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

  • Reses, Hannah E.1
  • Fajans, Mark1
  • Lee, Scott H.1
  • Heilig, Charles M.1
  • Chu, Victoria T.1, 1
  • Thornburg, Natalie J.1
  • Christensen, Kim2
  • Bhattacharyya, Sanjib3
  • Fry, Alicia1
  • Hall, Aron J.1
  • Tate, Jacqueline E.1
  • Kirking, Hannah L.1
  • Nabity, Scott A.1
  • Banks, Michelle
  • Battey, Katherine A.
  • Binder, Alison M.
  • Buono, Sean
  • Chancey, Rebecca J.
  • Christiansen, Ann
  • Conners, Erin E.
  • And 37 more
  • 1 Centers for Disease Control and Prevention,
  • 2 Utah Department of Health,
  • 3 City of Milwaukee Health Department,
Published Article
BMC Public Health
Springer (Biomed Central Ltd.)
Publication Date
Sep 25, 2021
DOI: 10.1186/s12889-021-11683-y
PMID: 34563163
PMCID: PMC8465785
PubMed Central
  • Research Article


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. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11683-y.

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