Prevalence of risk behaviors and correlates of SARS-CoV-2 positivity among in-school contacts of confirmed cases in a Georgia school district in the pre-vaccine era, December 2020-January 2021.

BACKGROUND: There is a continuing risk for COVID-19 transmission in school settings while transmission is ongoing in the community, particularly among unvaccinated populations. To ensure that schools continue to operate safely and to inform implementation of prevention strategies, it is imperative to gain better understanding of the risk behaviors of staff and students. This secondary analysis describes the prevalence of COVID-19 risk behaviors in an exposed population of students and school staff in the pre-vaccine era and identifies associations between these behaviors and testing positive for SARS-CoV-2. METHODS: From December 2020-January 2021, school staff and students exposed to confirmed COVID-19 cases in a Georgia school district were tested for SARS-CoV-2 and surveyed regarding risk behaviors in and out of school. Prevalence of risk behaviors was described by age group and school level, and associations with SARS-CoV-2 positivity were identified using chi squared tests. RESULTS: Overall, 717 students and 79 school staff participated in the investigation; SARS-CoV-2 positivity was 9.2%. In the 2 weeks prior to COVID-19 exposure, 24% of participants reported unmasked indoor time at school, 40% attended social gatherings with non-household members, and 71% visited out-of-school indoor locations, including 19% who ate indoors in restaurants. Frequencies of risk behaviors increased by age. Among students, 17% participated in school sports, of whom 86% participated without a mask. SARS-CoV-2 positivity was significantly associated with school sports and unmasked time in sports. Among K-5 students, positivity was associated with exposure to a teacher index case. CONCLUSIONS: This analysis highlights the high prevalence of risk behaviors in an unvaccinated population exposed to COVID-19 in school and identifies an association between student sports participation and SARS-CoV-2 positivity. These findings illustrate the importance of school-level prevention measures to reduce SARS-CoV-2 transmission, including limiting close-contact indoor sports and promoting consistent mask use in unvaccinated individuals. Future research could explore the role of community vaccination programs as a strategy to reduce COVID-19 transmission and introductions into school settings.

Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in a Georgia School District-United States, December 2020-January 2021.

BACKGROUND: To inform prevention strategies, we assessed the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and settings in which transmission occurred in a Georgia public school district. METHODS: During 1 December 2020-22 January 2021, SARS-CoV-2-infected index cases and their close contacts in schools were identified by school and public health officials. For in-school contacts, we assessed symptoms and offered SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) testing; performed epidemiologic investigations and whole-genome sequencing to identify in-school transmission; and calculated secondary attack rate (SAR) by school setting (eg, sports, elementary school classroom), index case role (ie, staff, student), and index case symptomatic status. RESULTS: We identified 86 index cases and 1119 contacts, 688 (61.5%) of whom received testing. Fifty-nine of 679 (8.7%) contacts tested positive; 15 of 86 (17.4%) index cases resulted in ≥2 positive contacts. Among 55 persons testing positive with available symptom data, 31 (56.4%) were asymptomatic. Highest SARs were in indoor, high-contact sports settings (23.8% [95% confidence interval {CI}, 12.7%-33.3%]), staff meetings/lunches (18.2% [95% CI, 4.5%-31.8%]), and elementary school classrooms (9.5% [95% CI, 6.5%-12.5%]). The SAR was higher for staff (13.1% [95% CI, 9.0%-17.2%]) vs student index cases (5.8% [95% CI, 3.6%-8.0%]) and for symptomatic (10.9% [95% CI, 8.1%-13.9%]) vs asymptomatic index cases (3.0% [95% CI, 1.0%-5.5%]). CONCLUSIONS: Indoor sports may pose a risk to the safe operation of in-person learning. Preventing infection in staff members, through measures that include coronavirus disease 2019 vaccination, is critical to reducing in-school transmission. Because many positive contacts were asymptomatic, contact tracing should be paired with testing, regardless of symptoms.

The Occupational Health Effects of Responding to a Natural Gas Pipeline Explosion Among Emergency First Responders - Lincoln County, Kentucky, 2019.

OBJECTIVE: The aim of the study was to assess occupational health effects 1 month after responding to a natural gas pipeline explosion. METHODS: First responders to a pipeline explosion in Kentucky were interviewed about pre- and post-response health symptoms, post-response health care, and physical exertion and personal protective equipment (PPE) use during the response. Logistic regression was used to examine associations between several risk factors and development of post-response symptoms. RESULTS: Among 173 first responders involved, 105 (firefighters [58%], emergency medical services [19%], law enforcement [10%], and others [12%]) were interviewed. Half (53%) reported at least 1 new or worsening symptom, including upper respiratory symptoms (39%), headache (18%), eye irritation (17%), and lower respiratory symptoms (16%). The majority (79%) of symptomatic responders did not seek post-response care. Compared with light-exertion responders, hard-exertion responders (48%) had significantly greater odds of upper respiratory symptoms (aOR: 2.99, 95% CI: 1.25-7.50). Forty-four percent of responders and 77% of non-firefighter responders reported not using any PPE. CONCLUSIONS: Upper respiratory symptoms were common among first responders of a natural gas pipeline explosion and associated with hard-exertion activity. Emergency managers should ensure responders are trained in, equipped with, and properly use PPE during these incidents and encourage responders to seek post-response health care when needed.

Low SARS-CoV-2 Seroprevalence and No Active Infections among Dogs and Cats in Animal Shelters with Laboratory-Confirmed COVID-19 Human Cases among Employees.

Human-to-animal and animal-to-animal transmission of SARS-CoV-2 has been documented; however, investigations into SARS-CoV-2 transmission in congregate animal settings are lacking. We investigated four animal shelters in the United States that had identified animals with exposure to shelter employees with laboratory-confirmed COVID-19. Of the 96 cats and dogs with specimens collected, only one dog had detectable SARS-CoV-2 neutralizing antibodies; no animal specimens had detectable viral RNA. These data indicate a low probability of human-to-animal transmission events in cats and dogs in shelter settings with early implementation of infection prevention interventions.

Late Conditions Diagnosed 1-4 Months Following an Initial Coronavirus Disease 2019 (COVID-19) Encounter: A Matched-Cohort Study Using Inpatient and Outpatient Administrative Data-United States, 1 March-30 June 2020.

BACKGROUND: Late sequelae of COVID-19 have been reported; however, few studies have investigated the time course or incidence of late new COVID-19-related health conditions (post-COVID conditions) after COVID-19 diagnosis. Studies distinguishing post-COVID conditions from late conditions caused by other etiologies are lacking. Using data from a large administrative all-payer database, we assessed type, association, and timing of post-COVID conditions following COVID-19 diagnosis. METHODS: Using the Premier Healthcare Database Special COVID-19 Release (release date, 20 October 2020) data, during March-June 2020, 27 589 inpatients and 46 857 outpatients diagnosed with COVID-19 (case-patients) were 1:1 matched with patients without COVID-19 through the 4-month follow-up period (control-patients) by using propensity score matching. In this matched-cohort study, adjusted ORs were calculated to assess for late conditions that were more common in case-patients than control-patients. Incidence proportion was calculated for conditions that were more common in case-patients than control-patients during 31-120 days following a COVID-19 encounter. RESULTS: During 31-120 days after an initial COVID-19 inpatient hospitalization, 7.0% of adults experienced ≥1 of 5 post-COVID conditions. Among adult outpatients with COVID-19, 7.7% experienced ≥1 of 10 post-COVID conditions. During 31-60 days after an initial outpatient encounter, adults with COVID-19 were 2.8 times as likely to experience acute pulmonary embolism as outpatient control-patients and also more likely to experience a range of conditions affecting multiple body systems (eg, nonspecific chest pain, fatigue, headache, and respiratory, nervous, circulatory, and gastrointestinal symptoms) than outpatient control-patients. CONCLUSIONS: These findings add to the evidence of late health conditions possibly related to COVID-19 in adults following COVID-19 diagnosis and can inform healthcare practice and resource planning for follow-up COVID-19 care.

Salmonella and Escherichia coli Prevalence in Meat and Produce Sold at Farmers' Markets in Northern California.

ABSTRACT: As the number of farmers' markets and other direct-to-consumer marketing channels increases, it is crucial to understand the potential risks associated with consuming directly marketed animal products and fresh produce. The overall aim of this project was to assess the prevalence of Salmonella and Escherichia coli in animal products and produce sold at farmers' markets in Northern California and to evaluate the food safety risks associated with consuming meat (e.g., beef, pork, and poultry) and fresh produce purchased from farmers' markets. Animal products and produce were purchased from a total of 44 certified farmers' markets in Northern California. Salmonella was found in 6 (1.8%) of 338 animal products and in 0 (0%) of 128 produce samples; E. coli was found in 40 (31.3%) of 128 fresh produce samples. E. coli concentration in produce ranged from 0 to 2.96, with an overall average of 0.13 log (most probable number + 1)/100 mL. Salmonella isolates were resistant to nalidixic acid and tetracycline. The results from this study highlight the need for further training on mitigation strategies to reduce contamination of animal products and fresh produce by foodborne pathogens.

Descriptive and multivariate analysis of the pig sector in Georgia and its implications for disease transmission.

BACKGROUND: Georgia is a country in the Caucasus region with a traditional backyard and highly variable pig farming system. The practices of such sectors have seldom been described and analyzed to better understand their implication in the introduction and spread of infectious pig diseases. Moreover, the Georgian pig sector was badly hit by an epidemic of African swine fever in 2007 that quickly spread throughout the region. MATERIALS AND METHODS: We interviewed 487 pig farmers and 116 butchers using closed questionnaires on socioeconomic issues related to pig production, husbandry practices, biosecurity, marketing and movements, and disease awareness. Surveys were conducted in four regions of Georgia and descriptive statistics were computed. Factorial analyses of mixed data and hierarchical clustering on principal components were applied to study the relationship among collected variables for both farmers and butchers. RESULTS: Results show that pig farming in Georgia is a non-professional sector, highly heterogeneous by region, characterized by smallholdings of few animals, with low inputs, outdated technologies, and poor biosecurity, which all translates into low outputs and productivity. The hierarchical clustering on principal components confirmed that there are five major production and husbandry strategies, which match the four regions where the study was conducted. CONCLUSIONS: Our results are the first step to quantify biosecurity gaps and risky behaviours, develop risk profiles, and identify critical control points across the market chain where to implement mitigation measures. This study provides the baseline information needed to design realistic and sustainable prevention, surveillance and control strategies.

Modeling the live-pig trade network in Georgia: Implications for disease prevention and control.

Live pig trade patterns, drivers and characteristics, particularly in backyard predominant systems, remain largely unexplored despite their important contribution to the spread of infectious diseases in the swine industry. A better understanding of the pig trade dynamics can inform the implementation of risk-based and more cost-effective prevention and control programs for swine diseases. In this study, a semi-structured questionnaire elaborated by FAO and implemented to 487 farmers was used to collect data regarding basic characteristics about pig demographics and live-pig trade among villages in the country of Georgia, where very scarce information is available. Social network analysis and exponential random graph models were used to better understand the structure, contact patterns and main drivers for pig trade in the country. Results indicate relatively infrequent (a total of 599 shipments in one year) and geographically localized (median Euclidean distance between shipments = 6.08 km; IQR = 0-13.88 km) pig movements in the studied regions. The main factors contributing to live-pig trade movements among villages were being from the same region (i.e., local trade), usage of a middleman or a live animal market to trade live pigs by at least one farmer in the village, and having a large number of pig farmers in the village. The identified villages' characteristics and structural network properties could be used to inform the design of more cost-effective surveillance systems in a country which pig industry was recently devastated by African swine fever epidemics and where backyard production systems are predominant.

Wild and Domestic Pig Interactions at the Wildlife-Livestock Interface of Murchison Falls National Park, Uganda, and the Potential Association with African Swine Fever Outbreaks.

Bushpigs (BPs) (Potamochoerus larvatus) and warthogs (WHs) (Phacochoerus africanus), which are widely distributed in Eastern Africa, are likely to cohabitate in the same environment with domestic pigs (DPs), facilitating the transmission of shared pathogens. However, potential interactions between BP, WH, and DP, and the resulting potential circulation of infectious diseases have rarely been investigated in Africa to date. In order to understand the dynamics of such interactions and the potential influence of human behavior and husbandry practices on them, individual interviews (n = 233) and participatory rural appraisals (n = 11) were carried out among Ugandan pig farmers at the edge of Murchison Falls National Park, northern Uganda. In addition, as an example of possible implications of wild and DP interactions, non-linear multivariate analysis (multiple correspondence analyses) was used to investigate the potential association between the aforementioned factors (interactions and human behavior and practices) and farmer reported African swine fever (ASF) outbreaks. No direct interactions between wild pigs (WPs) and DP were reported in our study area. However, indirect interactions were described by 83 (35.6%) of the participants and were identified to be more common at water sources during the dry season. Equally, eight (3.4%) farmers declared exposing their DP to raw hunting leftovers of WPs. The exploratory analysis performed suggested possible associations between the farmer reported ASF outbreaks and indirect interactions, free-range housing systems, dry season, and having a WH burrow less than 3 km from the household. Our study was useful to gather local knowledge and to identify knowledge gaps about potential interactions between wild and DP in this area. This information could be useful to facilitate the design of future observational studies to better understand the potential transmission of pathogens between wild and DPs.