Secondary Attack Rate and Family Clustering of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children of Healthcare Workers With Confirmed Coronavirus Disease 2019 (COVID-19)

Ladhani, Shamez; Andrews, Nick; Aiano, Felicity; Baawuah, Frances; Amin-Chowdhury, Zahin; Brown, Kevin E.; Amirthalingam, Gayatri; Ramsay, Mary; Waterfield, Thomas; team, Rapid Investigation

doi:10.1093/cid/ciaa1737

Cited by 9 publications

(12 citation statements)

References 15 publications

(18 reference statements)

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“…Our observation of a SAR ≈10 percentage points higher in adults than in children is consistent with household studies based on RT-PCR-confirmed SARS-CoV-2 infection (10). In contrast, previous household transmission studies based on SARS-CoV-2 serologic testing reported lower (18), similar (28%) (17), or higher (43%-52%) (19)(20)(21) SARs in children. However, these studies were relatively small.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Households with Children, Southwest Germany, May–August 2020

Stich¹,

Elling²,

Renk³

et al. 2021

Emerg. Infect. Dis.

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Section: Discussionsupporting

confidence: 89%

“…Previous household transmission studies found SARS-CoV-2-specific IgG in 28% (17), 34% (18), 42% (19), 45% (20) and 52% (21) of exposed children; SARs were lower (18), similar to (17,21), or higher (19) than in exposed adult household members. However, the low number of studied households with children (21-130 households) (17)(18)(19)(20)(21) was a limitation.…”

mentioning

confidence: 76%

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Households with Children, Southwest Germany, May–August 2020

Stich¹,

Elling²,

Renk³

et al. 2021

Emerg. Infect. Dis.

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“…Anecdotally, husbands and wives, siblings, and adult parents and children are not infrequently hospitalized in succession, though the prevalence of this is unknown. An inoculum effect may underlie this finding [31] and also explain why secondary cases in households appear to be overdispersed, with either most or all members infected, or none at all [6,32,33]. Viral load dynamics will no doubt continue to shape household transmission and the larger pandemic, as newer, potentially more infectious variants emerge even as vaccination decreases the “community viral load.”…”

Section: Discussionmentioning

confidence: 99%

High household transmission of SARS-CoV-2 in the United States: living density, viral load, and disproportionate impact on communities of color

Cerami

Rapp

Lin

et al. 2021

Preprint

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Background Few prospective studies of SARS-CoV-2 transmission within households have been reported from the United States, where COVID-19 cases are the highest in the world and the pandemic has had disproportionate impact on communities of color. Methods and Findings This is a prospective observational study. Between April-October 2020, the UNC CO-HOST study enrolled 102 COVID-positive persons and 213 of their household members across the Piedmont region of North Carolina, including 45% who identified as Hispanic/Latinx or non-white. Households were enrolled a median of 6 days from onset of symptoms in the index case. Secondary cases within the household were detected either by PCR of a nasopharyngeal (NP) swab on study day 1 and weekly nasal swabs (days 7, 14, 21) thereafter, or based on seroconversion by day 28. After excluding household contacts exposed at the same time as the index case, the secondary attack rate (SAR) among susceptible household contacts was 60% (106/176, 95% CI 53%-67%). The majority of secondary cases were already infected at study enrollment (73/106), while 33 were observed during study follow-up. Despite the potential for continuous exposure and sequential transmission over time, 93% (84/90, 95% CI 86%-97%) of PCR-positive secondary cases were detected within 14 days of symptom onset in the index case, while 83% were detected within 10 days. Index cases with high NP viral load (>10^6 viral copies/ul) at enrollment were more likely to transmit virus to household contacts during the study (OR 4.9, 95% CI 1.3-18 p=0.02). Furthermore, NP viral load was correlated within families (ICC=0.44, 95% CI 0.26-0.60), meaning persons in the same household were more likely to have similar viral loads, suggesting an inoculum effect. High household living density was associated with a higher risk of secondary household transmission (OR 5.8, 95% CI 1.3-55) for households with >3 persons occupying <6 rooms (SAR=91%, 95% CI 71-98%). Index cases who self-identified as Hispanic/Latinx or non-white were more likely to experience a high living density and transmit virus to a household member, translating into an SAR in minority households of 70%, versus 52% in white households (p=0.05). Conclusions SARS-CoV-2 transmits early and often among household members. Risk for spread and subsequent disease is elevated in high-inoculum households with limited living space. Very high infection rates due to household crowding likely contribute to the increased incidence of SARS-CoV-2 infection and morbidity observed among racial and ethnic minorities in the US. Quarantine for 14 days from symptom onset of the first case in the household is appropriate to prevent onward transmission from the household. Ultimately, primary prevention through equitable distribution of effective vaccines is of paramount importance.

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“…In our formulation, R G = p and f h is h multiplied by the secondary attack rate within households. We use the estimated secondary attack rate from UK data, which varies between 0.25 for large household sizes and 0.49 for households of size 2 [ 15 , 16 ]. Furthermore, below the percolation threshold, R H < 1 because the infection is necessarily limited to small, disconnected clusters.…”

Section: Methodsmentioning

confidence: 99%

Household bubbles and COVID-19 transmission: insights from percolation theory

Danon

Lacasa

Brooks-Pollock

2021

Phil. Trans. R. Soc. B

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In the era of social distancing to curb the spread of COVID-19, bubbling is the combining of two or more households to create an exclusive larger group. The impact of bubbling on COVID-19 transmission is challenging to quantify because of the complex social structures involved. We developed a network description of households in the UK, using the configuration model to link households. We explored the impact of bubbling scenarios by joining together households of various sizes. For each bubbling scenario, we calculated the percolation threshold, that is, the number of connections per individual required for a giant component to form, numerically and theoretically. We related the percolation threshold to the household reproduction number. We find that bubbling scenarios in which single-person households join with another household have a minimal impact on network connectivity and transmission potential. Ubiquitous scenarios where all households form a bubble are likely to lead to an extensive transmission that is hard to control. The impact of plausible scenarios, with variable uptake and heterogeneous bubble sizes, can be mitigated with reduced numbers of contacts outside the household. Bubbling of households comes at an increased risk of transmission; however, under certain circumstances risks can be modest and could be balanced by other changes in behaviours. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK'.

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Secondary Attack Rate and Family Clustering of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children of Healthcare Workers With Confirmed Coronavirus Disease 2019 (COVID-19)

Cited by 9 publications

References 15 publications

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Households with Children, Southwest Germany, May–August 2020

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Households with Children, Southwest Germany, May–August 2020

High household transmission of SARS-CoV-2 in the United States: living density, viral load, and disproportionate impact on communities of color

Household bubbles and COVID-19 transmission: insights from percolation theory

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