Broadening symptom criteria improves early case identification in SARS-CoV-2 contacts.

Autor:	Houston H; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK.; H. Houston and S. Hakki contributed equally., Hakki S; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK.; H. Houston and S. Hakki contributed equally., Pillay TD; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Madon K; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Derqui-Fernandez N; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Koycheva A; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Singanayagam A; National Infection Service, Public Health England, London, UK., Fenn J; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Kundu R; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Conibear E; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Varro R; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Cutajar J; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Quinn V; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Wang L; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Narean JS; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Tolosa-Wright MR; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Barnett J; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK., Kon OM; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK.; Tuberculosis Service, Imperial College Healthcare NHS Trust, London, UK., Tedder R; Molecular Diagnostics Unit, Imperial College London, London, UK., Taylor G; Section of Virology, Dept of Infectious Disease, Imperial College London, London, UK., Zambon M; National Infection Service, Public Health England, London, UK., Ferguson N; Dept of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK., Dunning J; National Infection Service, Public Health England, London, UK.; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Oxford, Oxford, UK., Deeks JJ; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.; H. Houston and S. Hakki contributed equally., Lalvani A; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK a.lalvani@imperial.ac.uk.; J.J. Deeks and A. Lalvani contributed equally.
Jazyk:	angličtina
Zdroj:	The European respiratory journal [Eur Respir J] 2022 Jul 07; Vol. 60 (1). Date of Electronic Publication: 2022 Jul 07 (Print Publication: 2022).
DOI:	10.1183/13993003.02308-2021
Abstrakt:	Background: The success of case isolation and contact tracing for the control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission depends on the accuracy and speed of case identification. We assessed whether inclusion of additional symptoms alongside three canonical symptoms (CS), i.e. fever, cough and loss or change in smell or taste, could improve case definitions and accelerate case identification in SARS-CoV-2 contacts. Methods: Two prospective longitudinal London (UK)-based cohorts of community SARS-CoV-2 contacts, recruited within 5 days of exposure, provided independent training and test datasets. Infected and uninfected contacts completed daily symptom diaries from the earliest possible time-points. Diagnostic information gained by adding symptoms to the CS was quantified using likelihood ratios and area under the receiver operating characteristic curve. Improvements in sensitivity and time to detection were compared with penalties in terms of specificity and number needed to test. Results: Of 529 contacts within two cohorts, 164 (31%) developed PCR-confirmed infection and 365 (69%) remained uninfected. In the training dataset (n=168), 29% of infected contacts did not report the CS. Four symptoms (sore throat, muscle aches, headache and appetite loss) were identified as early-predictors (EP) which added diagnostic value to the CS. The broadened symptom criterion "≥1 of the CS, or ≥2 of the EP" identified PCR-positive contacts in the test dataset on average 2 days earlier after exposure (p=0.07) than "≥1 of the CS", with only modest reduction in specificity (5.7%). Conclusions: Broadening symptom criteria to include individuals with at least two of muscle aches, headache, appetite loss and sore throat identifies more infections and reduces time to detection, providing greater opportunities to prevent SARS-CoV-2 transmission. Competing Interests: Conflict of interest: No competing interests were declared by any of the study authors. (Copyright ©The authors 2022.)
Databáze:	MEDLINE
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