Kubva muna Ndira 21 kusvika Kukadzi 23, 2020, masangano ehutano everuzhinji akaona gumi nemana eUS nyaya dzechirwere checonavirus 14 (COVID-2019), zvese zvine chekuita nekufamba kubva kuChina (19). Mhosva yekutanga isina hukama neUS yakasimbiswa muna Kukadzi 1,2 mugari wekuCalifornia akange arwara muna Kukadzi 26 (13). Mazuva maviri gare gare, muna Kukadzi 3, nyaya yechipiri ine hukama-yakasimbiswa mudunhu reWashington (28). Kuongororwa kwemitsara mina yeuchapupu kunopa nzwisiso yenguva yekusuma uye yekutanga kutapurirana kweSARS-CoV-4,5, hutachiona hunokonzera COVID-2, kuUnited States kusati kwaonekwa nyaya mbiri idzi.

Chekutanga, kutariswa kwesyndromic kwakavakirwa pamarekodhi edhipatimendi rekukurumidzira kubva kumatunhu akakanganisika nedenda hakuna kuratidza kuwedzera kwekushanya kweCCIDID-19-sechirwere chakadai Kukadzi 28 isati yasvika. Nzvimbo dzemuUS kutanga Ndira 2 dzakaratidza hapana mhedzisiro yakanaka Kukadzi 11,000 isati yasvika. Chechitatu, ongororo yemavhairasi RNA kutevedzana kubva muzviitiko zvekutanga yakaratidza kuti mutsara mumwe chete wehutachiona hwakaunzwa kubva kunze zvakananga kana zvisina kunanga kubva kuChina hwakatanga kutenderera muUnited States pakati paNdira 1 naKukadzi 20, ndokutevera. neakati wandei SARS-CoV-18 ekunze kubva kuEurope.

Pakupedzisira, kuitika kwenyaya nhatu, mumwe mugari wekuCalifornia akafa muna Kukadzi 6, wechipiri mune mumwe mugari wedunhu rimwe chete akafa Kukadzi 17, uye chetatu mumutyairi asingazivikanwe kana nhengo yevashandi muchikepe chePacific chakasiya. San Francisco muna Kukadzi 11, inosimbisa kutenderera kwehutachiona kutanga kwaFebruary. Idzi data dzinoratidza kuti kutapurirana kwakaramba kuchiitwa munharaunda kwakatanga kusati kwaonekwa nyaya mbiri dzekutanga dzeUS, dzingangodaro dzakakonzerwa nekupinzwa kunze kwemutsara mumwe chete wehutachiona kubva kuChina mukupera kwaNdira kana kutanga kwaFebruary, zvichiteverwa nekutengwa kwakawanda kubva kuEurope. Kubuda kwakawanda kweCCIDID-19 muUnited States yese mushure meKukadzi kunoratidza kukosha kwemasisitimu akasimba ehutano hweveruzhinji kupindura nekukasira kutyisidzira kwehutachiona.

Syndromic Surveillance

Kuburikidza neNational Syndromic Surveillance Program, masangano ezvehutano eUS anogamuchira data chaiyo-nguva kubva kumadhipatimendi ekukurumidzira munzvimbo dzinosvika zviuru zvina zvehutano munzvimbo makumi mana nenomwe dzeU.S. neDunhu reColumbia. Mumatunhu gumi nemana ane nyaya dzekutanga dzakatorwa nenharaunda dzeCCIDID-4,000, hapana kuwedzera kwakanyanya kwakaonekwa muchikamu cheCCIDID-47-sechirwere (fivha uye kukosora kana kutadza kufema kana kutadza kufema, kana kunyorwa kwekoronavirus diagnostic code) pamberi paFebruary 14.

Kuongororwa kweAcute SARS-CoV-2 Utachiona Iyo Seattle Flu Chidzidzo (5) yakatanga kutarisa chirwere chekufema munzvimbo yeSeattle metropolitan muna Mbudzi 2018. Mukupera kwaFebruary 2020, chidzidzo ichi chakatanga kuyedza sampuli vachishandisa reverse transcription-polymerase chain reaction (RT- PCR) kuongororwa kweSARS-CoV-2. Mhedzisiro yekutanga yerabhoritari yakanaka yeSARS-CoV-2 yakaonekwa muna Kukadzi 28 kubva kumuenzaniso wakaunganidzwa Kukadzi 24. Mushure mekuonekwa uku, zvidhori zvakatorwa zvakaunganidzwa kare zvakaongororwa hutachiona. Pakange pasina mhedzisiro yakanaka pakati pe5,270 yekufema mienzaniso yakaunganidzwa muna Ndira 1-Kukadzi 20 (5) (T. Bedford, Fred Hutchinson Cancer Research Center, Seattle, Washington, kutaurirana kwevanhu, Chivabvu 6, 2020). Muenzaniso wekutanga wakaonekwa kuti une hutachiwana pakati pezvienzaniso zvakaongororwa zvekare zvakaunganidzwa muna Kukadzi 21. Muvhiki inotanga Kukadzi 21, zvisere pazvikamu 1,255 (0.6%) zvakaonekwa kuti zvine hutachiona, uye muvhiki rinotevera, makumi maviri nepfumbamwe e29 (1,862%) akaedzwa. positive. Manetiweki maviri ekudzivirira furuwenza yekudzidza ane masaiti ari mumatunhu matanhatu (Michigan, Pennsylvania, Tennessee, Texas, Washington, neWisconsin) akaongorora zvekare zvimiro zvekufema kubva kuvarwere vane chirwere chekufema cheSARS-CoV-1.6 neRT-PCR. Panzvimbo yeWashington, hapana kana chimwe chezvienzaniso mazana mana nemakumi mapfumbamwe nenomwe zvakaunganidzwa muna Ndira 2-Kukadzi 497 akaonekwa aine hutachiona; muenzaniso wekutanga wakaonekwa kuti une hutachiwona wakaunganidzwa muna Kukadzi 19. Pane dzimwe nzvimbo shanu (Ann Arbor neDetroit, Michigan; Pittsburgh, Pennsylvania; Temple, Texas; Marshfield, Wisconsin; uye Nashville, Tennessee), hapana kana imwe ye24 samples dzakaunganidzwa muna Ndira. 25–Kukadzi 2,620 akaongororwa aine SARS-CoV-19. Kubva muna Chivabvu 29, 2, ina (<22%) yezvienzaniso zvinosvika zviuru zvitatu zvakatorwa kubva kuvana nevechiri kuyaruka vane makore gumi nemasere vakanyoresa muNew Vaccine Surveillance Network† muna Ndira 2020-Kurume 0.2 vakaedza kuti vane SARS-CoV-3,000. Mhedzisiro yekutanga yakanaka kubva kumuenzaniso wakaunganidzwa Kurume 18 muSeattle.

Phylogenetic Analysis

Ongororo yekusiyana kwegenomic yeSARS-CoV-2 kubva mukutanga nyaya dzeCCIDID-19 kubva munzvimbo yeSeattle yakaona kuti hutachiona hwakawanda hwaive hwechikamu chimwe chete (iyo Washington State clade), ane tateguru achangoburwa anofungidzirwa kuti aivepo pakati peanenge. Ndira 18 naKukadzi 9 (inofungidzira = Kukadzi 1) § Kutevedzana kwakafanotaurwa kwehutachiona hwehutachiona hwaienderana neiyo kubva kuUS nyaya yekutanga yeCOVID-19, yakaitika mumurume akasvika muSeattle achibva kuWuhan, China. , pana January 15 uye akazorwara mazuva mana gare gare. Nekudaro, zvakare zvinogoneka kuti iyo Washington State clade yakasimuka kubva kuhutachiona ine yakafanana kana yakafanana kutevedzana kubva kune mumwe munhu ane hutachiona hweSARS-CoV-4. Ongororo yehutachiona muCalifornia nekuchamhembe kwakadziva kumabvazuva kweUnited States kubva muna Kukadzi kusvika pakati paKurume yakaratidza kuti kwave nekutengwa kwehutachiona kubva kunze kwenyika, kunyanya kubva kuEurope, kuchiteverwa nekufambiswa kwehutachiona mukati meUnited States.

Mhosva Dzinozivikanwa Muvanhu Vasina Nyaya Yekufamba

Pamberi paFebruary 26 Mhosva mbiri dzinozivikanwa dzeCCIDID-19 dzakaitika muSanta Clara County, California: mumwe mumukadzi akarwara muna Ndira 31 ndokufa muna Kukadzi 6 uye mumwe mumurume asina hukama akafira pamba pakati paKukadzi 13 na17. Hapanawo akanga afamba kune dzimwe nyika mumavhiki asati afa. SARS-CoV-2 RNA yakaonekwa nekuongororwa kweRT-PCR kuCDC kubva kune postmortem tissue specimens kubva kuvarwere ava. Rufu urwu rwakasimbiswa nemuongorori wekurapa seCOVID-19- kufa kwakabatana. Kuferefetwa kwenyaya idzi kuri kuenderera mberi. Kubuda kweCCIDID-19 kwakaitika panguva mbiri dzakatevedzana dzechikepe cheGrand Princess cruise (7). The genomic kutevedzana kwehutachiona kubva mukubuda uku kwaive mukati meWashington State clade, zvichiratidza kuti mutyairi kana nhengo yevatyairi ane hutachiona uhwu aive mungarava payakabva paPort of San Francisco muna Kukadzi 11 rwendo rwekudzoka nekudzoka. Kuti ndiani munhu iyeye haazivikanwi. Hurukuro Ruzivo kubva kune akasiyana dhata masosi inoratidza kuti kushoma kwenharaunda kutapurirana kweSARS-CoV-2 muUnited States kwakaitika pakati pehafu yekupedzisira yaNdira uye kutanga kwaFebruary, zvichitevera kupinzwa kunze kweSARS-CoV-2 kubva kuChina. Kupinzwa kunze uku kwakatanga mutsara, Washington State clade, iyo yakazopararira muSeattle metropolitan nharaunda uye pamwe kumwewo. Kupinza kwakati wandei kweSARS-CoV-2 kubva kuEurope kwakatevera muna Kukadzi naKurume. Hazvizivikanwe kuti vangani veU.S. hutachiona hwakaitika muna Kukadzi naKurume, asi huwandu hwezvirwere pamberi paKukadzi 28 hwakanga hwakaderera kuti zvionekwe kuburikidza nedhipatimendi rekukurumidzira syndromic surveillance data. Zvakare hazvizivikanwe mazuva ekupinda mavhairasi akatorwa kunze kwenyika muUnited States uye mazita evanhu vakaatakura. Imwe inobvira manyuko ekutanga ndiyo yekutanga yakashumwa yeU.S. nyaya yeCCIDID-19, yakaitika muWashington murume akarwara muna Ndira 19 adzoka kubva kuWuhan, China, muna Ndira 15; kutevedzana kwehutachiona hwehutachiona hwakaparadzaniswa nemurume iyeye kunoenderana nekuve kwake kunobva kuWashington State clade, kunyange hazvo kunyatsoita kuferefetwa kwenyaya iyi uye kusavapo kwenyaya dzechipiri dzakaonekwa zvinopokana neizvi (8). Nekudaro, mishumo yakazoburitswa yakaratidza kuti kutapukirwa neSARS-CoV-2 kunowanzo asymptomatic uye kutapurirana kunogona kuitika zviratidzo zvisati zvatanga (9). Iko mukana we presymptomatic kutapurirana kunomutsa zvimwe zvitatu zvinogona kuitika zvinosanganisira nyaya iyi: 1) kuti imwe kana kupfuura yechipiri asymptomatic kutapukira kungave kwakaitika pakati pevanobatwa nemurwere uye izvo zvakakonzera kuenderera mberi, kusingaonekwe kupararira kwehutachiona; 2) kuti murume anogona kunge aine hutachiona chiratidzo chake chisati chatanga (vakadaro vangadai vasina kuzivikanwa kuburikidza nechiyero chakakurudzirwa kuonana nekuferefeta panguva iyoyo); kana 3) kuti iye nemumwe munhu mumwe chete vakatapukirwa nemumwe mutyairi mundege imwe chete kubva kuWuhan, uye kupararira kusingaonekwe kubva kune vamwe vanhu vane hutachiona kwakakonzera Washington State clade. Izvo, kana zviripo, zvezviitiko izvi zvakaitika zvichida hazvizombofa zvakazivikanwa. Zvinogoneka zvakare, kupihwa kushomeka kwepasirese phylogenetic kusiyana kweSARS-CoV-2 panguva iyoyo, kuti Washington State clade yakapinzwa kuUnited States nemumwe, munhu asingazivikanwe panguva imwe chete. Mhedzisiro yekuongorora serologic haina kuratidzwa pano, nekuti serology (kureva, kuyedza antibody kuSARS-CoV-2) inogona kunge iri nzira isinganzwisisike yekuona hutachiona huchangobuda, kunyanya kana zvienzaniso zvakaunganidzwa zvisina tsarukano kwete kubva. vanhu vangangotapukirwa (mukupesana, semuenzaniso, kuongororwa kwehutachiona hwevarwere vekunze kana varwere vari muchipatara vane chirwere chekufema zvakanyanya) uye nekuti serologic assays kazhinji haiswedere 100% chaiyo kunze kwekunge imwe nzira yekusimbisa yekuongorora iripo. Semuenzaniso, ongororo yekufungidzira serologic muSeattle metropolitan area (vagari ve3.5 miriyoni) yakaitwa mushure mekutanga 3,500 kutapukira yaizowana seroprevalence yechokwadi ye0.1%, nepo kushandiswa kweassay ine 99% chaiyo yaizotarisirwa kuburitsa manyepo. mu 10 nguva yakawanda semasampuli akawanda. Ongororo dzeSerologic, zvisinei, dzinobatsira mukutsvaga mafambiro echirwere ichi kana yangotanga uye kuve nemukana wekuona hutachiona hwese, zvisinei nechiratidzo chechiratidzo. Zvakawanikwa mumushumo uyu zviri pasi pezvisingakwanisi katatu. Kutanga, iyo data yakapihwa pano ndeye retrospective. Kunyangwe iwo akasiyana enzvimbo, haakwanise kupa mufananidzo wakajeka wekutapurirana sezvaizovepo dai kuongororwa kwakapararira kwave kuwanikwa mushure mekuwanikwa kwehutachiona. Chechipiri, zvimwe zvezvidzidzo zvakadudzwa uye pamwe zvimwe zviri kuenderera mberi nekuyedza samples zvekare uye vanogona kuwana nyaya dzekare pane dzakaratidzwa mumushumo uyu. Chekupedzisira, iyo phylogenetic homogeneity yeSARS-CoV-2 pasi rose muna Ndira uye kutanga kwaFebruary yakaganhura izvo zvinogona kufungidzirwa kubva genomic ongororo. Nyika shoma dzakanzvenga kutengwa kunze kwenyika uye kupararira kwakasimba kweCOVID-19. MuUnited States, SARS-CoV-2 yave kutenderera zvakanyanya mushure mekutengesa kwakati wandei kubva kuChina, Europe, nekumwewo. Matanho ari kuenderera mberi muU.S. veruzhinji hutano system yekuvandudza zviratidzo zveSARS-CoV-2 chiitiko, kusanganisira kuwedzera syndromic ongororo pakati pemadhipatimendi ekukurumidzira uye kuwedzera kuwanikwa kwekuyedzwa kweSARS-CoV-2. Tichifunga nezve bviro yokuti vazhinji veU.S.

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ZVOKUBVA MUNYAYA INO:

Finally, the occurrence of three cases, one in a California resident who died on February 6, a second in another resident of the same county who died February 17, and a third in an unidentified passenger or crew member aboard a Pacific cruise ship that left San Francisco on February 11, confirms cryptic circulation of the virus by early February.
In 14 counties with early community-acquired cases of COVID-19, no substantial increase was observed in the proportion of COVID-19–like illness (fever and cough or shortness of breath or difficulty breathing, or the listing of a coronavirus diagnostic code) before February 28.
Third, analysis of viral RNA sequences from early cases suggested that a single lineage of virus imported directly or indirectly from China began circulating in the United States between January 18 and February 9, followed by several SARS-CoV-2 importations from Europe.