Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 25;21(1):1747.
doi: 10.1186/s12889-021-11683-y.

Performance of existing and novel surveillance case definitions for COVID-19 in household contacts of PCR-confirmed COVID-19

Hannah E Reses #  1 , Mark Fajans #  1 , Scott H Lee  1 , Charles M Heilig  1 , Victoria T Chu  1   2 , Natalie J Thornburg  1 , Kim Christensen  3 , Sanjib Bhattacharyya  4 , Alicia Fry  1 , Aron J Hall  1 , Jacqueline E Tate  1 , Hannah L Kirking  1 , Scott A Nabity  5 ; U.S. COVID-19 Household Investigation Team
Collaborators, Affiliations

Performance of existing and novel surveillance case definitions for COVID-19 in household contacts of PCR-confirmed COVID-19

Hannah E Reses et al. BMC Public Health. .

Abstract

Background: Optimized symptom-based COVID-19 case definitions that guide public health surveillance and individual patient management in the community may assist pandemic control.

Methods: We assessed diagnostic performance of existing cases definitions (e.g. influenza-like illness, COVID-like illness) using symptoms reported from 185 household contacts to a PCR-confirmed case of COVID-19 in Wisconsin and Utah, United States. We stratified analyses between adults and children. We also constructed novel case definitions for comparison.

Results: Existing COVID-19 case definitions generally showed high sensitivity (86-96%) but low positive predictive value (PPV) (36-49%; F-1 score 52-63) in this community cohort. Top performing novel symptom combinations included taste or smell dysfunction and improved the balance of sensitivity and PPV (F-1 score 78-80). Performance indicators were generally lower for children (< 18 years of age).

Conclusions: Existing COVID-19 case definitions appropriately screened in household contacts with COVID-19. Novel symptom combinations incorporating taste or smell dysfunction as a primary component improved accuracy. Case definitions tailored for children versus adults should be further explored.

Keywords: Adults; COVID-19; Children; Diagnostic accuracy; Predictive values; SARS-CoV-2; Sensitivity; Specificity; Surveillance; Symptoms; Syndromic.

PubMed Disclaimer

Conflict of interest statement

The authors report no competing interests.

Figures

Fig. 1
Fig. 1
Sensitivity and 100%-specificity for individual COVID-19 symptoms, existing case definitions, and derived compound symptom combinations for a community cohort of 185 individuals with household exposure to COVID-19 in Utah and Wisconsin, United States, March–May 2020. Specificity is the probability of testing negative when disease is absent. Sensitivity is the probability of testing positive when disease is present. CDC symptom list=U.S. Centers for Disease Control and Prevention (CDC) list of symptoms that may indicate COVID-19 infection (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html). This symptom list was last updated on 13 May 2020. ARI=World Health Organization (WHO) acute respiratory infection (ARI) definition for community-based respiratory syncytial virus (RSV) surveillance (https://www.who.int/influenza/rsv/rsv_case_definition/en/). Last updated 04 February 2020. CSTE combination 1=U.S. Council of State and Territorial Epidemiologists (CSTE) original clinical criteria for COVID-19 reporting (https://cdn.ymaws.com/www.cste.org/resource/resmgr/2020ps/interim-20-id-01_covid-19.pdf). This interim position statement (Interim-20-ID-01) was approved on 05 April 2020 and was replaced by Interim-20-ID-02 on 07 August 2020. CSTE combination 2=U.S. Council of State and Territorial Epidemiologists (CSTE) revised clinical criteria for COVID-19 reporting (https://cdn.ymaws.com/www.cste.org/resource/resmgr/ps/positionstatement2020/interim-20-id-02_COVID-19.pdf). This interim position statement (Interim-20-ID-02) was approved on 07 August 2020 and replaced Interim-20-ID-01. CLI=U.S. Centers for Disease Control and Prevention (CDC) COVID-19-like illness (CLI) definition was used to guide early diagnostic testing strategies from 17 January 2020–08 March 2020 (https://emergency.cdc.gov/han/han00426.asp). ††ILI=Influenza-like illness (ILI) outpatient visit information collected through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) (https://www.cdc.gov/flu/weekly/overview.htm#anchor_1539281266932). This collaborative effort between CDC, state and local health departments, and healthcare providers has been tracking patients with ILI since the 1997–1998 influenza season. Derived compound combination 1: Taste and/or smell dysfunction, OR one of the following: shortness of breath, myalgia, or fever or chills. Derived compound combination 2: Taste and/or smell dysfunction or discomfort breathing, OR at least two of the following: shortness of breath, wheezing, or fever/chills. Derived compound combination 3: Taste and/or smell dysfunction, OR at least two of the following: shortness of breath, wheezing, discomfort breathing, or fever/chills. Derived compound combination 4: Taste and/or smell dysfunction, OR shortness of breath and fever/chills. Points closest to the upper left corner represent those with the highest sensitivity and specificity values
Fig. 2
Fig. 2
Sensitivity and 100%-specificity for individual COVID-19 symptoms, existing case definitions, and derived compound symptom combinations for a community cohort of 122 adults (upper case letters) and 63 children (lower case letters) with household exposure to COVID-19 in Utah and Wisconsin, United States, March–May 2020. Specificity is the probability of testing negative when disease is absent. Sensitivity is the probability of testing positive when disease is present. CDC symptom list=U.S. Centers for Disease Control and Prevention (CDC) list of symptoms that may indicate COVID-19 infection (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html). This symptom list was last updated on 13 May 2020. ARI=World Health Organization (WHO) acute respiratory infection (ARI) definition for community-based respiratory syncytial virus (RSV) surveillance (https://www.who.int/influenza/rsv/rsv_case_definition/en/). Last updated 04 February 2020. CSTE combination 1=U.S. Council of State and Territorial Epidemiologists (CSTE) original clinical criteria for COVID-19 reporting (https://cdn.ymaws.com/www.cste.org/resource/resmgr/2020ps/interim-20-id-01_covid-19.pdf). This interim position statement (Interim-20-ID-01) was approved on 05 April 2020 and was replaced by Interim-20-ID-02 on 07 August 2020. CSTE combination 2=U.S. Council of State and Territorial Epidemiologists (CSTE) revised clinical criteria for COVID-19 reporting (https://cdn.ymaws.com/www.cste.org/resource/resmgr/ps/positionstatement2020/interim-20-id-02_COVID-19.pdf). This interim position statement (Interim-20-ID-02) was approved on 07 August 2020 and replaced Interim-20-ID-01. CLI=U.S. Centers for Disease Control and Prevention (CDC) COVID-19-like illness (CLI) definition was used to guide early diagnostic testing strategies from 17 January 2020–08 March 2020 (https://emergency.cdc.gov/han/han00426.asp). ILI=Influenza-like illness (ILI) outpatient visit information collected through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) (https://www.cdc.gov/flu/weekly/overview.htm#anchor_1539281266932). This collaborative effort between CDC, state and local health departments, and healthcare providers has been tracking patients with ILI since the 1997–1998 influenza season. Derived compound combination 1: Taste and/or smell dysfunction, OR one of the following: shortness of breath, myalgia, or fever or chills. Derived compound combination 2: Taste and/or smell dysfunction or discomfort breathing, OR at least two of the following: shortness of breath, wheezing, or fever/chills. Derived compound combination 3: Taste and/or smell dysfunction, OR at least two of the following: shortness of breath, wheezing, discomfort breathing, or fever/chills. Derived compound combination 4: Taste and/or smell dysfunction, OR shortness of breath and fever/chills. Points closest to the upper left corner represent those with the highest sensitivity and specificity values
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W, China Novel Coronavirus Investigating and Research Team A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. Tsang TK, Wu P, Lin Y, Lau EHY, Leung GM, Cowling BJ. Effect of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China: a modelling study. Lancet Public Health. 2020;5(5):e289–e296. doi: 10.1016/S2468-2667(20)30089-X. - DOI - PMC - PubMed
    1. Pascarella G, Strumia A, Piliego C, Bruno F, Del Buono R, Costa F, Scarlata S, Agro FE. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192–206. doi: 10.1111/joim.13091. - DOI - PMC - PubMed
    1. Tostmann A, Bradley J, Bousema T, Yiek WK, Holwerda M, Bleeker-Rovers C, et al. Strong associations and moderate predictive value of early symptoms for SARS-CoV-2 test positivity among healthcare workers, the Netherlands, March 2020. Euro Surveill. 2020;25(16). 10.2807/1560-7917.ES.2020.25.16.2000508. - PMC - PubMed
    1. Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA, Ganesh S, Varsavsky T, Cardoso MJ, El-Sayed Moustafa JS, et al. Real-time tracking of self-reported symptoms to predict potential COVID-19. Nat Med. 2020;26(7):1037–1040. doi: 10.1038/s41591-020-0916-2. - DOI - PMC - PubMed

Publication types