PCR testing of traced contacts for SARS-CoV-2 in England, January to July 2021.

BackgroundThe NHS Test and Trace (NHSTT) programme was established in May 2020 in England to deliver SARS-CoV-2 testing and contact tracing in order to identify infected individuals and reduce COVID-19 spread. To further control transmission, people identified as contacts were asked to self-isolate for 10 days and test only if they became symptomatic. From March 2021, eligibility criteria for PCR testing expanded to include asymptomatic contacts of confirmed cases.AimTo analyse testing patterns of contacts before and after the change in testing guidance in England to assess the impact on PCR testing behaviour with respect to symptom status and contact type.MethodsTesting and contact tracing data were extracted from the national data systems and linked. Subsequently, descriptive statistical analysis was applied to identify trends in testing behaviour.ResultsBetween 1 January and 31 July 2021, over 5 million contacts were identified and reached by contact tracers; 42.3% took a PCR test around the time they were traced. Overall positivity rate was 44.3% and consistently higher in symptomatic (60-70%) than asymptomatic (around 20%, March-June) contacts. The proportion of tests taken by asymptomatic contacts increased over time, especially after the change in testing guidance. No link was observed between uptake of PCR tests and vaccination coverage. Fully vaccinated contacts showed lower positivity (23.8%) than those with one dose (37.2%) or unvaccinated (51.0%).ConclusionAlmost 1 million asymptomatic contacts were tested for SARS-CoV-2, identifying 214,056 positive cases, demonstrating the value of offering PCR testing to this group.

A new bovine tuberculosis model for England and Wales (BoTMEW) to simulate epidemiology, surveillance and control.

BACKGROUND: Bovine tuberculosis (bTB) is a zoonotic disease of cattle caused by Mycobacterium bovis, widespread in England and Wales. It has high incidence towards the South West of England and Wales, with much lower incidence to the East and North. A stochastic simulation model was developed to simulate M. bovis transmission among cattle, transfer by cattle movements and transmission from environmental reservoirs (often wildlife and especially badgers). It distinguishes five surveillance streams, including herd tests, pre-movement testing and slaughter surveillance. The model thereby simulates interventions in bTB surveillance and control, and generates outputs directly comparable to detailed disease records. An anonymized version of the executable model with its input data has been released. The model was fitted to cattle bTB records for 2008-2010 in a cross-sectional comparison, and its projection was compared with records from 2010 to 2016 for validation. RESULTS: The fitted model explained over 99% of the variation among numbers of breakdowns in four defined regions and surveillance streams in 2010. It classified 7800 (95% confidence interval c. 5500 - 14,000) holdings within high incidence regions as exposed to infectious environmental reservoirs, out of over 31,000 cattle holdings identified as potentially exposed to such sources. The model was consistent with previous estimates of low M. bovis transmission rate among cattle, but cattle to cattle transmission was clearly required to generate the number of cattle cases observed. When projected to 2016, the model as fitted to 2010 continued to match the distribution of bTB among counties, although it was notable that the actual distribution of bTB in 2010 was itself a close match for its distribution in 2016. CONCLUSIONS: The close model fit demonstrated that cattle movements could generate breakdowns as observed in low incidence regions, if persistent environmental reservoirs such as wildlife maintained infection levels in the high incidence regions. The model suggests that environmental reservoirs may be a challenge for control, because, although many holdings are exposed to infection from wildlife or the environment, they are a minority of holdings. Large impacts on disease in wildlife will be required to avoid each individual transmission event to cattle.