemiology ; Recreation ; Water Microbiology ; Water Purification ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-06-26
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.mm6925a3
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Article ; Online: Shiga Toxin 1-Producing Shigella sonnei Infections, California, United States, 2014-2015.

Lamba, Katherine / Nelson, Jennifer A / Kimura, Akiko C / Poe, Alyssa / Collins, Joan / Kao, Annie S / Cruz, Laura / Inami, Gregory / Vaishampayan, Julie / Garza, Alvaro / Chaturvedi, Vishnu / Vugia, Duc J

Emerging infectious diseases

2016 Volume 22, Issue 4, Page(s) 679–686

Abstract: Shiga toxins (Stx) are primarily associated with Shiga toxin-producing Escherichia coli and Shigella dysenteriae serotype 1. Stx production by other shigellae is uncommon, but in 2014, Stx1-producing S. sonnei infections were detected in California. ... ...

Abstract	Shiga toxins (Stx) are primarily associated with Shiga toxin-producing Escherichia coli and Shigella dysenteriae serotype 1. Stx production by other shigellae is uncommon, but in 2014, Stx1-producing S. sonnei infections were detected in California. Surveillance was enhanced to test S. sonnei isolates for the presence and expression of stx genes, perform DNA subtyping, describe clinical and epidemiologic characteristics of case-patients, and investigate for sources of infection. During June 2014-April 2015, we identified 56 cases of Stx1-producing S. sonnei, in 2 clusters. All isolates encoded stx1 and produced active Stx1. Multiple pulsed-field gel electrophoresis patterns were identified. Bloody diarrhea was reported by 71% of case-patients; none had hemolytic uremic syndrome. Some initial cases were epidemiologically linked to travel to Mexico, but subsequent infections were transmitted domestically. Continued surveillance of Stx1-producing S. sonnei in California is necessary to characterize its features and plan for reduction of its spread in the United States.
MeSH term(s)	Adolescent ; Adult ; Anti-Bacterial Agents/therapeutic use ; California/epidemiology ; Child ; Child, Preschool ; Diarrhea/epidemiology ; Diarrhea/microbiology ; Diarrhea/pathology ; Dysentery, Bacillary/epidemiology ; Dysentery, Bacillary/microbiology ; Dysentery, Bacillary/pathology ; Electrophoresis, Gel, Pulsed-Field ; Epidemiological Monitoring ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; Shiga Toxin 1/biosynthesis ; Shiga Toxin 1/isolation & purification ; Shigella sonnei/classification ; Shigella sonnei/genetics ; Shigella sonnei/isolation & purification
Chemical Substances	Anti-Bacterial Agents ; Shiga Toxin 1
Language	English
Publishing date	2016-04
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2204.151825
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Article ; Online: Public Health Responses to COVID-19 Outbreaks on Cruise Ships - Worldwide, February-March 2020.

Moriarty, Leah F / Plucinski, Mateusz M / Marston, Barbara J / Kurbatova, Ekaterina V / Knust, Barbara / Murray, Erin L / Pesik, Nicki / Rose, Dale / Fitter, David / Kobayashi, Miwako / Toda, Mitsuru / Cantey, Paul T / Scheuer, Tara / Halsey, Eric S / Cohen, Nicole J / Stockman, Lauren / Wadford, Debra A / Medley, Alexandra M / Green, Gary /

Regan, Joanna J / Tardivel, Kara / White, Stefanie / Brown, Clive / Morales, Christina / Yen, Cynthia / Wittry, Beth / Freeland, Amy / Naramore, Sara / Novak, Ryan T / Daigle, David / Weinberg, Michelle / Acosta, Anna / Herzig, Carolyn / Kapella, Bryan K / Jacobson, Kathleen R / Lamba, Katherine / Ishizumi, Atsuyoshi / Sarisky, John / Svendsen, Erik / Blocher, Tricia / Wu, Christine / Charles, Julia / Wagner, Riley / Stewart, Andrea / Mead, Paul S / Kurylo, Elizabeth / Campbell, Stefanie / Murray, Rachel / Weidle, Paul / Cetron, Martin / Friedman, Cindy R

MMWR. Morbidity and mortality weekly report

2020 Volume 69, Issue 12, Page(s) 347–352

Abstract: An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes ... ...

Abstract	An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.
MeSH term(s)	Adult ; Aged ; Betacoronavirus/isolation & purification ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Disease Outbreaks/prevention & control ; Female ; Global Health/statistics & numerical data ; Humans ; Male ; Middle Aged ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; Public Health Practice ; Risk Factors ; SARS-CoV-2 ; Ships ; Travel-Related Illness ; United States/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-03-27
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.mm6912e3
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Article ; Online: Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study.

Collier, Melissa G / Khudyakov, Yury E / Selvage, David / Adams-Cameron, Meg / Epson, Erin / Cronquist, Alicia / Jervis, Rachel H / Lamba, Katherine / Kimura, Akiko C / Sowadsky, Rick / Hassan, Rashida / Park, Sarah Y / Garza, Eric / Elliott, Aleisha J / Rotstein, David S / Beal, Jennifer / Kuntz, Thomas / Lance, Susan E / Dreisch, Rebecca /

Wise, Matthew E / Nelson, Noele P / Suryaprasad, Anil / Drobeniuc, Jan / Holmberg, Scott D / Xu, Fujie

The Lancet. Infectious diseases

2014 Volume 14, Issue 10, Page(s) 976–981

Abstract: Background: In May, 2013, an outbreak of symptomatic hepatitis A virus infections occurred in the USA. Federal, state, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We investigated ...

Abstract	Background: In May, 2013, an outbreak of symptomatic hepatitis A virus infections occurred in the USA. Federal, state, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We investigated the source of the outbreak and assessed the public health measures used. Methods: We interviewed patients, obtained their shopping information, and did genetic analysis of hepatitis A virus recovered from patients' serum and stool samples. We tested products for the virus and traced supply chains. Findings: Of 165 patients identified from ten states, 69 (42%) were admitted to hospital, two developed fulminant hepatitis, and one needed a liver transplant; none died. Illness onset occurred from March 31 to Aug 12, 2013. The median age of patients was 47 years (IQR 35-58) and 91 (55%) were women. 153 patients (93%) reported consuming product B from retailer A. 40 patients (24%) had product B in their freezers, and 113 (68%) bought it according to data from retailer A. Hepatitis A virus genotype IB, uncommon in the Americas, was recovered from specimens from 117 people with hepatitis A virus illness. Pomegranate arils that were imported from Turkey--where genotype IB is common--were identified in product B. No hepatitis A virus was detected in product B. Interpretation: Imported frozen pomegranate arils were identified as the vehicle early in the investigation by combining epidemiology--with data from several sources--genetic analysis of patient samples, and product tracing. Product B was removed from store shelves, the public were warned not to eat product B, product recalls took place, and postexposure prophylaxis with both hepatitis A virus vaccine and immunoglobulin was provided. Our findings show that modern public health actions can help rapidly detect and control hepatitis A virus illness caused by imported food. Our findings show that postexposure prophylaxis can successfully prevent hepatitis A illness when a specific product is identified. Imported food products combined with waning immunity in some adult populations might make this type of intervention necessary in the future. Funding: US Centers for Disease Control and Prevention, US Food and Drug Administration, and US state and local public health departments.
MeSH term(s)	Adult ; Disease Notification ; Disease Outbreaks ; Epidemiologic Studies ; Feces/virology ; Female ; Food Contamination ; Fruit/virology ; Genotype ; Hepatitis A/epidemiology ; Hepatitis A/prevention & control ; Hepatitis A/therapy ; Hepatitis A Virus, Human/genetics ; Hepatitis A Virus, Human/immunology ; Hepatitis A Virus, Human/isolation & purification ; Humans ; Immunoglobulins/administration & dosage ; Male ; Middle Aged ; Phylogeny ; Product Recalls and Withdrawals ; Punicaceae/virology ; Sequence Analysis, DNA ; Turkey ; United States/epidemiology ; Viral Vaccines/administration & dosage
Chemical Substances	Immunoglobulins ; Viral Vaccines
Language	English
Publishing date	2014-10
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	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(14)70883-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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