High variability in transmission of SARS-CoV-2 within households and implications for control

<h4>Background</h4> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a high risk of transmission in close-contact indoor settings, which may include households. Prior studies have found a wide range of household secondary attack rates and may contain biases due to simpl...

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Autores principales:	Damon J. A. Toth, Alexander B. Beams, Lindsay T. Keegan, Yue Zhang, Tom Greene, Brian Orleans, Nathan Seegert, Adam Looney, Stephen C. Alder, Matthew H. Samore
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/59be16b2e3d54adeac97ace4c1a997d7
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spelling	oai:doaj.org-article:59be16b2e3d54adeac97ace4c1a997d72021-11-18T07:37:10ZHigh variability in transmission of SARS-CoV-2 within households and implications for control1932-6203https://doaj.org/article/59be16b2e3d54adeac97ace4c1a997d72021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580228/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a high risk of transmission in close-contact indoor settings, which may include households. Prior studies have found a wide range of household secondary attack rates and may contain biases due to simplifying assumptions about transmission variability and test accuracy. <h4>Methods</h4> We compiled serological SARS-CoV-2 antibody test data and prior SARS-CoV-2 test reporting from members of 9,224 Utah households. We paired these data with a probabilistic model of household importation and transmission. We calculated a maximum likelihood estimate of the importation probability, mean and variability of household transmission probability, and sensitivity and specificity of test data. Given our household transmission estimates, we estimated the threshold of non-household transmission required for epidemic growth in the population. <h4>Results</h4> We estimated that individuals in our study households had a 0.41% (95% CI 0.32%– 0.51%) chance of acquiring SARS-CoV-2 infection outside their household. Our household secondary attack rate estimate was 36% (27%– 48%), substantially higher than the crude estimate of 16% unadjusted for imperfect serological test specificity and other factors. We found evidence for high variability in individual transmissibility, with higher probability of no transmissions or many transmissions compared to standard models. With household transmission at our estimates, the average number of non-household transmissions per case must be kept below 0.41 (0.33–0.52) to avoid continued growth of the pandemic in Utah. <h4>Conclusions</h4> Our findings suggest that crude estimates of household secondary attack rate based on serology data without accounting for false positive tests may underestimate the true average transmissibility, even when test specificity is high. Our finding of potential high variability (overdispersion) in transmissibility of infected individuals is consistent with characterizing SARS-CoV-2 transmission being largely driven by superspreading from a minority of infected individuals. Mitigation efforts targeting large households and other locations where many people congregate indoors might curb continued spread of the virus.Damon J. A. TothAlexander B. BeamsLindsay T. KeeganYue ZhangTom GreeneBrian OrleansNathan SeegertAdam LooneyStephen C. AlderMatthew H. SamorePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Damon J. A. Toth Alexander B. Beams Lindsay T. Keegan Yue Zhang Tom Greene Brian Orleans Nathan Seegert Adam Looney Stephen C. Alder Matthew H. Samore High variability in transmission of SARS-CoV-2 within households and implications for control
description	<h4>Background</h4> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a high risk of transmission in close-contact indoor settings, which may include households. Prior studies have found a wide range of household secondary attack rates and may contain biases due to simplifying assumptions about transmission variability and test accuracy. <h4>Methods</h4> We compiled serological SARS-CoV-2 antibody test data and prior SARS-CoV-2 test reporting from members of 9,224 Utah households. We paired these data with a probabilistic model of household importation and transmission. We calculated a maximum likelihood estimate of the importation probability, mean and variability of household transmission probability, and sensitivity and specificity of test data. Given our household transmission estimates, we estimated the threshold of non-household transmission required for epidemic growth in the population. <h4>Results</h4> We estimated that individuals in our study households had a 0.41% (95% CI 0.32%– 0.51%) chance of acquiring SARS-CoV-2 infection outside their household. Our household secondary attack rate estimate was 36% (27%– 48%), substantially higher than the crude estimate of 16% unadjusted for imperfect serological test specificity and other factors. We found evidence for high variability in individual transmissibility, with higher probability of no transmissions or many transmissions compared to standard models. With household transmission at our estimates, the average number of non-household transmissions per case must be kept below 0.41 (0.33–0.52) to avoid continued growth of the pandemic in Utah. <h4>Conclusions</h4> Our findings suggest that crude estimates of household secondary attack rate based on serology data without accounting for false positive tests may underestimate the true average transmissibility, even when test specificity is high. Our finding of potential high variability (overdispersion) in transmissibility of infected individuals is consistent with characterizing SARS-CoV-2 transmission being largely driven by superspreading from a minority of infected individuals. Mitigation efforts targeting large households and other locations where many people congregate indoors might curb continued spread of the virus.
format	article
author	Damon J. A. Toth Alexander B. Beams Lindsay T. Keegan Yue Zhang Tom Greene Brian Orleans Nathan Seegert Adam Looney Stephen C. Alder Matthew H. Samore
author_facet	Damon J. A. Toth Alexander B. Beams Lindsay T. Keegan Yue Zhang Tom Greene Brian Orleans Nathan Seegert Adam Looney Stephen C. Alder Matthew H. Samore
author_sort	Damon J. A. Toth
title	High variability in transmission of SARS-CoV-2 within households and implications for control
title_short	High variability in transmission of SARS-CoV-2 within households and implications for control
title_full	High variability in transmission of SARS-CoV-2 within households and implications for control
title_fullStr	High variability in transmission of SARS-CoV-2 within households and implications for control
title_full_unstemmed	High variability in transmission of SARS-CoV-2 within households and implications for control
title_sort	high variability in transmission of sars-cov-2 within households and implications for control
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/59be16b2e3d54adeac97ace4c1a997d7
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High variability in transmission of SARS-CoV-2 within households and implications for control

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