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Volume 28, Number 1—January 2022
Synopsis

Multistate Outbreak of SARS-CoV-2 Infections, Including Vaccine Breakthrough Infections, Associated with Large Public Gatherings, United States

Radhika Gharpure1, Samira Sami1, Johanna Vostok, Hillary Johnson, Noemi Hall, Anne Foreman, Rebecca T. Sabo, Petra L. Schubert, Hanna Shephard, Vance R. Brown, Ben Brumfield, Jessica N. Ricaldi, Andrew B. Conley, Lindsay Zielinski, Lenka Malec, Alexandra P. Newman, Michelle Chang, Lauren E. Finn, Cameron Stainken, Anil T. Mangla, Patrick Eteme, Morgan Wieck, Alison Green, Alexandra Edmundson, Diana Reichbind, Vernell Brown, Laura Quiñones, Allison Longenberger, Elke Hess, Megan Gumke, Alicia Manion, Hannah Thomas, Carla A. Barrios, Adrianna Koczwara, Thelonious W. Williams, Marcia Pearlowitz, Moussokoura Assoumou, Alessandra F. Senisse Pajares, Hope Dishman, Cody Schardin, Xiong Wang, Kendalyn Stephens, Nakema S. Moss, Gurpalik Singh, Christine Feaster, Lindsey Martin Webb, Anna Krueger, Kristen Dickerson, Courtney Dewart, Bree Barbeau, Amelia Salmanson, Lawrence C. Madoff, Julie M. Villanueva, Catherine M. Brown2, and A. Scott Laney2Comments to Author 
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R. Gharpure, S. Sami, N. Hall, A. Foreman, R.T. Sabo, V.R. Brown, B. Brumfield, J.N. Ricaldi, C. Dewart, J.M. Villanueva, A.S. Laney); Massachusetts Department of Public Health, Boston, Massachusetts, USA (J. Vostok, H. Johnson, P.L. Schubert, H. Shephard, L.C. Madoff, C.M. Brown); Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Atlanta (H. Shephard, A. Edmundson); Georgia Institute of Technology, Atlanta (A.B. Conley); New York City Department of Health and Mental Hygiene, New York, New York, USA (L. Zielinski, L. Malec); New York State Department of Health, Albany, New York, USA (A.P. Newman); Los Angeles County Department of Public Health, Los Angeles, California, USA (M. Chang, L.E. Finn); California Department of Public Health, Richmond, California, USA (C. Stainken); DC Health, Washington, DC, USA (A.T. Mangla, P. Eteme); Rhode Island Department of Health, Providence, Rhode Island, USA (M. Wieck, A. Green); Connecticut Department of Public Health, Hartford, Connecticut, USA (A. Edmundson, D. Reichbind); CDC Foundation, Atlanta (D. Reichbind, C.A. Barrios, T.W. Williams); Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA (V. Brown Jr., L. Quiñones); Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA (A. Longenberger, E. Hess); Florida Department of Health, Tallahassee, Florida, USA (M. Gumke); New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA (A. Manion, H. Thomas); Chicago Department of Public Health, Chicago, Illinois, USA (C.A. Barrios, A. Koczwara); Maryland Department of Health, Baltimore, Maryland, USA (T.W. Williams, M. Pearlowitz); Alexandria Health Department, Alexandria, Virginia, USA (M. Assoumou); Virginia Department of Health, Richmond, Virginia, USA (A.F. Senisse Pajares); Georgia Department of Public Health, Atlanta (H. Dishman); Minnesota Department of Health, St. Paul, Minnesota, USA (C. Schardin, X. Wang); North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA (K. Stephens); Alabama Department of Public Health, Montgomery, Alabama, USA (N.S. Moss); Indiana Department of Health, Indianapolis, Indiana, USA (G. Singh, C. Feaster); Colorado Department of Public Health and Environment, Denver, Colorado, USA (L.M. Webb); Maine Center for Disease Control and Prevention, Augusta, Maine, USA (A. Krueger); Ohio Department of Health, Columbus, Ohio, USA (K. Dickerson, C. Dewart); Utah Department of Health, Salt Lake City, Utah, USA (B. Barbeau, A. Salmanson)

Main Article

Table 1

Demographic and clinical characteristics of persons who had primary and secondary cluster-associated cases of SARS-CoV-2 infection, by vaccination status, after large public gatherings in Provincetown, Massachusetts, USA, July 2021*

Characteristic Overall, n = 1,128 Vaccination status†
Fully vaccinated, n = 918 Non–fully vaccinated, n = 210
Sex‡ n = 1,122 n = 914 n = 208
M 981 (87) 822 (90) 159 (76)
F
 139 (12)
 90 (10)
 49 (24)
Age group, y n = 1,096 n = 894 n = 202
<1–11 17 (2) 0 17 (8)
12–18 8 (0.7) 2 (0.2) 6 (3)
19–49 720 (66) 589 (66) 131 (65)
50–64 306 (28) 264 (30) 42 (21)
65–74 41 (4) 35 (4) 6 (3)
>75
 4 (0.4)
 4 (0.4)
 0
Race/ethnic group n = 1,058 n = 863 n = 195
Hispanic or Latino 70 (7) 42 (5) 28 (14)
Non-Hispanic White 694 (66) 615 (71) 79 (41)
Non-Hispanic Black 18 (2) 11 (1) 7 (4)
Non-Hispanic other race or multiracial
 276 (26)
 195 (23)
 81 (42)
Residence n = 1,128 n = 918 n = 210
Provincetown 253 (22) 171 (19) 82 (39)
Other area in Massachusetts 389 (34) 312 (34) 77 (37)
Outside Massachusetts
 486 (43)
 435 (47)
 51 (24)
Previous COVID-19 diagnosis§ n = 383 n = 345 n = 38
Previous COVID-19 diagnosis
 12 (3)
 10 (3)
 2 (5)
Duration since previous positive test result, d n = 10 n = 8 n = 2
Median 205 205 300
Range 122–488 136–488 122–478
Interquartile range
 177–434
 186–367
 211–389
Underlying medical conditions¶ n = 1,128 n = 918 n = 210
Any
 130 (12)
 118 (13)
 12 (6)
Symptoms n = 1,036 n = 873 n = 163
Asymptomatic 40 (4) 32 (4) 8 (5)
Symptomatic
 996 (96)
 841 (96)
 155 (95)
Symptoms reported n = 947 n = 799 n = 148
Abdominal pain 61 (6) 48 (6) 13 (9)
Chills 323 (34) 280 (35) 43 (29)
Congestion 524 (55) 463 (58) 61 (41)
Cough 667 (70) 582 (73) 85 (57)
Diarrhea 176 (19) 160 (20) 16 (11)
Difficulty breathing/shortness of breath 94 (10) 83 (10) 11 (7)
Fatigue 374 (39) 331 (41) 43 (29)
Fever 417 (44) 343 (43) 74 (50)
Headache 453 (48) 378 (47) 75 (51)
Loss of appetite 150 (16) 128 (16) 22 (15)
Loss of smell or taste 456 (48) 402 (50) 54 (36)
Muscle aches/pains 374 (40) 313 (39) 61 (41)
Sore throat 380 (40) 338 (42) 42 (28)
Vomiting
 29 (3)
 26 (3)
 3 (2)
Symptom count n = 947 n = 799 n = 148
Median 4 5 4
Range 1–13 1–13 1–12
Interquartile range
 3–7
 3–7
 2–6
Time from symptom onset to specimen collection, d n = 930 n = 783 n = 147
Median 2 2 2
Range −5 to 16 −3 to 14 −5 to 16
Interquartile range
 1–4
 1–4
 1–4
Clinical course n = 1,128 n = 918 n = 210
Admitted to hospital
 8 (0.7)
 7 (0.8)
 1 (0.5)
Duration of hospitalization, d
Median 5 5 6
Range 2–39 2–39 NA
Interquartile range 3.75–6.25 3.5–6.0 NA
Admitted to intensive care 2 (0.1) 2 (0.2) 0

*Values are no. (%) unless indicated otherwise. Percentages might not total 100% because of rounding. Denominators for individual variables exclude cases that have missing data. COVID-19, coronavirus disease; NA, not applicable; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

†Fully vaccinated persons were those who were >14 d after completion of all recommended doses of a US Food and Drug Administration‒authorized COVID-19 vaccine (2 doses of Pfizer/BioNTech [https://www.pfizer.com] or Moderna [https://www.modernatx.com], or 1 dose of Johnson & Johnson [https://www.jandj.com]), with documentation in their state immunization information system or self-report of vaccination details during case investigation. Non–fully vaccinated includes 39 persons who were partially vaccinated and 171 who were unvaccinated or whose vaccination status was unknown.

‡Gender responses of “Transgender/non-binary” (2; <1%) are not shown because of small counts.

§Previous COVID-19 was defined as detection of SARS-CoV-2 RNA or antigen in a respiratory specimen >90 d before collection of the cluster-associated specimen.

¶Persons who had underlying medical conditions associated with increased risk for severe COVID-19, including active cancer, autoimmune disease, cardiovascular disease, chronic kidney disease, chronic liver disease, chronic lung disease, current pregnancy, diabetes, solid organ or stem cell transplant, infection with HIV, and other immunocompromising conditions. Specific underlying conditions are described in Appendix Table 2.

Main Article

1These authors contributed equally to this article.

2These senior authors contributed equally to this article.

Page created: November 05, 2021
Page updated: December 20, 2021
Page reviewed: December 20, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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