SARS-CoV-2 incidence, transmission, and reinfection in a rural and an urban setting: results of the PHIRST-C cohort study, South Africa, 2020–21

Dawood, Fatimah S.; Mkhencele, Thulisa; Sun, Kaiyuan; Viboud, Cécile; Bhiman, Jinal N.; Buys, Amelia; Carrim, Maimuna; Cohen, Cheryl; Gouveia, Linda de; Plessis, Mignon du; Toit, Jacques du; Gómez‐Olivé, Francesc Xavier; Kahn, Kathleen; Kgasago, Kgaugelo P; Kleynhans, Jackie; Kotane, Retshidisitswe; Lebina, Limakatso; Martinson, Neil; McMorrow, Meredith; Moloantoa, Tumelo; Moyes, Jocelyn; Tempia, Stefano; Tollman, Stephen; Gottberg, Anne von; Wafawanaka, Floidy; Wolter, Nicole

doi:10.1016/s1473-3099(22)00069-x

Cited by 104 publications

(141 citation statements)

References 30 publications

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“…HCIR was also higher when contacts were aged 13-17 and 18-34, compared to younger than 5 years. Contacts aged 13-18 years were also associated with higher HCIR in the South African PHIRST-C study,[2] although studies from earlier in the pandemic showed higher attack rates in elderly household members. [19, 21] This may be related to the shift in age-distribution of cases from the older population to younger individuals with progression of the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…At end of January 2022, South Africa had reported 3.6 million coronavirus disease 2019 (COVID-19) cases and 94.3 thousand deaths; the highest reported from Africa, likely due to the highest testing capacity. [1, 2] South Africa experienced four severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) waves of infection: the first dominated by ancestral variants, followed by Beta (B.1.351), Delta (B.1.617.2) and Omicron (B.1.1.529) variant dominated waves, respectively. [3]…”

Section: Introductionmentioning

confidence: 99%

“…One study from a South African household cohort showed no increase in household transmission from or acquisition of SARS-CoV-2 infection in people LWH. [2] People LWH with severe COVID-19 who are not virally suppressed shed SARS-CoV-2 for longer periods,[2, 13] which could also lead to increased secondary transmission.…”

Section: Introductionmentioning

confidence: 99%

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Household transmission of SARS-CoV-2 from adult index cases living with and without HIV in South Africa, 2020-2021: a case-ascertained, prospective observational household transmission study

Kleynhans

Walaza

Martinson

et al. 2022

Preprint

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BackgroundIn South Africa 19% of the adult population aged 15-49 years are living with HIV (LWH). Few data on the influence of HIV on SARS-CoV-2 household transmission are available.MethodsWe performed a case-ascertained, prospective household transmission study of symptomatic index SARS-CoV-2 cases LWH and HIV-uninfected adults and their contacts in South Africa. Households were followed up thrice weekly for 6 weeks to collect nasal swabs for SARS-CoV-2 testing. We estimated household cumulative infection risk (HCIR), duration of SARS-CoV-2 positivity (at cycle threshold value<30 as proxy for high viral load), and assessed associated factors.ResultsWe recruited 131 index cases and 457 household contacts. HCIR was 59% (220/373); not differing by index HIV status (60% [50/83] in cases LWH vs 58% [173/293] in HIV-uninfected cases, OR 1.0, 95%CI 0.4-2.3). HCIR increased with index case age (35-59 years: aOR 3.4 95%CI 1.5-7.8 and ≥60 years: aOR 3.1, 95%CI 1.0-10.1) compared to 18-34 years, and contacts’ age, 13-17 years (aOR 7.1, 95%CI 1.5-33.9) and 18-34 years (aOR 4.4, 95%CI 1.0-18.4) compared to <5 years. Mean positivity duration at high viral load was 7 days (range 2-28), with longer positivity in cases LWH (aHR 0.3, 95%CI 0.1-0.7).ConclusionsHIV-infection was not associated with higher HCIR, but cases LWH had longer positivity duration at high viral load. Adults aged >35 years were more likely to transmit, and individuals aged 13-34 to acquire SARS-CoV-2 in the household. Health services must maintain HIV testing with initiation of antiretroviral therapy for those HIV-infected.SummaryIn this case-ascertained, prospective household transmission study, household cumulative infection risk was 59% from symptomatic SARS-CoV-2 index cases, not differing based on index HIV status. Index cases living with HIV were positive for SARS-CoV-2 for longer at higher viral loads.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Household transmission of SARS-CoV-2 from adult index cases living with and without HIV in South Africa, 2020-2021: a case-ascertained, prospective observational household transmission study

Kleynhans

Walaza

Martinson

et al. 2022

Preprint

Self Cite

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“…1 , 2 In The Lancet Infectious Diseases , Cheryl Cohen and colleagues explore the nuances involved in SARS-CoV-2 household transmission. 3 Current evidence supports transmission between household contacts as a substantial driver of SARS-CoV-2 spread. 4 , 5 Increased transmission in household settings is likely to be due to non-use of personal protective equipment and close prolonged contact during daily activities within the household.…”

mentioning

confidence: 89%

“…The prospective household cohort study of SARS-CoV-2, influenza, and respiratory syncytial virus community burden, transmission dynamics, and viral interaction in South Africa (PHIRST-C) by Cohen and colleagues comprehensively investigated the incidence, reinfection, and transmission dynamics within urban and rural households in South Africa. 3 Novel study methodology included intensive symptom screening, midturbinate nasal swabs twice a week for testing of SARS-CoV-2 with real-time RT-PCR (RT-rtPCR; irrespective of symptoms), and anti-SARS-CoV-2 antibody testing every 2 months. The study period coincided with three COVID-19 waves in South Africa, which were driven by original wild-type variant in the first wave, the beta variant in the second wave, and the delta variant in the third wave.…”

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confidence: 99%