MMWR) Section NavigationOutbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021
Early Release / July 30, 2021 / 70
Catherine M. Brown, DVM1; Johanna Vostok, MPH1; Hillary Johnson, MHS1; Meagan Burns, MPH1; Radhika Gharpure, DVM2; Samira Sami, DrPH2; Rebecca T. Sabo, MPH2; Noemi Hall, PhD2; Anne Foreman, PhD2; Petra L. Schubert, MPH1; Glen R. Gallagher, PhD1; Timelia Fink1; Lawrence C. Madoff, MD1; Stacey B. Gabriel, PhD3; Bronwyn MacInnis, PhD3; Daniel J. Park, PhD3; Katherine J. Siddle, PhD3; Vaira Harik, MS4; Deirdre Arvidson, MSN4; Taylor Brock-Fisher, MSc5; Molly Dunn, DVM5; Amanda Kearns5; A. Scott Laney, PhD2 (View author affiliations)
Variants of SARS-CoV-2 continue to emerge. The B.1.617.2 (Delta) variant is highly transmissible.
What is added by this report?
In July 2021, following multiple large public events in a Barnstable County, Massachusetts, town, 469 COVID-19 cases were identified among Massachusetts residents who had traveled to the town during July 3–17; 346 (74%) occurred in fully vaccinated persons. Testing identified the Delta variant in 90% of specimens from 133 patients. Cycle threshold values were similar among specimens from patients who were fully vaccinated and those who were not.
What are the implications for public health practice?
Jurisdictions might consider expanded prevention strategies, including universal masking in indoor public settings, particularly for large public gatherings that include travelers from many areas with differing levels of SARS-CoV-2 transmission
During July 10–26, using travel history data from the state COVID-19 surveillance system, MA DPH identified a cluster of cases among Massachusetts residents. Additional cases were identified by local health jurisdictions through case investigation. COVID-19 cases were matched with the state immunization registry. A cluster-associated case was defined as receipt of a positive SARS-CoV-2 test (nucleic acid amplification or antigen) result ≤14 days after travel to or residence in the town in Barnstable County since July 3. COVID-19 vaccine breakthrough cases were those in fully vaccinated Massachusetts residents (those with documentation from the state immunization registry of completion of COVID-19 vaccination as recommended by the Advisory Committee on Immunization Practices,† ≥14 days before exposure). Specimens were submitted for whole genome sequencing§ to either the Massachusetts State Public Health Laboratory or the Broad Institute of the Massachusetts Institute of Technology and Harvard University. Ct values were obtained for 211 specimens tested using a noncommercial real-time RT-PCR panel for SARS-CoV-2 performed under Emergency Use Authorization at the Broad Institute Clinical Research Sequencing Platform. On July 15, MA DPH issued the first of two Epidemic Information Exchange notifications to identify additional cases among residents of U.S. jurisdictions outside Massachusetts associated with recent travel to the town in Barnstable County during July 2021. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶
By July 26, a total of 469 COVID-19 cases were identified among Massachusetts residents; dates of positive specimen collection ranged from July 6 through July 25 (Figure 1). Most cases occurred in males (85%); median age was 40 years (range = <1–76 years). Nearly one half (199; 42%) reported residence in the town in Barnstable County. Overall, 346 (74%) persons with COVID-19 reported symptoms consistent with COVID-19.** Five were hospitalized; as of July 27, no deaths were reported. One hospitalized patient (age range = 50–59 years) was not vaccinated and had multiple underlying medical conditions.†† Four additional, fully vaccinated patients§§ aged 20–70 years were also hospitalized, two of whom had underlying medical conditions. Initial genomic sequencing of specimens from 133 patients identified the Delta variant in 119 (89%) cases and the Delta AY.3 sublineage in one (1%) case; genomic sequencing was not successful for 13 (10%) specimens.
Among the 469 cases in Massachusetts residents, 346 (74%) occurred in persons who were fully vaccinated; of these, 301 (87%) were male, with a median age of 42 years. Vaccine products received by persons experiencing breakthrough infections were Pfizer-BioNTech (159; 46%), Moderna (131; 38%), and Janssen (56; 16%); among fully vaccinated persons in the Massachusetts general population, 56% had received Pfizer-BioNTech, 38% had received Moderna, and 7% had received Janssen vaccine products. Among persons with breakthrough infection, 274 (79%) reported signs or symptoms, with the most common being cough, headache, sore throat, myalgia, and fever. Among fully vaccinated symptomatic persons, the median interval from completion of ≥14 days after the final vaccine dose to symptom onset was 86 days (range = 6–178 days). Among persons with breakthrough infection, four (1.2%) were hospitalized, and no deaths were reported. Real-time RT-PCR Ct values in specimens from 127 fully vaccinated patients (median = 22.77) were similar to those among 84 patients who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown (median = 21.54) (Figure 2).
Early Release / July 30, 2021 / 70
Catherine M. Brown, DVM1; Johanna Vostok, MPH1; Hillary Johnson, MHS1; Meagan Burns, MPH1; Radhika Gharpure, DVM2; Samira Sami, DrPH2; Rebecca T. Sabo, MPH2; Noemi Hall, PhD2; Anne Foreman, PhD2; Petra L. Schubert, MPH1; Glen R. Gallagher, PhD1; Timelia Fink1; Lawrence C. Madoff, MD1; Stacey B. Gabriel, PhD3; Bronwyn MacInnis, PhD3; Daniel J. Park, PhD3; Katherine J. Siddle, PhD3; Vaira Harik, MS4; Deirdre Arvidson, MSN4; Taylor Brock-Fisher, MSc5; Molly Dunn, DVM5; Amanda Kearns5; A. Scott Laney, PhD2 (View author affiliations)
View suggested citation SummaryWhat is already known about this topic?
Variants of SARS-CoV-2 continue to emerge. The B.1.617.2 (Delta) variant is highly transmissible.
What is added by this report?
In July 2021, following multiple large public events in a Barnstable County, Massachusetts, town, 469 COVID-19 cases were identified among Massachusetts residents who had traveled to the town during July 3–17; 346 (74%) occurred in fully vaccinated persons. Testing identified the Delta variant in 90% of specimens from 133 patients. Cycle threshold values were similar among specimens from patients who were fully vaccinated and those who were not.
What are the implications for public health practice?
Jurisdictions might consider expanded prevention strategies, including universal masking in indoor public settings, particularly for large public gatherings that include travelers from many areas with differing levels of SARS-CoV-2 transmission
https://newsazi.com/cdc-alarmed-74-of-cases-in-cape-cod-cluster-were-among-the-vaxxed/
During July 10–26, using travel history data from the state COVID-19 surveillance system, MA DPH identified a cluster of cases among Massachusetts residents. Additional cases were identified by local health jurisdictions through case investigation. COVID-19 cases were matched with the state immunization registry. A cluster-associated case was defined as receipt of a positive SARS-CoV-2 test (nucleic acid amplification or antigen) result ≤14 days after travel to or residence in the town in Barnstable County since July 3. COVID-19 vaccine breakthrough cases were those in fully vaccinated Massachusetts residents (those with documentation from the state immunization registry of completion of COVID-19 vaccination as recommended by the Advisory Committee on Immunization Practices,† ≥14 days before exposure). Specimens were submitted for whole genome sequencing§ to either the Massachusetts State Public Health Laboratory or the Broad Institute of the Massachusetts Institute of Technology and Harvard University. Ct values were obtained for 211 specimens tested using a noncommercial real-time RT-PCR panel for SARS-CoV-2 performed under Emergency Use Authorization at the Broad Institute Clinical Research Sequencing Platform. On July 15, MA DPH issued the first of two Epidemic Information Exchange notifications to identify additional cases among residents of U.S. jurisdictions outside Massachusetts associated with recent travel to the town in Barnstable County during July 2021. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶
By July 26, a total of 469 COVID-19 cases were identified among Massachusetts residents; dates of positive specimen collection ranged from July 6 through July 25 (Figure 1). Most cases occurred in males (85%); median age was 40 years (range = <1–76 years). Nearly one half (199; 42%) reported residence in the town in Barnstable County. Overall, 346 (74%) persons with COVID-19 reported symptoms consistent with COVID-19.** Five were hospitalized; as of July 27, no deaths were reported. One hospitalized patient (age range = 50–59 years) was not vaccinated and had multiple underlying medical conditions.†† Four additional, fully vaccinated patients§§ aged 20–70 years were also hospitalized, two of whom had underlying medical conditions. Initial genomic sequencing of specimens from 133 patients identified the Delta variant in 119 (89%) cases and the Delta AY.3 sublineage in one (1%) case; genomic sequencing was not successful for 13 (10%) specimens.
Among the 469 cases in Massachusetts residents, 346 (74%) occurred in persons who were fully vaccinated; of these, 301 (87%) were male, with a median age of 42 years. Vaccine products received by persons experiencing breakthrough infections were Pfizer-BioNTech (159; 46%), Moderna (131; 38%), and Janssen (56; 16%); among fully vaccinated persons in the Massachusetts general population, 56% had received Pfizer-BioNTech, 38% had received Moderna, and 7% had received Janssen vaccine products. Among persons with breakthrough infection, 274 (79%) reported signs or symptoms, with the most common being cough, headache, sore throat, myalgia, and fever. Among fully vaccinated symptomatic persons, the median interval from completion of ≥14 days after the final vaccine dose to symptom onset was 86 days (range = 6–178 days). Among persons with breakthrough infection, four (1.2%) were hospitalized, and no deaths were reported. Real-time RT-PCR Ct values in specimens from 127 fully vaccinated patients (median = 22.77) were similar to those among 84 patients who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown (median = 21.54) (Figure 2).
但是实际上还有许多复杂因素。死亡率的降低是否与医院的治疗经验增加有关？Delta传染性更强，但致死率偏低也是一种假说。
《纽约时报》今天说：Covid is more mysterious than we often admit.
https://www.google.com/amp/s/abcnews.go.com/amp/US/vast-majority-icu-patients-covid-19-unvaccinated-abc/story%3fid=79128401
老人摔伤住院在特护病房。如果没有家人天天去看和医护沟通基本就没命了。第一次看老人在尿包里泡五个小时了。没人关注常见的褥疮就要命。还有水离的远，老人不能动，够不到水。家人沟通了几次明显改观。
新冠初期批量死的基本是这些没家人关注的老人。有的养老院几天没人管。
值得高兴的是，目前医院很安全。没有风声鹤唳 草木皆兵的景象