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SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020

Our take —

Despite following the guidelines put forward regarding overnight camps in Georgia, there was an outbreak at an overnight camp that resulted in an estimated attack rate of 44% overall, among which three-quarters had symptoms. These findings are based on identified positive viral cases from the Georgia State Electronic Notifiable Disease Surveillance System. Those whose test results were not found were included and counted as negative, likely underestimating the attack rate. Attack rates were high across age groups, including 6-10 year-olds who had an attack rate of 51%, providing additional evidence of the susceptibility and potential for transmission among youth, including young children.

Study design

Case Series

Study population and setting

Between June 17 and 27, 2020, there was an outbreak of SARS-CoV-2 at an overnight camp in Georgia. Orientation among staff (n=138) and trainees (n=120) was from June 17 to 20, 2020, and the camp opened to campers (n=363) from June 20 to 27, 2020. As per the Georgia state guidelines, the camp required documentation of a negative viral test from all those attending 12 days or fewer days prior to arrival. Masks were required to be worn by staff members, but not required for campers. Campers were cohorted by cabin, attempts were made to limit mixing and windows were shut within cabins. However, singing and cheering that would normally take place was still allowed. A staff member became symptomatic on June 23 and left for testing, confirmed as positive on June 24, and the camp fully closed on June 27, 2020. The Georgia Department of Public Health recommended that all attendees be tested, and conducted an investigation of cases linked to the camp using the State Electronic Notifiable Disease Surveillance System and a specific investigation. Cases linked to the camp were defined as a positive viral RNA test from those attending from when they first arrived until 14 days after they left. Attack rates were calculated as positive test results over the total number of Georgia attendees.

Summary of Main Findings

In total, 597 Georgia residents attended the camp and were included in these analyses (27 out of state campers attended, but were not included as access to results was not available). The median age among staff was 17 years, and among campers was 12 years. Test results were obtained for 344 individuals, and among them 76% (260/344) were positive. The calculated attack rate was 44% overall (260/597). Given that Georgia often does not report back negative results, an assumption was made that those without results were negative. Estimated attack rates by age were: 6-10 years: 51%; 11-16 years: 44%; 18-21 years: 33%; 22-59 years: 29%. Among those testing positive and with symptom data (n=136), 26% (n=36) reported no symptoms.

Study Strengths

This study utilized a surveillance system to determine the attack rate associated with attending this overnight camp.

Limitations

There was an important assumption that any cases captured during this period were acquired as a result of camp attendance, while it is possible that cases were acquired during this period outside of the camp. Those who were not captured in the disease surveillance system were assumed negative in the calculation of the attack rate, likely underestimating the overall attack rate. Those who were not Georgia residents were excluded from these analyses (n=24).

Value added

The results presented here provide evidence for the rapid spread of SARS-CoV-2 from attendance at an overnight camp among children and youth.

This review was posted on: 4 August 2020