ABSTRACT
Background SARS-CoV-2 clinical presentation is associated with the patients' age group. Overall, young individuals present higher proportions of asymptomatic or mild COVID-19 infection, compared to adults. Data on secondary COVID-19 transmission in households, according to the cases' age group, are accumulating. Methods A follow-up cohort study including all COVID-19 RT-PCR -confirmed cases (adolescent students and school staff) diagnosed in an epidemiological investigation of a large high school outbreak. We compared the adolescent and adult groups regarding clinical symptoms, time to negative COVID-19 RT-PCR tests and infection transmission in households. Results The study population included 817 persons. The confirmed COVID-19 RT-PCR outbreak cases (n=178) were followed (students aged 12-19 years, median age 14 years, n=153, school staff aged 24-67 years, median age 39 years, n=25) and the cases' household close contacts (n=639) were tested. The adolescents had lower symptomatic infection rates, shorter time to negative COVID-19 RT-PCR tests and lower transmission rates to household members, compared to the adults. The general transmission rate among household contacts was 13.5%, (86/639) ranging from 8.6% in asymptomatic students' contacts to 27.3% in symptomatic staff contacts. COVID-19 transmission rates were significantly higher in contacts of symptomatic cases compared to asymptomatic cases (Odds Ratio: 2.06, 95%CI 1.26-3.4) and higher in adults compared to adolescents (Odds Ratio: 2.69, 95%CI 1.43-4.89). Conclusions Adolescents and adults diagnosed in an outbreak investigation differ as to COVID-19 clinical presentation and transmission. As adolescents may show mild or no symptoms, COVID-19 prevention in school settings is challenging. Implementing non-pharmaceutical measures and promoting vaccination programs in eligible staff and students should be considered. Graphical abstract Image, graphical abstract
ABSTRACT
Measles is a highly contagious disease. A 24 years old patient, recently exposed to measles (unvaccinated), presented in the emergency department with severe agitation, compatible with an acute psychotic episode, during the measles epidemic which spread in Israel in 2018-2019. Upon hospital admission, strict isolation was instructed, yet, without compliance, probably due to the patient's status. Measles diagnosis was promptly confirmed. As measles transmission was eminent, public health measures were employed through immediate implementation of the section 15 of the Public Health Ordinance, allowing for compulsory short-term isolation. The patient's condition improved within a few days and the measures were no longer necessary. This measles case occurred in the pre-Coronavirus disease 2019 (COVID-19) epidemic when use of a Public Health Ordinance was considered an extreme measure. This is in contrast to the current global use of Public Health laws to enforce strict quarantine and isolation on persons infected or potentially exposed to COVID-19. Nevertheless, minimizing infectious diseases transmission is a core function of public health law. Utilizing legal enforcement in circumstances of immediate public health hazard, such as nosocomial measles transmission, necessitates careful consideration. The integrative clinical and public health approach and prompt measures employed in this exceptional case, led to prevention of further infection spread.
Subject(s)
Cross Infection/prevention & control , Measles/prevention & control , Patient Isolation/legislation & jurisprudence , Public Health/legislation & jurisprudence , Acute Disease , Emergency Service, Hospital , Hospitalization , Humans , Israel/epidemiology , Male , Measles/complications , Measles/epidemiology , Psychotic Disorders/etiology , Psychotic Disorders/therapy , Young AdultABSTRACT
On 13 March 2020, Israel's government declared closure of all schools. Schools fully reopened on 17 May 2020. Ten days later, a major outbreak of coronavirus disease (COVID-19) occurred in a high school. The first case was registered on 26 May, the second on 27 May. They were not epidemiologically linked. Testing of the complete school community revealed 153 students (attack rate: 13.2%) and 25 staff members (attack rate: 16.6%) who were COVID-19 positive.