Contact Tracing Activities Research Articles

Determinants for university students’ location data sharing with public institutions during COVID-19: The Italian case

Abstract Data on real-time individuals’ location may provide significant opportunities for managing emergency situations. For example, in the case of outbreaks, besides informing on the proximity of people, hence supporting contact tracing activities, location data can be used to understand spatial heterogeneity in virus transmission. However, individuals’ low consent to share their data, proved by the low penetration rate of contact tracing apps in several countries during the coronavirus disease-2019 (COVID-19) pandemic, re-opened the scientific and practitioners’ discussion on factors and conditions triggering citizens to share their positioning data. Following the Antecedents → Privacy Concerns → Outcomes (APCO) model, and based on Privacy Calculus and Reasoned Action Theories, the study investigates factors that cause university students to share their location data with public institutions during outbreaks. To this end, an explanatory survey was conducted in Italy during the second wave of COVID-19, collecting 245 questionnaire responses. Structural equations modeling was used to contemporary investigate the role of trust, perceived benefit, and perceived risk as determinants of the intention to share location data during outbreaks. Results show that respondents’ trust in public institutions, the perceived benefits, and the perceived risk are significant predictor of the intention to disclose personal tracking data with public institutions. Results indicate that the latter two factors impact university students’ willingness to share data more than trust, prompting public institutions to rethink how they launch and manage the adoption process for these technological applications.

Evaluation of mpox contact tracing activities and data collection in EU/EEA countries during the 2022 multicountry outbreak in nonendemic countries.

To control human-to-human mpox transmission during the 2022 outbreak, European Union (EU)/European Economic Area (EEA) countries conducted case investigation and contact tracing (CT). We aimed to provide an overview of CT activities, describe CT data collection practices, and identify related facilitators, barriers, and potential opportunities for improvement. Between April 03, 2023 and May 12, 2023, a survey was distributed to CT stakeholders in 30 EU/EEA countries, asking about mpox CT activities and data collection and requesting to rank enablers, barriers, and improvements for CT on a five-point Likert scale. The 139 respondents from 27 countries indicated having performed case investigations (96%, n = 133), backward CT (88%, n = 122), forward CT (87%, n = 121), and follow-up on contacts' outcomes (77%, n = 107). Sixty percent (n = 80/134) used standardized data collection forms and 73% (n = 91/124) used databases. The highest-rated enablers were clear guidelines (mean = 3.9), quick access to laboratory results (3.6), and sufficient expertise (3.6). Highly rated barriers were inability to contact contacts (3.0) or cases (2.5) and lack of staff (2.4). The most needed improvements were availability of staff (3.5), expertise on affected populations (3.4) and data reporting tools and systems (3.3). To improve CT of mpox and diseases with similar transmission patterns, EU/EEA countries should increase workforce capacity in public and sexual health, offer training on CT operations and communication with affected communities, and use common CT data collection tools and systems.

Privacy Aspects of Contact Tracing Applications in Europe and Recommendations for Their Future Use

The first global pandemic in the age of digitalism indicated that there might be new types of privacy risks stemming from the processing activities taking place within the scope of digital contact tracing activities. While the right to life of all individuals living in the community should be primarily protected, their right to privacy should also be considered. Therefore, a balance between privacy and public health should be struck by both regulators and data controllers. The purpose of this review is to analyze the compliance efforts of data controllers in Europe with the existing EU data protection regulations, and guidance, and draw lessons for the use of contact tracing applications within the scope of potential disaster scenarios that may arise in the future by reviewing the existing literature and the privacy policies of the applications.

COVID-19 cross-border case and contact tracing activities - experiences and lessons learnt, Germany, April-December 2020

BackgroundInterruption of transmission chains has been crucial in the COVID-19 response. The Emergency Operations Centre (EOC) at the Robert Koch Institute (RKI) coordinated cross-border case and contact tracing activities at the national level by sharing data with German public health authorities (PHA) and other countries. Data on these activities were not collected in the national surveillance system, and thus were challenging to quantify. Our aim was to describe cross-border COVID-19 case and contact tracing activities including lessons learnt by PHA to adapt the procedures accordingly.MethodsCase and contact tracing events were recorded using unique identifiers. We collected data on cases, contacts, dates of exposure and/or SARS-CoV-2 positive test results and exposure setting. We performed descriptive analyses of events from 06.04.-31.12.2020. We conducted interviews with PHA to understand experiences and lessons learnt, applying a thematic approach for qualitative analysis.ResultsFrom 06.04.-31.12.2020 data on 7,527 cross-border COVID-19 case and contact tracing activities were collected. Germany initiated communication 5,200 times, and other countries 2,327 times. Communication from other countries was most frequently initiated by Austria (n = 1,184, 50.9%), Switzerland (n = 338, 14.5%), and the Netherlands (n = 168, 7.2%). Overall, 3,719 events (49.4%) included information on 5,757 cases (median 1, range: 1–42), and 4,114 events (54.7%) included information on 13,737 contacts (median: 1, range: 1–1,872). The setting of exposure was communicated for 2,247 of the events (54.6%), and most frequently included private gatherings (35.2%), flights (24.1%) and work-related meetings (20.3%). The median time delay between exposure date and contact information receipt at RKI was five days. Delay between positive test result and case information receipt was three days. Main challenges identified through five interviews were missing data or delayed accessibility particularly from flights, and lack of clear and easy to use communication channels. More and better trained staff were mentioned as ideas for improving future pandemic response preparedness.ConclusionCross-border case and contact tracing data can supplement routine surveillance but are challenging to measure. We need improved systems for cross-border event management, by improving training and communication channels, that will help strengthen monitoring activities to better guide public health decision-making and secure a good future pandemic response.

Marburg virus disease: lesson learned from the first outbreak encounter in Tanzania

Marburg virus disease: lesson learned from the first outbreak encounter in Tanzania

Scalable Strategies to Increase Efficiency and Augment Public Health Activities During Epidemic Peaks.

Scalable strategies to reduce the time burden and increase contact tracing efficiency are crucial during early waves and peaks of infectious transmission. We enrolled a cohort of SARS-CoV-2-positive seed cases into a peer recruitment study testing social network methodology and a novel electronic platform to increase contact tracing efficiency. Index cases were recruited from an academic medical center and requested to recruit their local social contacts for enrollment and SARS-CoV-2 testing. A total of 509 adult participants enrolled over 19 months (384 seed cases and 125 social peers). Participants completed a survey and were then eligible to recruit their social contacts with unique "coupons" for enrollment. Peer participants were eligible for SARS-CoV-2 and respiratory pathogen screening. The main outcome measures were the percentage of tests administered through the study that identified new SARS-CoV-2 cases, the feasibility of deploying the platform and the peer recruitment strategy, the perceived acceptability of the platform and the peer recruitment strategy, and the scalability of both during pandemic peaks. After development and deployment, few human resources were needed to maintain the platform and enroll participants, regardless of peaks. Platform acceptability was high. Percent positivity tracked with other testing programs in the area. An electronic platform may be a suitable tool to augment public health contact tracing activities by allowing participants to select an online platform for contact tracing rather than sitting for an interview.

Clinical Features Present, Past & Future Prospective of Monkey Pox: A Orthopoxvirus

Some issues regarding the potential spread of monkeypox have arisen just as the international world is beginning to recover from the initial alarm that was caused by the probable spread of coronavirus disease 2019 (COVID-19). Despite the fact that parts of Africa have traditionally been more susceptible to monkeypox than other regions of the world, the majority of new cases that have been linked to the outbreak that began in 2022 have been reported in countries located in Europe and the western hemisphere. Despite the fact that a great number of organisations are working on contact-tracing activities at the moment, the origin of this outbreak is still unknown at this time. The monkeypox virus belongs to the family of viruses known as Poxviridae and the genus known as Orthopoxvirus. Following the eradication of smallpox across the globe in the 1970s, news of monkeypox caused widespread worry across the globe. Through vaccination with the smallpox virus, individuals were able to develop cross-immunity against monkeypox. After distribution of the smallpox vaccine was discontinued, the number of outbreaks of monkeypox rose. The monkeypox epidemic that occurred in the United States in 2003 was the first time that the disease gained extensive notice in the media. In spite of its name, the virus known as monkeypox is not transmitted by monkeys. Although a number of different kinds of rodents and other small mammals have been suggested as the primal hosts of the monkeypox virus, the virus's true lineage is still a mystery. The virus that causes monkeypox was first identified in macaque monkeys, which is where the disease was first seen. When monkeypox does transfer from one person to another, it often does so through a person's mucocutaneous lesions or through the respiratory droplets that they expel. However, this only happens very infrequently. However, supporting therapy can be given to reduce symptoms, and medications such tecovirimat may be administered in really severe cases. At this time, there is no specific treatment for patients who have infected the virus; however, supportive treatments can be given. It is debatable whether or not these treatments are successful in reducing symptoms because there are no concrete guidelines to follow in this regard.

Isolation and Quarantine for Coronavirus Disease 2019 in the United States, 2020-2022.

Public health programs varied in ability to reach people with coronavirus disease 2019 (COVID-19) and their contacts to encourage separation from others. For both adult case patients with COVID-19 and their contacts, we estimated the impact of contact tracing activities on separation behaviors from January 2020 until March 2022. We used a probability-based panel survey of a nationally representative sample to gather data for estimates and comparisons. An estimated 64 255 351 adults reported a positive severe acute respiratory syndrome coronavirus 2 test result; 79.6% isolated for ≥5 days, 60.2% isolated for ≥10 days, and 79.2% self-notified contacts. A total of, 24 057 139 (37.7%) completed a case investigation, and 46.2% of them reported contacts to health officials. More adults who completed a case investigation isolated than those who did not complete a case investigation (≥5 days, 82.6% vs 78.2%, respectively; ≥10 days, 69.8% vs 54.8%; both P < .05). A total of 84 946 636 adults were contacts of a COVID-19 case patient. Of these, 73.1% learned of their exposure directly from a case patient; 49.4% quarantined for ≥5 days, 18.7% quarantined for ≥14 days, and 13.5% completed a contact tracing call. More quarantined among those who completed a contact tracing call than among those who did not complete a tracing call (≥5 days, 61.2% vs 48.5%, respectively; ≥14 days, 25.2% vs 18.0%; both P < .05). Engagement in contact tracing was positively correlated with isolation and quarantine. However, most adults with COVID-19 isolated and self-notified contacts regardless of whether the public health workforce was able to reach them. Identifying and reaching contacts was challenging and limited the ability to promote quarantining, and testing.

Human Monkey pox virus in Democratic Republic of the Congo: a potential health threat?

Human Monkey pox virus in Democratic Republic of the Congo: a potential health threat?

The experiences of nurses who were involved in the COVID-19 contact tracing and tracking activities in Bulawayo, Zimbabwe

Background: The COVID-19 pandemic had a significant impact on the healthcare systems worldwide. For countries to contain the spread of COVID-19 and to mitigate its impact, contact tracing was adopted as one of the COVID-19 response strategies. The objective of this study was to explore and describe the experiences of nurses who were involved in the COVID-19 contact tracing and tracking activities in Bulawayo, Zimbabwe. Methods: A descriptive phenomenological design was utilised in this study. Data was collected telephonically using in-depth individual interviews between the 28th of December 2020 and 25th February 2021. Twelve participants comprising of two males and ten females with experience in contact tracing were purposively sampled and interviewed telephonically to get lived experiences. The number of females and males who were purposefully sampled depended on the proportion of this participants in the setting. Analysis followed the seven steps by Colaizzi strategies. Results: The study findings demonstrated that the participants experienced challenges as they implemented contact tracing activities. Four themes on contact tracing emerged: follow-up and contact-tracing activities; support systems; psychosocial implications; and witnessed patients’ experiences. Fourteen sub-themes were identified: negative perceptions of the re-assigned roles; unintended outcomes; delayed COVID-19 test results; increased workload; provision of personal protective equipment; training and orientation on COVID-19; meals for providers involved in contact tracing; we want to be heard and listened to; anxiety and fear; stress; emotionally challenging moments; unable to provide a service; witnessed discomfort; and stigma and discrimination. Conclusions: Contact tracing is key in the response to the COVID-19 pandemic. The strategy has proven to be complex, with increased workload, which is emotionally draining – hence the need for an effective support system for staff conducting contact-tracing activities.

The epidemiology of the COVID-19 pandemic in the small, low-resource country of Timor-Leste, January 2020 - June 2022.

Timor-Leste, a small, mountainous half-island nation which shares a land border with Indonesia and which is 550 km from Australia, has a population of 1.3 million and achieved independence for the second time in 2002. It is one of the poorest nations in Asia. In response to the global coronavirus disease 2019 (COVID-19) pandemic, the Timor-Leste Ministry of Health undertook surveillance and contact tracing activities on all notified COVID-19 cases. Between 1 January 2020 and 30 June 2022, there were 22,957 cases of COVID-19 notified which occurred in three waves, the first which was delayed until April 2021 (community transmission of B.1.466.2 variant following major flooding), followed by waves in August 2021 (B.1.617.2 Delta variant transmission) and February 2022 (B.1.1.529 Omicron variant transmission). There were 753 people hospitalised due to COVID-19 and 133 deaths. Of the 133 deaths, 122 (92%) were considered not fully vaccinated (< 2 COVID-19 vaccines) and none had received boosters. Timor-Leste implemented measures to control COVID-19, including: rapid closure of international borders; isolation of cases; quarantining of international arrivals and close contacts; restrictions on internal travel; social and physical distancing; and, finally, a country-wide vaccination program. The health system's capacity was never exceeded.

Efficacy and effectiveness of case isolation and quarantine during a growing phase of the COVID-19 epidemic in Finland

Based on data collected as part of the contact tracing activity of the City of Helsinki Epidemiological Operations Unit, we evaluated the efficacy and effectiveness of isolating SARS-CoV-2 cases and quarantining their exposed contacts during a mildly growing phase of the COVID-19 epidemic in Finland in autumn 2020. Based on the observed symptom-to-symptom intervals in 1016 pairs of primary and secondary cases, we estimated that without case isolation or quarantine 40% (90% credible interval, CI 25–59) of transmission would have occurred on the day of or after symptom onset. One third of SARS-CoV-2 cases (N = 1521) had initially been quarantined, with a self-reported time until isolation (quarantine) of 0.8 days before symptom onset. This delay translates into an efficacy of 50% (90% CI 40–63) of averting secondary infections per quarantined case. Due to later isolation (mean 2.6 days after symptoms), the efficacy was smaller (24%; 90% CI 12–41) in those two third of the cases (N = 3101) whose isolation was prompted by their symptoms, i.e. without being previously quarantined. At the population level, we evaluated the effectiveness of case isolation and quarantine on the growth rate of the COVID-19 epidemic in the autumn of 2020. Under a wide range of underlying assumptions, the rate would have been at least 2 times higher without case isolation and quarantine. The numbers needed to isolate or quarantine to prevent one secondary case were 2 and 20, respectively.

City-wide study of laboratory-confirmed COVID-19 cases in San Antonio: An investigation of stressful events accompanying infection and their relation to psychosocial functioning

Little is known about how Coronavirus Disease-2019 (COVID-19) infection is associated with stressful events (SEs) and stress-related psychological symptoms. This study examined the prevalence of SEs and incidence of stress-related symptoms accompanying COVID-19 infection. The association between these stress-related symptoms and psychosocial functioning were also examined. A city-wide sample of 3,595 adults with lab-informed cases of COVID-19 infection in San Antonio, Texas completed an online assessment of their psychological health and well-being after completing contact tracing activities in 2021–2022. A total 88.3% of participants reported exposure to SEs related to COVID-19 infection and their “worst” SEs were related to physical symptoms, fear of infecting others, financial problems, being isolated/quarantined, and loss of a loved one. Based on these SEs, 14.8% of the sample screened positive for substantial stress-related psychological problems related to COVID-19 infection. These psychological symptoms were strongly associated with worse psychosocial functioning. Together, these findings suggest SEs were commonly experienced by adults infected with COVID-19. Only a relatively small proportion reported substantial psychological symptoms related to their infection, but those who did had a high likelihood of impaired psychosocial functioning. Targeted support for individuals at high-risk of psychological symptoms following COVID-19 infection may help mitigate long-term psychological effects.

Estimation of the incubation period and generation time of SARS-CoV-2 Alpha and Delta variants from contact tracing data.

Quantitative information on epidemiological quantities such as the incubation period and generation time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants is scarce. We analysed a dataset collected during contact tracing activities in the province of Reggio Emilia, Italy, throughout 2021. We determined the distributions of the incubation period for the Alpha and Delta variants using information on negative polymerase chain reaction tests and the date of last exposure from 282 symptomatic cases. We estimated the distributions of the intrinsic generation time using a Bayesian inference approach applied to 9724 SARS-CoV-2 cases clustered in 3545 households where at least one secondary case was recorded. We estimated a mean incubation period of 4.9 days (95% credible intervals, CrI, 4.4-5.4) for Alpha and 4.5 days (95% CrI 4.0-5.0) for Delta. The intrinsic generation time was estimated to have a mean of 7.12 days (95% CrI 6.27-8.44) for Alpha and of 6.52 days (95% CrI 5.54-8.43) for Delta. The household serial interval was 2.43 days (95% CrI 2.29-2.58) for Alpha and 2.74 days (95% CrI 2.62-2.88) for Delta, and the estimated proportion of pre-symptomatic transmission was 48-51% for both variants. These results indicate limited differences in the incubation period and intrinsic generation time of SARS-CoV-2 variants Alpha and Delta compared to ancestral lineages.

Programmatic Cost-Effectiveness of a Second-Time Visit to Detect New Tuberculosis and Diabetes Mellitus in TB Contact Tracing in Myanmar.

Integration of diabetes mellitus screening in home visits for contact tracing for tuberculosis could identify hidden patients with either tuberculosis or diabetes mellitus. However, poor compliance to the first home screening has been reported. A second time visit not only increases screening compliance but also the cost. This study aimed to determine if an additional second time visit was cost effective based on the health system perspective of the tuberculosis contact tracing program in Myanmar. This cross-sectional study was based on usual contact tracing activity in the Yangon Region, Myanmar, from April to December 2018 with integration of diabetes mellitus screening and an additional home visit to take blood glucose tests along with repeated health education and counseling to stress the need for a chest X-ray. New tuberculosis and diabetes mellitus cases detected were the main outcome variables. Programmatic operational costs were calculated based on a standardized framework for cost evaluation on tuberculosis screening. The effectiveness of an additional home visit was estimated using disability-adjusted life years averted. The willingness to pay threshold was taken as 1250.00 US dollars gross domestic product per capita of the country. Single and additional home visits could lead to 42.5% and 65.0% full compliance and 27.2 and 9.3 additional years of disability-adjusted life years averted, respectively. The respective base costs and additional costs were 3280.95 US dollars and 1989.02 US dollars. The programmatic costs for an extra unit of disability-adjusted life years averted was 213.87 US dollars, which was lower than the willingness to pay threshold. From the programmatic perspective, conducting the second time visit for tuberculosis contact tracing integrated with diabetes mellitus screening was found to be cost effective.

Experiences with Eviction, House Foreclosure, and Homelessness Among COVID-19 Infected Adults and Their Relation to Mental Health in a Large U.S. City.

This study examined experiences with eviction, house foreclosures, and homelessness in a large U.S. city sample of adults with Coronavirus Disease-2019 (COVID-19). A total of 3595 adults with COVID-19 participated in an assessment of health and well-being after completing contact tracing activities. The sample had a 5.7% lifetime prevalence of eviction, 3.7% lifetime prevalence of house foreclosure, and 8.2% lifetime prevalence of homelessness. Relative importance analyses revealed drug use was the most important variable associated with any lifetime eviction, lifetime house foreclosure, lifetime homelessness, and being currently at-risk of eviction or recently evicted. Loneliness was also relatively strongly associated with any lifetime eviction or homelessness, while socioeconomic characteristics were the most importance variables associated with late mortgage payments in the past month. Treatment for addiction problems may be important for in the aftermath of the COVID-19 pandemic and adults with histories of housing instability may be particularly at risk.

New proposed measures to evaluate contact tracing effectiveness

Abstract Issue/problem Contact tracing is an important and widely used method to control transmission of communicable diseases. The COVID-19 pandemic presented a new and big challenge with a high number of confirmed cases and contacts and subsequent high burden on contact tracing activities. Naturally, the effectiveness of such interventions needs to be assessed, and appropriate measures are still rather underdeveloped. Description of the problem We propose two new measures for assessing contact tracing effectiveness: “number needed to quarantine” (NNQ), which is the number of quarantined person-days needed to prevent one infectious person-day, and the proportion of infectious days prevented by the quarantined (PPID). We have applied these measures to assess COVID-19 contact tracing effectiveness in COVID-19 confirmed cases diagnosed between July and mid-September 2020 in a local Public Health Unity in the Northern region of Portugal (Espinho/Gaia). For robustness checks and accounting for the uncertainty of the infectiousness period, we used three different scenarios. Results Depending on the infectiousness period considered, we have found a NNQ between 19.8 and 41.8 and a PPID between 19.7% and 38.2%. Contact tracing effectiveness was higher for some specific groups such as cohabitants and symptomatic contacts. Effectiveness also decreased with the increasing time from diagnosis or symptom onset to contact isolation Lessons NNQ and PPID are straightforward and easy to use measures to evaluate contact tracing effectiveness in communicable diseases. Although this example focuses in the COVID-19 pandemic at a local setting, these measures can also be used for different communicable diseases and at different levels. This assessment step can be important for priority setting of transmission control activities but also on a health management perspective. Key messages • New measures to evaluate contact tracing effectiveness are proposed: “number needed to quarantine” and “proportion of prevented infectious days”. • These measures allow the identification of priority groups that must be quarantined, as well as time periods of intervention, for better transmission control.

Religious pilgrimage and COVID-19. An observational report in Italy from contact tracing activities

Abstract Issue/Problem Religious Mass Gathering (MG) represent one of public health challenges for Health Authorities due to potential spread of communicable diseases. This is much more true during a pandemic as COVID-19. Surveillance is crucial to prevent further spreading of infectious disease related to a religious MG. Description of the problem During international contact tracing activities an increase of reporting of COVID-cases with a travel history to a Catholic shrine in Europe was observed, despite travel restrictions put in place. In order to promote public health actions as risk communication, a risk evaluation was conducted. A descriptive analysis was carried out: personal and vaccination data were collected; for cases, date and type of positive tests, date of symptoms’ onset were collected; for high-risk contacts, date and type of negative tests at the end of follow-up were collected. Frequencies were calculated. Results Six journeys back from Medjugorje were identified, with at least one positive case. All trips took place between 18/09/2021 and 29/10/2021. 31 positive cases out of 160 travellers were identified, with number of cases per travel ranging from 1 to 11. Lessons Religious MG represent an important global health issue. Even though a specific surveillance was not activated, international contact tracing activities turned out a great source of epidemic intelligence and consequent surveillance and control activities led to risk assessment and communication actions. Key messages • In the pandemic context, where travel restrictions were put in place, surveillance for Religious MG should be always implemented. • Cooperation among all the stakeholders involved as Church, travel agency, Regional Health Systems and Government Bodies has to be promoted for specific surveillance in religious MG events.

Lessons learnt from decentralization of COVID-19 response in a southwest state of Nigeria

Introduction: This report shows the outcomes and lessons learnt from a 3-month intervention focused on decentralization of COVID-19 coordination, testing and contact tracing activities in three hotspot local government areas (LGAs) of a state in the southwest of Nigeria. Methods: A description of COVID-19 outbreak response from the occurrence of the index case was documented. A health facility and community-based intervention implemented in three hotspots LGA as part of response to COVID-19 pandemic from 24th May to 22nd August, 2021 was described. The interventions implemented focused on integrating COVID-19 testing into routine healthcare services in 103 health facilities, engagement of community-based volunteers to conduct contact tracing, and improving coordination of the response through the conduct of incident management meetings at state and LGA levels. The COVID-19 dataset from 22nd February to 22nd August, was obtained from the State Ministry of Health and analyzed. Data were summarized using charts and maps. Results: A higher number of cases (3879) were tested between 24th May to 22nd August, 2021 (during intervention) compared to 1667 cases tested between 23 February to 23 May, 2021 (before intervention) across the three LGAs. Generally, there was a decline in the cumulative number of contacts traced and line-listed during the intervention (778) compared to the period before the intervention (1170) in two of the three LGAs. The number of weekly incident management meetings held improved by 25% at State level, while 83% of weekly LGA meetings were held at the three hot spot LGAs during the intervention compared to the period before the intervention, where no meeting was held at LGA level. Conclusions: The decentralization of the COVID-19 outbreak response from a central approach to the LGA level improved only testing numbers and the number of incident management meetings conducted across the three hot spot LGAs. The number of contacts line-listed, positivity rate and reported cases reduced following the interventions. The need to supplement contact tracing activities using information technology for self-report as done in other climes, as well as engaging community, religious leaders and key community groups as integral members of the contact tracing team was emphasized.

Feasibility and acceptability of saliva-based testing for the screening of SARS-CoV-2 infection in prison.

BackgroundSaliva molecular tests have shown a similar sensitivity and specificity compared to nasopharyngeal test for SARS-CoV-2 diagnosis in both symptomatic and asymptomatic individuals. The SARS-CoV-2 pandemic affected Lombardy prisons, generating the need for extensive contact tracing activities and for detecting asymptomatic carriers. The availability of a less invasive test in a setting that hosts a high-risk and often hard-to-reach population, suggests its possible use in prisons.MethodsThe study was carried out on a population of new incomers in Milan San Vittore pre-trial prison. All the new incomers were submitted to quarantine and to saliva test and nasopharyngeal swab (NPS) for SARS-CoV-2 detection at the entry and at the end of quarantine before their admission in community (Protocol 1–February 2nd to March 5th, 2021). Starting from March 8th to July 30th, 2021, the screening protocol was adjusted to avoid biases in sample collection (Protocol II), and saliva testing was performed at entrance.Results12/1,120 enrolled subjects were excluded from the study. Among the 1,080 processed samples, 1 tested positive, 5 weakly positive, 1,069 negative, 3 were invalid, and 2 samples tested positive for the viral gene N2 only, with Ct value above 38. During Protocol I, 6/156 coupled saliva/NPS tests were discordant due to food ingestion prior saliva collection, prompting us to establishing Protocol II.ConclusionsSaliva molecular testing is feasible in prison setting, being less invasive and easier to use, and reliable. Acceptability was very high even in a complex context as that of newly incarcerated persons.