French National Public Health Agency, Department of Infectious Diseases, Saint-Maurice, France.
Infectious Diseases Department, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
Clin Infect Dis. 2020 Jul 28;71(15):825-832. doi: 10.1093/cid/ciaa424.
On 7 February 2020, French Health authorities were informed of a confirmed case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an Englishman infected in Singapore who had recently stayed in a chalet in the French Alps. We conducted an investigation to identify secondary cases and interrupt transmission.
We defined as a confirmed case a person linked to the chalet with a positive reverse-transcription polymerase chain reaction sample for SARS-CoV-2.
The index case stayed 4 days in the chalet with 10 English tourists and a family of 5 French residents; SARS-CoV-2 was detected in 5 individuals in France, 6 in England (including the index case), and 1 in Spain (overall attack rate in the chalet: 75%). One pediatric case, with picornavirus and influenza A coinfection, visited 3 different schools while symptomatic. One case was asymptomatic, with similar viral load as that of a symptomatic case. Seven days after the first cases were diagnosed, 1 tertiary case was detected in a symptomatic patient with from the chalet a positive endotracheal aspirate; all previous and concurrent nasopharyngeal specimens were negative. Additionally, 172 contacts were monitored; all contacts tested for SARS-CoV-2 (N = 73) were negative.
The occurrence in this cluster of 1 asymptomatic case with similar viral load as a symptomatic patient suggests transmission potential of asymptomatic individuals. The fact that an infected child did not transmit the disease despite close interactions within schools suggests potential different transmission dynamics in children. Finally, the dissociation between upper and lower respiratory tract results underscores the need for close monitoring of the clinical evolution of suspected cases of coronavirus disease 2019.
2020 年 2 月 7 日，法国卫生当局收到一名在新加坡感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的英国人的确诊病例报告，该患者近期曾在法国阿尔卑斯山的一间小屋里逗留。我们开展了一项调查，以确定继发病例并阻断传播。
我们将与小屋有联系且 SARS-CoV-2 逆转录聚合酶链反应样本阳性的人定义为确诊病例。
该指数病例在小屋里逗留了 4 天，与 10 名英国游客和 1 户 5 名法国居民同住；在法国发现 5 例、英国（包括指数病例）6 例和西班牙 1 例 SARS-CoV-2 感染病例（小屋内总体感染率：75%）。1 例儿科病例在出现症状时同时感染了小核糖核酸病毒和甲型流感，曾访问过 3 所不同的学校。1 例病例为无症状，其病毒载量与有症状病例相似。在首例病例确诊 7 天后，在从小屋来的 1 例有症状患者的阳性气管抽吸物中检测到 1 例三级病例；之前和同期的所有鼻咽标本均为阴性。此外，还监测了 172 名接触者；对所有检测 SARS-CoV-2 的接触者（N=73）均为阴性。
在该聚集性病例中，有 1 例无症状病例的病毒载量与有症状患者相似，提示无症状个体可能具有传播能力。尽管在学校内有密切接触，但受感染的儿童未传播疾病，这表明儿童的传播动力学可能有所不同。最后，上呼吸道和下呼吸道结果的分离突出表明需要密切监测疑似 2019 冠状病毒病病例的临床演变。
