Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 during Border Quarantine and Air Travel, New Zealand (Aotearoa)

Eichler, Nick; Thornley, Craig; Swadi, Tara; Devine, Tom; McElnay, Caroline; Sherwood, Jillian; Brunton, Cheryl; Williamson, Felicity; Freeman, Josh; Berger, Sarah; Ren, Xiaoyun; Storey, Matt; Ligt, Joep de; Geoghegan, Jemma L.

doi:10.3201/eid2705.210514

Cited by 80 publications

(88 citation statements)

References 14 publications

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“…However, this was one of 13 cases not sequenced, and quarantine hotel information was missing for 15 cases in total (n=15/59, 25.4%). Given that instances of SARS-CoV-2 transmission among epidemiologically unlinked cases during quarantine have been documented 15 , we cannot conclusively determine whether transmission occurred in transit or quarantine.…”

Section: Resultsmentioning

confidence: 99%

Air travel-related outbreak of multiple SARS-CoV-2 variants

Vijaykrishna

Edwards

Xie

et al. 2021

Preprint

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Background. A large cluster of 59 cases were linked to a single flight with 146 passengers from New Delhi to Hong Kong in April 2021. This outbreak coincided with early reports of exponential pandemic growth in New Delhi, which reached a peak of >400,000 newly confirmed cases on 7 May 2021. Methods. Epidemiological information including date of symptom onset, date of positive-sample detection, and travel and contact history for individual cases from this flight were collected. Whole genome sequencing was performed, and sequences were classified based on the dynamic Pango nomenclature system. Maximum-likelihood phylogenetic analysis compared sequences from this flight alongside other cases imported from India to Hong Kong on 26 flights between June 2020 and April 2021, as well as sequences from India or associated with India-related travel from February to April 2021, and 1,217 reference sequences. Results. Sequence analysis identified six lineages of SARS-CoV-2 belonging to two variants of concern (Alpha and Delta) and one variant of public health interest (Kappa) involved in this outbreak. Phylogenetic analysis confirmed at least three independent sub-lineages of Alpha with limited onward transmission, a superspreading event comprising 37 cases of Kappa, and transmission of Delta to only one passenger. Additional analysis of another 26 flights from India to Hong Kong confirmed widespread circulation of all three variants in India since early March 2021. Conclusions. The broad spectrum of disease severity and long incubation period of SARS-CoV-2 pose a challenge for surveillance and control. As illustrated by this particular outbreak, opportunistic infections of SARS-CoV-2 can occur irrespective of variant lineage, and requiring a nucleic acid test within 72 hours of departure may be insufficient to prevent importation or in-flight transmission.

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Section: Resultsmentioning

confidence: 99%

Air travel-related outbreak of multiple SARS-CoV-2 variants

Vijaykrishna

Edwards

Xie

et al. 2021

Preprint

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“…Several reports suggest that aerosol transmission is indeed a nonnegligible mode of SARS-CoV-2 transmission and that respirator masks may provide additional protection compared to surgical masks. [17][18][19]21,22 On the other hand, single case reports have suggested that surgical masks are equivalent to respirators in protecting HCW from SARS-CoV-2 infection. 23,24 These supposedly contradictory findings can be reconciled when considering a particular feature of SARS-CoV-2, namely its high overdispersion.…”

Section: Discussionmentioning

confidence: 99%

Use of respirator vs. surgical masks in healthcare personnel and its impact on SARS-CoV-2 acquisition – a prospective multicentre cohort study

Haller

Guesewell

Egger

et al. 2021

Preprint

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Background There is insufficient evidence regarding the role of respirators in the prevention of SARS-CoV-2 infection. We analysed the impact of filtering facepiece class 2 (FFP2) vs. surgical masks on the risk of SARS-CoV-2 acquisition among Swiss healthcare workers (HCW). Methods Our prospective multicentre cohort enrolled patient-facing HCWs from June to August 2020. Participants were asked about COVID-19 risk exposures/behaviours, including preferred mask type when caring for COVID-19 patients outside of aerosol-generating procedures (AGP). For those performing AGPs, we asked whether they used FFP2 irrespective of the patients COVID-19 status (i.e. universal use). The impact of FFP2 on i) self-reported SARS-CoV-2-positive nasopharyngeal PCR/rapid antigen tests captured during weekly surveys, and ii) SARS-CoV-2 seroconversion between baseline and January/February 2021 was assessed. Results We enrolled 3259 participants from nine healthcare institutions, whereof 716 (22%) preferentially used FFP2 respirators. Among these, 81/716 (11%) reported a SARS-CoV-2-positive swab, compared to 352/2543 (14%) surgical mask users (median follow-up 242 days); seroconversion was documented in 85/656 (13%) FFP2 and 426/2255 (19%) surgical mask users. Adjusted for baseline characteristics, COVID-19 exposure, and risk behaviour, FFP2 use was non-significantly associated with a decreased risk for SARS-CoV-2-positive swab (adjusted hazard ratio [aHR] 0.8, 95% CI 0.6-1.0, p=0.052) and seroconversion (adjusted odds ratio [aOR] 0.7, 95% CI 0.5-1.0, p=0.053); household exposure was the strongest risk factor (aHR for positive swab 10.1, p<0.001; aOR for seroconversion 5.0, p<0.001). In subgroup analysis, FFP2 use was clearly protective among those with frequent (>20 patients) COVID-19 exposure (aHR 0.7, p<0.001; aOR 0.6, p=0.035). Universal FFP2 use during AGPs showed no protective effect (aHR 1.1, p=0.7; aOR 0.9, p=0.53). Conclusion Respirators compared to surgical masks may convey additional protection from SARS-CoV-2 for HCW with frequent exposure to COVID-19 patients.

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“…Recently, a similar incident occurred at a managed isolation and quarantine facility in Christchurch, New Zealand. 13 In the Christchurch event, the genomic and epidemiological data suggested that an initial transmission event happened between two quarantined rooms during a brief 50-second gap of door opening between two quarters into the shared corridor. This incident resulted in two known transmission events outside the facility in New Zealand.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Transmission among Healthcare Workers at a Quarantine Facility in Thailand: Genomic and Outbreak Investigations

Atsawawaranunt

Kochakarn

Kongklieng

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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During the COVID-19 pandemic, Thailand implemented a quarantine program at approved quarantine facilities for every international traveler. Here, we report an epidemiological and genomic investigation of a COVID-19 cluster consisting of seven healthcare workers (HCWs) at a quarantine facility and its partnered hospital in Thailand. Outbreak investigations were implemented to obtain contact tracing data and to establish chains of transmission. Genomic sequencing of SARS-CoV-2 with samples within the cohort was performed. Investigations of 951 HCWs and staff with quarantined travelers were implemented to determine the chain of transmission. Genomic and outbreak investigations identified the international travelers infected with the B.1.1.31 SARS-CoV-2 lineage as the source of this outbreak. The genomic data and the investigated timeline revealed a putative transmission chain among HCWs, pointing toward the transmission via the use of common living quarters at the investigated quarantine site. The evaluation of this cohort has led to a policy recommendation on quarantine facility management. International travel quarantine is an important strategy to contain importation of COVID-19 cases. However, a quarantine facility is likely to become a potential hotspot, requiring thorough preventive measures. Reducing the exposure risk by providing private living quarters and scheduling clinical duties at a quarantine site separated from the conventional healthcare workforce have been implemented.

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Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 during Border Quarantine and Air Travel, New Zealand (Aotearoa)

Cited by 80 publications

References 14 publications

Air travel-related outbreak of multiple SARS-CoV-2 variants

Air travel-related outbreak of multiple SARS-CoV-2 variants

Use of respirator vs. surgical masks in healthcare personnel and its impact on SARS-CoV-2 acquisition – a prospective multicentre cohort study

COVID-19 Transmission among Healthcare Workers at a Quarantine Facility in Thailand: Genomic and Outbreak Investigations

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