Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings - Barnstable County, Massachusetts, July 2021
Catherine M Brown, Johanna Vostok, Hillary Johnson, Meagan Burns, Radhika Gharpure, Samira Sami, Rebecca T Sabo, Noemi Hall, Anne Foreman, Petra L Schubert, Glen R Gallagher, Timelia Fink, Lawrence C Madoff, Stacey B Gabriel, Bronwyn MacInnis, Daniel J Park, Katherine J Siddle, Vaira Harik, Deirdre Arvidson, Taylor Brock-Fisher, Molly Dunn, Amanda Kearns, A Scott Laney, Catherine M Brown, Johanna Vostok, Hillary Johnson, Meagan Burns, Radhika Gharpure, Samira Sami, Rebecca T Sabo, Noemi Hall, Anne Foreman, Petra L Schubert, Glen R Gallagher, Timelia Fink, Lawrence C Madoff, Stacey B Gabriel, Bronwyn MacInnis, Daniel J Park, Katherine J Siddle, Vaira Harik, Deirdre Arvidson, Taylor Brock-Fisher, Molly Dunn, Amanda Kearns, A Scott Laney
Abstract
During July 2021, 469 cases of COVID-19 associated with multiple summer events and large public gatherings in a town in Barnstable County, Massachusetts, were identified among Massachusetts residents; vaccination coverage among eligible Massachusetts residents was 69%. Approximately three quarters (346; 74%) of cases occurred in fully vaccinated persons (those who had completed a 2-dose course of mRNA vaccine [Pfizer-BioNTech or Moderna] or had received a single dose of Janssen [Johnson & Johnson] vaccine ≥14 days before exposure). Genomic sequencing of specimens from 133 patients identified the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, in 119 (89%) and the Delta AY.3 sublineage in one (1%). Overall, 274 (79%) vaccinated patients with breakthrough infection were symptomatic. Among five COVID-19 patients who were hospitalized, four were fully vaccinated; no deaths were reported. Real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values in specimens from 127 vaccinated persons with breakthrough cases were similar to those from 84 persons who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown (median = 22.77 and 21.54, respectively). The Delta variant of SARS-CoV-2 is highly transmissible (1); vaccination is the most important strategy to prevent severe illness and death. On July 27, CDC recommended that all persons, including those who are fully vaccinated, should wear masks in indoor public settings in areas where COVID-19 transmission is high or substantial.* Findings from this investigation suggest that even jurisdictions without substantial or high COVID-19 transmission might consider expanding prevention strategies, including masking in indoor public settings regardless of vaccination status, given the potential risk of infection during attendance at large public gatherings that include travelers from many areas with differing levels of transmission.
Conflict of interest statement
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Stacey B. Gabriel reports receiving grants from CDC. Bronwyn MacInnis, Katherine Siddle, and Daniel Park report receiving grants from CDC and the National Institutes of Health. Taylor Brock-Fisher reports receiving a grant from the Community Tracing Collaborative. No other potential conflicts of interest were disclosed.
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References
- CDC. COVID-19: SARS-CoV-2 variant classifications and definitions. Atlanta, GA: US Department of Health and Human Services, CDC; 2021. Accessed July 25, 2021.
- Massachusetts Department of Public Health. COVID-19 response reporting. Boston, MA: Massachusetts Department of Public Health; 2021. Accessed July 25, 2021.
- Massachusetts Department of Public Health. Massachusetts COVID-19 vaccination data and updates. Boston, MA: Massachusetts Department of Public Health; 2021. Accessed July 25, 2021.
- Christie A, Brooks JT, Hicks LA, Sauber-Schatz EK, Yoder JS, Honein MA. Guidance for implementing COVID-19 prevention strategies in the context of varying community transmission levels and vaccination coverage. MMWR Morb Mortal Wkly Rep 2021;70:1044–7. 10.15585/mmwr.mm7030e2
Source: PubMed