We produced high-quality SARS-CoV-2 genomes (unambiguous length ≥24,000 nt and successful gene annotation) from 467 unique individuals. We sequenced SARS-CoV-2 genomes from residual diagnostic specimens collected between July 9th and August 2nd in the Provincetown area as part of outbreak-associated and enhanced community surveillance testing (STAR Methods). Here, we describe the genomic epidemiology of this outbreak, including evidence for frequent SARS-CoV-2 Delta transmission from and between fully vaccinated individuals.Ī large outbreak of Delta in a highly vaccinated population The rapid increase in cases despite high vaccination rates prompted state and local public health departments to launch a comprehensive outbreak response ( Brown et al., 2021), including SARS-CoV-2 genome sequencing to characterize the viruses driving the outbreak and to support contact tracing efforts.
This was the first large, well-characterized outbreak of COVID-19 in a highly vaccinated population in the US and contributed to the CDC’s decision to reinstate their indoor mask recommendation for vaccinated individuals ( CDC, 2021).
PROVINCETOWN COVID SPIKE FULL
As of July 1st, estimated COVID-19 full vaccination coverage among the eligible population was 68% in Barnstable County (where Provincetown is located) and 67% across MA ( Massachusetts Department of Public Health, 2021). Notably, 74% of the reported cases were fully vaccinated individuals, of whom 79% were symptomatic ( Brown et al., 2021). COVID-19 incidence in the area rose quickly during the subsequent two-week period, from 0 cases in the 14 days before July 3rd to a peak of 456 cases per 100,000 persons per day during July 11th–24th. Provincetown had attracted thousands of visitors, many of whom reported attending multiple large public and private gatherings-often indoors and unmasked, in accordance with public health guidance at the time-starting with the 4th of July weekend and throughout the following week. On July 10th, 2021, the Massachusetts Department of Public Health (MADPH) received reports of an increase in COVID-19 cases among people who resided in or had recently visited Provincetown, a tourist town on Cape Cod, MA. However, despite its magnitude, the outbreak had limited onward impact in MA and the US overall, likely due to high vaccination rates and a robust public health response. Genomic and epidemiological data supported multiple transmissions of Delta from and between fully vaccinated individuals. The Delta variant accounted for 99% of cases in this dataset it was introduced from at least 40 sources, but 83% of cases derived from a single source, likely through transmission across multiple settings over a short time rather than a single event. To address these questions, we combined viral genomic and epidemiological data from 467 individuals, including 40% of outbreak-associated cases. Sabeti 1, 2, 3, 14, 15, 17Īn outbreak of over 1,000 COVID-19 cases in Provincetown, Massachusetts (MA), in July 2021-the first large outbreak mostly in vaccinated individuals in the US-prompted a comprehensive public health response, motivating changes to national masking recommendations and raising questions about infection and transmission among vaccinated individuals. Gallagher, 4, 17 Sandra Smole, 4, 17 Lawrence C. Hanage, 8, 9 Clare Bernard, 1 Anthony Philippakis, 1 Niall J.
Larkin, 1 Kyle Vernest, 1 Sushma Chaluvadi, 1 Deirdre Arvidson, 11 Maurice Melchiono, 11 Theresa Covell, 11 Vaira Harik, 12 Taylor Brock-Fisher, 13 Molly Dunn, 13 Amanda Kearns, 13 William P. Lang, 4 Stephanie Baez, 4 John Beauchamp, 4 Scott Hennigan, 4 Erika Buzby, 4 Stephanie Ash, 4 Jessica Brown, 4 Selina Clancy, 4 Seana Cofsky, 4 Luc Gagne, 4 Joshua Hall, 4 Rachel Harrington, 4 Gabrielle L. Shephard, 4, 10 Matthew Doucette, 4 Timelia Fink, 4 Andrew S. Taylor, 8, 9 Bryn Loftness, 1 Hillary Johnson, 4 Petra L. Paull, 1, 7 Beau Schaeffer, 8, 9 Bradford P. Lemieux, 1, 5 Nikolaos Barkas, 1 Christine Loreth, 1 Ivan Specht, 1, 6 Christopher H.
Schaffner, 1, 2, 3, 16 Johanna Vostok, 4 Nicholas A.
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