Interventions to Disrupt Coronavirus Disease Transmission at a University, Wisconsin, USA, August-October 2020.

University settings have demonstrated potential for coronavirus disease (COVID-19) outbreaks; they combine congregate living, substantial social activity, and a young population predisposed to mild illness. Using genomic and epidemiologic data, we describe a COVID-19 outbreak at the University of Wisconsin-Madison, Madison, Wisconsin, USA. During August-October 2020, a total of 3,485 students, including 856/6,162 students living in dormitories, tested positive. Case counts began rising during move-in week, August 25-31, 2020, then rose rapidly during September 1-11, 2020. The university initiated multiple prevention efforts, including quarantining 2 dormitories; a subsequent decline in cases was observed. Genomic surveillance of cases from Dane County, in which the university is located, did not find evidence of transmission from a large cluster of cases in the 2 quarantined dorms during the outbreak. Coordinated implementation of prevention measures can reduce COVID-19 spread in university settings and may limit spillover to the surrounding community.

Epidemiologic Characteristics Associated With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antigen-Based Test Results, Real-Time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) Cycle Threshold Values, Subgenomic RNA, and Viral Culture Results From University Testing.

BACKGROUND: Real-time reverse transcription polymerase chain reaction (rRT-PCR) and antigen tests are important diagnostics for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sensitivity of antigen tests has been shown to be lower than that of rRT-PCR; however, data to evaluate epidemiologic characteristics that affect test performance are limited. METHODS: Paired mid-turbinate nasal swabs were collected from university students and staff and tested for SARS-CoV-2 using both Quidel Sofia SARS Antigen Fluorescent Immunoassay (FIA) and rRT-PCR assay. Specimens positive by either rRT-PCR or antigen FIA were placed in viral culture and tested for subgenomic RNA (sgRNA). Logistic regression models were used to evaluate characteristics associated with antigen results, rRT-PCR cycle threshold (Ct) values, sgRNA, and viral culture. RESULTS: Antigen FIA sensitivity was 78.9% and 43.8% among symptomatic and asymptomatic participants, respectively. Among rRT-PCR positive participants, negative antigen results were more likely among asymptomatic participants (odds ratio [OR] 4.6, 95% confidence interval [CI]: 1.3-15.4) and less likely among participants reporting nasal congestion (OR 0.1, 95% CI: .03-.8). rRT-PCR-positive specimens with higher Ct values (OR 0.5, 95% CI: .4-.8) were less likely, and specimens positive for sgRNA (OR 10.2, 95% CI: 1.6-65.0) more likely, to yield positive virus isolation. Antigen testing was >90% positive in specimens with Ct values < 29. Positive predictive value of antigen test for positive viral culture (57.7%) was similar to that of rRT-PCR (59.3%). CONCLUSIONS: SARS-CoV-2 antigen test advantages include low cost, wide availability and rapid turnaround time, making them important screening tests. The performance of antigen tests may vary with patient characteristics, so performance characteristics should be accounted for when designing testing strategies and interpreting results.

An Evaluation of Situation Reports and Incident Notices: The DBPR/ESRB Experience.

OBJECTIVE: The main objective of this study is to review information within the situation reports (SITREPs) and incident notices (INs) prepared by the Division of Bioterrorism Preparedness and Response/Epidemiology Surveillance and Response Branch, (DBPR/ESRB), Centers for Disease Control and Prevention (CDC). The secondary objective is to evaluate accuracy and completeness of the information provided in these documents. METHODS: The authors reviewed all SITREPs/INs prepared by DBPR/ESRB from January 2007 to June 2009. Data were abstracted for variables related to the type of incidents, the type of CDC assistance requested, the geographic origin of the calls, and the organization reporting the event or requesting CDC assistance or both. In addition, variables were also created to assess the accuracy and completeness of reports for quality improvement analysis. RESULTS: The DBPR/ESRB prepared 77 SITREPs and 22 INs. Most of them were related to unknown white powders/suspicious packages or BioWatch Actionable Reports (78%). Most calls (79%), requesting CDC assistance or not, were domestic. Almost all calls requesting CDC assistance were for clinical and/or laboratory consultation and/or request for analysis of samples. Most of the calls requesting CDC assistance came from city, county, state, or federal government agencies and military organizations (82%). However, 14 of the analyzed documents (14.4%) were misclassified, that is, a SITREP was written when it should have been an IN or vice versa. The authors also noted the absence of some relevant information among some of the documents, for example, date/time of update. CONCLUSIONS: All of the issues/incidents reported in this article to which DBPR/ESRB responded were cause for legitimate concern. However, significant improvement can be made in the preparation of these reports by CDC staff to ensure efficient and effective response from CDC and its partners. Finally, local entities may wish to develop a similar documentation and reporting process to help manage significant incidents.

Comparing electronic news media reports of potential bioterrorism-related incidents involving unknown white powder to reports received by the United States Centers for Disease Control and Prevention and the Federal Bureau of Investigation: U.S.A., 2009-2011.

There have been periodic electronic news media reports of potential bioterrorism-related incidents involving unknown substances (often referred to as "white powder") since the 2001 intentional dissemination of Bacillus anthracis through the U.S. Postal System. This study reviewed the number of unknown "white powder" incidents reported online by the electronic news media and compared them with unknown "white powder" incidents reported to the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Federal Bureau of Investigation (FBI) during a 2-year period from June 1, 2009 and May 31, 2011. Results identified 297 electronic news media reports, 538 CDC reports, and 384 FBI reports of unknown "white powder." This study showed different unknown "white powder" incidents captured by each of the three sources. However, the authors could not determine the public health implications of this discordance.

Postmortem blood cadmium, lead, and mercury concentrations: comparisons with regard to sampling location and reference ranges for living persons.

This study's goal was to determine cadmium (Cd), lead (Pb), total mercury (THg), and inorganic mercury (IHg) levels in human cadavers to compare measured levels with established reference ranges for living persons and to determine whether blood levels varied with time from death to sample collection or by body collection site. Subjects (n = 66) recruited from the Fulton County Medical Examiner's Office in Atlanta, GA, were 20 years of age or older, had no penetrating trauma, no obvious source of environmental contamination of the vasculature, and had whole blood accessible from the femoral (F) site, the cardiac (C) site, or both. Geometric mean results were as follows: 2.59 microg/L F-Cd; 11.81 microg/L C-Cd; 1.03 microg/L F-THg; 2.01 microg/L C-THg; 0.29 microg/L F-IHg; 0.49 microg/L C-IHg; 1.78 microg/dL F-Pb; and 1.87 microg/dL C-Pb. Both F- and C-Cd levels as well as C-THg levels were significantly higher than reference values among living persons (C- and F-Cd, p < 0.0001 and C-THg, p = 0.0001, respectively). Based on regression modeling, as the postmortem interval increased, blood Cd levels increased (p < 0.006). Postmortem blood Cd concentrations were elevated compared to population values and varied with respect to sampling location and postmortem interval.

Internet-based morbidity and mortality surveillance among Hurricane Katrina evacuees in Georgia.

INTRODUCTION: The Internet has revolutionized the way public health surveillance is conducted. Georgia has used it for notifiable disease reporting, electronic outbreak management, and early event detection. We used it in our public health response to the 125,000 Hurricane Katrina evacuees who came to Georgia. METHODS: We developed Internet-based surveillance forms for evacuation shelters and an Internet-based death registry. District epidemiologists, hospital-based physicians, and medical examiners/coroners electronically completed the forms. We analyzed these data and data from emergency departments used by the evacuees. RESULTS: Shelter residents and patients who visited emergency departments reported primarily chronic diseases. Among 33 evacuee deaths, only 2 were from infectious diseases, and 1 was indirectly related to the hurricane. CONCLUSION: The Internet was essential to collect health data from multiple locations, by many different people, and for multiple types of health encounters during Georgia's Hurricane Katrina public health response.