@article{4494,
  keywords = {Humans, Female, Male, United States, Phylogeny, Disease Outbreaks, COVID-19, SARS-CoV-2, Military Personnel},
  author = {Rhonda Lizewski and Rachel Sealfon and Sang Park and Gregory Smith and Chad Porter and Ana Gonzalez-Reiche and Yongchao Ge and Clare Miller and Carl Goforth and Hanna Pincas and Michael Termini and Irene Ramos and Venugopalan Nair and Stephen Lizewski and Hala Alshammary and Regina Cer and Hua Chen and Mary-Catherine George and Catherine Arnold and Lindsay Glang and Kyle Long and Francisco Malagon and Jan Marayag and Edgar Nunez and Gregory Rice and Ernesto Ana and Megan Schilling and Darci Smith and Victor Sugiharto and Peifang Sun and Adriana van de Guchte and Zenab Khan and Jayeeta Dutta and Sindhu Vangeti and Logan Voegtly and Dawn Weir and C Jessica Metcalf and Olga Troyanskaya and Kimberly Bishop-Lilly and Bryan Grenfell and Harm van Bakel and Andrew Letizia and Stuart Sealfon},
  title = {SARS-CoV-2 Outbreak Dynamics in an Isolated US Military Recruit Training Center With Rigorous Prevention Measures.},
  abstract = { <p><b>BACKGROUND: </b>Marine recruits training at Parris Island experienced an unexpectedly high rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, despite preventive measures including a supervised, 2-week, pre-entry quarantine. We characterize SARS-CoV-2 transmission in this cohort.</p><p><b>METHODS: </b>Between May and November 2020, we monitored 2,469 unvaccinated, mostly male, Marine recruits prospectively during basic training. If participants tested negative for SARS-CoV-2 by quantitative polymerase chain reaction (qPCR) at the end of quarantine, they were transferred to the training site in segregated companies and underwent biweekly testing for 6 weeks. We assessed the effects of coronavirus disease 2019 (COVID-19) prevention measures on other respiratory infections with passive surveillance data, performed phylogenetic analysis, and modeled transmission dynamics and testing regimens.</p><p><b>RESULTS: </b>Preventive measures were associated with drastically lower rates of other respiratory illnesses. However, among the trainees, 1,107 (44.8\%) tested SARS-CoV-2-positive, with either mild or no symptoms. Phylogenetic analysis of viral genomes from 580 participants revealed that all cases but one were linked to five independent introductions, each characterized by accumulation of mutations across and within companies, and similar viral isolates in individuals from the same company. Variation in company transmission rates (mean reproduction number R 0 ; 5.5 [95\% confidence interval [CI], 5.0, 6.1]) could be accounted for by multiple initial cases within a company and superspreader events. Simulations indicate that frequent rapid-report testing with case isolation may minimize outbreaks.</p><p><b>CONCLUSIONS: </b>Transmission of wild-type SARS-CoV-2 among Marine recruits was approximately twice that seen in the community. Insights from SARS-CoV-2 outbreak dynamics and mutations spread in a remote, congregate setting may inform effective mitigation strategies.</p> },
  year = {2022},
  journal = {Epidemiology},
  volume = {33},
  pages = {797-807},
  month = {2022 Nov 01},
  issn = {1531-5487},
  doi = {10.1097/EDE.0000000000001523},
  language = {eng},
}