1887
Outbreaks Open Access
Like 0

Abstract

We report three clusters related with potential pre-symptomatic transmission of coronavirus disease (COVID-19) between January and February 2020 in Shanghai, China. Investigators interviewed suspected COVID-19 cases to collect epidemiological information, including demographic characteristics, illness onset, hospital visits, close contacts, activities’ trajectories between 14 days before illness onset and isolation, and exposure histories. Respiratory specimens of suspected cases were collected and tested for SARS-CoV-2 by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) assay. The interval between the onset of illness in the primary case and the last contact of the secondary case with the primary case in our report was 1 to 7 days. In Cluster 1 (five cases), illness onset in the five secondary cases was 2 to 5 days after the last contact with the primary case. In Cluster 2 (five cases) and Cluster 3 (four cases), the illness onset in secondary cases occurred prior to or on the same day as the onset in the primary cases. The study provides empirical evidence for transmission of COVID-19 during the incubation period and indicates that pre-symptomatic person-to-person transmission can occur following sufficient exposure to confirmed COVID-19 cases. The potential pre-symptomatic person-to-person transmission puts forward higher requirements for prevention and control measures.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2020.25.33.2000228
2020-08-20
2024-11-24
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.33.2000228
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/25/33/eurosurv-25-33-1.html?itemId=/content/10.2807/1560-7917.ES.2020.25.33.2000228&mimeType=html&fmt=ahah

References

  1. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) – China, 2020. China CDC Weekly.2020;2(8):113-22.  https://doi.org/10.46234/ccdcw2020.032 
  2. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3.  https://doi.org/10.1016/S0140-6736(20)30185-9  PMID: 31986257 
  3. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.  https://doi.org/10.1056/NEJMoa2001017  PMID: 31978945 
  4. World Health Organization (WHO). Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Geneva: WHO; 30 Jan 2020. Available from: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov).
  5. World Health Organization (WHO). Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Geneva: WHO; 11 Mar 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
  6. World Health Organization (WHO). Coronavirus disease 2019 (COVID-19) Situation report – 69. Geneva: WHO; 29 Mar 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200329-sitrep-69-covid-19.pdf?sfvrsn=8d6620fa_2
  7. Kinross P, Suetens C, Gomes Dias J, Alexakis L, Wijermans A, Colzani E, et al. Rapidly increasing cumulative incidence of coronavirus disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020. Euro Surveill. 2020;25(11):2000285.  https://doi.org/10.2807/1560-7917.ES.2020.25.11.2000285  PMID: 32186277 
  8. World Health Organization (WHO). Coronavirus disease 2019 (COVID-19) Situation report – 174. Geneva: WHO; 12 July 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200712-covid-19-sitrep-174.pdf?sfvrsn=5d1c1b2c_2.
  9. National Health Commission of the People’s Republic of China (NHC). Epidemic situation of COVID-19 on January 22. Beijing: NHC; 22 Jan 2020. Available from: http://www.nhc.gov.cn/xcs/yqtb/202001/a3c8b5144067417889d8760254b1a7ca.shtml
  10. Shanghai Municipal Government of the People’s Republic of China. Shanghai declared the first-level response for major public health emergency to firmly curb the spread of the epidemic. Shanghai: Shanghai Municipal Government of the People’s Republic of China; 25 Jan 2020. Available from: http://www.shanghai.gov.cn/nw2/nw2314/nw2315/nw4411/u21aw1423526.html
  11. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207.  https://doi.org/10.1056/NEJMoa2001316  PMID: 31995857 
  12. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-23.  https://doi.org/10.1016/S0140-6736(20)30154-9  PMID: 31986261 
  13. Huang R, Xia J, Chen Y, Shan C, Wu C. A family cluster of SARS-CoV-2 infection involving 11 patients in Nanjing, China. Lancet Infect Dis. 2020;20(5):534-5.  https://doi.org/10.1016/S1473-3099(20)30147-X  PMID: 32119823 
  14. Nicastri E, D’Abramo A, Faggioni G, De Santis R, Mariano A, Lepore L, et al. Coronavirus disease (COVID-19) in a paucisymptomatic patient: epidemiological and clinical challenge in settings with limited community transmission, Italy, February 2020. Euro Surveill. 2020;25(11):2000230.  https://doi.org/10.2807/1560-7917.ES.2020.25.11.2000230  PMID: 32209164 
  15. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382(10):970-1.  https://doi.org/10.1056/NEJMc2001468  PMID: 32003551 
  16. Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14):1406.  https://doi.org/10.1001/jama.2020.2565  PMID: 32083643 
  17. Li P, Fu JB, Li KF, Liu J-N, Wang H-L, Liu L-J, et al. Transmission of COVID-19 in the terminal stages of the incubation period: A familial cluster. Int J Infect Dis. 2020;96:452-3.  https://doi.org/10.1016/j.ijid.2020.03.027  PMID: 32194239 
  18. National Health Commission of the People’s Republic of China (NHC). The 3rd version of Prevention and Control Guidelines for Novel Coronavirus Pneumonia. Beijing: NHC; 28 Jan 2020. Available from: http://www.nhc.gov.cn/jkj/s7923/202001/470b128513fe46f086d79667db9f76a5.shtml
  19. World Health Organization (WHO). Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans. Geneva: WHO. [Accessed: 2 Apr 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance
  20. The Standing Committee of the National People's Congress of the People's Republic of China (NPCSC). Law of the People's Republic of China on prevention and control of infectious diseases. Beijing: NPCSC; 30 Aug 2018. Available from: http://www.nhc.gov.cn/fzs/s3576/201808/6d00c158844f42c5bcf94993bffa665a.shtml
  21. National Health Commission of the People’s Republic of China (NHC). The 5th version of prevention and control guidelines for novel coronavirus pneumonia. Beijing: NHC; 21 Feb 2020. Available from: http://www.nhc.gov.cn/jkj/s3577/202002/a5d6f7b8c48c451c87dba14889b30147.shtml
  22. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177-9.  https://doi.org/10.1056/NEJMc2001737  PMID: 32074444 
  23. World Health Organization (WHO). Interim guidance: Considerations in the investigation of cases and clusters of COVID-19. Geneva: WHO; 2 Apr 2020. Available from: https://www.who.int/publications-detail/considerations-in-the-investigation-of-cases-and-clusters-of-covid-19
  24. Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020;25(5):2000062.  https://doi.org/10.2807/1560-7917.ES.2020.25.5.2000062  PMID: 32046819 
  25. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020;172(9):577-82.  https://doi.org/10.7326/M20-0504  PMID: 32150748 
  26. Glasser JW, Hupert N, McCauley MM, Hatchett R. Modeling and public health emergency responses: lessons from SARS. Epidemics. 2011;3(1):32-7.  https://doi.org/10.1016/j.epidem.2011.01.001  PMID: 21420657 
  27. Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020;25(10):2000180.  https://doi.org/10.2807/1560-7917.ES.2020.25.10.2000180  PMID: 32183930 
  28. Wang Y, Liu Y, Liu L, Wang X, Luo N, Li L. Clinical outcomes in 55 patients with severe acute respiratory syndrome coronavirus 2 who were asymptomatic at hospital admission in Shenzhen, China. J Infect Dis. 2020;221(11):1770-4.  https://doi.org/10.1093/infdis/jiaa119  PMID: 32179910 
  29. Hellewell J, Abbott S, Gimma A, Bosse NI, Jarvis CI, Russell TW, et al. Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. Lancet Glob Health. 2020;8(4):e488-96.  https://doi.org/10.1016/S2214-109X(20)30074-7  PMID: 32119825 
  30. Okada P, Buathong R, Phuygun S, Thanadachakul T, Parnmen S, Wongboot W, et al. Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand, January 2020. Euro Surveill. 2020;25(8):2000097.  https://doi.org/10.2807/1560-7917.ES.2020.25.8.2000097  PMID: 32127124 
  31. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929-36.  https://doi.org/10.1056/NEJMoa2001191  PMID: 32004427 
/content/10.2807/1560-7917.ES.2020.25.33.2000228
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error