Attack rates amongst household members of outpatients with confirmed COVID-19 in Bergen, Norway: A case-ascertained study

Households studies reflect the natural spread of SARS-CoV-2 in immunologically naive populations with limited preventive measures to control transmission. We hypothesise that seropositivity provides more accurate household attack rates than RT-PCR. Here, we investigated the importance of age in household transmission dynamics. We enroled 112 households (291 participants) in a case-ascertained study in Bergen, Norway from 28th February to 4th April 2020, collecting demographic and clinical data from index patients and household members. SARS-CoV-2-specific antibodies were measured in sera collected 6–8 weeks after index patient nasopharyngeal testing to define household attack rates. The overall attack rate was 45% (95% CI 38–53) assessed by serology, and 47% when also including seronegative RT-PCR positives. Serology identified a higher number of infected household members than RT-PCR. Attack rates were equally high in children (48%) and young adults (42%). The attack rate was 16% in asymptomatic household members and 42% in RT-PCR negative contacts. Older adults had higher antibody titres than younger adults. The risk of household transmission was higher when the index patient had fever (aOR 3.31 [95% CI 1.52–7.24]; p = 0.003) or dyspnoea (aOR 2.25 [95% CI 1.80–4.62]; p = 0.027) during acute illness. Serological assays provide more sensitive and robust estimates of household attack rates than RT-PCR. Children are equally susceptible to infection as young adults. Negative RT-PCR or lack of symptoms are not sufficient to rule out infection in household members. Helse Vest (F-11628), Trond Mohn Foundation (TMS2020TMT05). Studier av husstander gjenspeiler den naturlige spredningen av SARS-CoV-2 blant ikke-immune populasjoner med begrensede tiltak for å forebygge smittespredning. Vår hypotese er at antistoff-påvisning gir mer nøyaktige angrepsrater i husstander sammenliknet med RT-PCR. Her undersøker vi betydnignenngen betydningen av alder i smittespredningen. Vi rekrutterte 112 husstander (291 studiedeltakere) i en indeks kasus-bekreftet studie i Bergen, Norge fra 28.02.2020 til 04.04.2020, og samlet inn demografiske og kliniske data fra indekspasienter og deres husstandsmedlemmer. Angrepsrate i husstander ble beregnet ved å måle SARS-CoV-2-spesifikke antistoffer i sera samlet 6–8 uker etter nasofarynksprøve av indekspasienten. Den totale angrepsraten var 45% (95% KI 38–53) vurdert ved serologi, og 47% ved å inkludere antistoff negative, RT-PCR positive husst