Natural history of shedding and household transmission of severe acute respiratory syndrome coronavirus 2 using intensive high-resolution sampling
The COVID-19 pandemic has led to 775 million documented cases and over 7 million deaths worldwide as of March 2024 and is an ongoing health crisis. To limit viral spread within households and in the community, public health officials have recommended self-isolation, self-quarantine of exposed househ...
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| Veröffentlicht in: | PloS one 2024-07, Vol.19 (7), p.e0305300 |
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| creator | Altamirano, Jonathan Govindarajan, Prasanthi Blomkalns, Andra L Leary, Sean Robinson, India Chun, Leanne X Shaikh, Nuzhat J Robinson, Makeda L Lopez, Marcela Tam, Grace K-Y Carrington, Yuan J De Araujo, Monique B Walter, Katharine S Andrews, Jason R Burns, Julianne Hogan, Catherine Pinsky, Benjamin A Maldonado, Yvonne |
| description | The COVID-19 pandemic has led to 775 million documented cases and over 7 million deaths worldwide as of March 2024 and is an ongoing health crisis. To limit viral spread within households and in the community, public health officials have recommended self-isolation, self-quarantine of exposed household contacts, and mask use. Yet, risk of household transmission (HHT) may be underestimated due to low frequency of sampling, and risk factors for HHT are not well understood.
To estimate the secondary attack rate of SARS-CoV-2 within households and to define the risk factors for new infections in household members who are in close contact with the index case.
In this prospective cohort study, from March 2020-December 2021 we enrolled 60 households with index cases who tested positive for SARS-CoV-2. All household contacts and index cases were tested daily for SARS-CoV-2 via reverse transcription polymerase chain reaction (RT-PCR) using self-collected anterior nares specimens. Households were followed until all study participants in the household tested negative for SARS-CoV-2 for seven consecutive days. We collected sex, age, race/ethnicity, comorbidities, and relationship to index case for secondary contacts, household level characteristics including primary income, household density, and square feet per person on property. We compared the sociodemographic variables between COVID-19 positive and negative household members and between households where secondary transmission did and did not occur.
Daily anterior nares swabs were tested for SARS-CoV-2 using RT-PCR, in order to assess duration of nasal shedding of SARS-CoV-2, as well as risk of transmission to secondary household contacts.
Of the 163 participants in this study, 84 (51.5%) were women; median age (IQR) was 36.0 (17.0-54.0) years of age; 78 (47.8%) were white and 48 (29.5%) were Hispanic/LatinX. Of the fifty households with household contacts, at least one secondary case occurred in twenty-six households (52.0%) and forty-five household contacts (43.7%) were infected. Secondary attack rate was lowest among children of index cases (6/23, 26.1%). Modified Poisson regression identified that the risk of transmission to household contacts increases significantly with age (Risk ratio for each increase in years of age = 1.01, 95% CI = 1.00-1.02). Mixed effects regression models identified that participants with chronic diseases, such as asthma, diabetes, cancer, or cardiac disease, had higher Cts at baselin |
| doi_str_mv | 10.1371/journal.pone.0305300 |
| format | Article |
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To estimate the secondary attack rate of SARS-CoV-2 within households and to define the risk factors for new infections in household members who are in close contact with the index case.
In this prospective cohort study, from March 2020-December 2021 we enrolled 60 households with index cases who tested positive for SARS-CoV-2. All household contacts and index cases were tested daily for SARS-CoV-2 via reverse transcription polymerase chain reaction (RT-PCR) using self-collected anterior nares specimens. Households were followed until all study participants in the household tested negative for SARS-CoV-2 for seven consecutive days. We collected sex, age, race/ethnicity, comorbidities, and relationship to index case for secondary contacts, household level characteristics including primary income, household density, and square feet per person on property. We compared the sociodemographic variables between COVID-19 positive and negative household members and between households where secondary transmission did and did not occur.
Daily anterior nares swabs were tested for SARS-CoV-2 using RT-PCR, in order to assess duration of nasal shedding of SARS-CoV-2, as well as risk of transmission to secondary household contacts.
Of the 163 participants in this study, 84 (51.5%) were women; median age (IQR) was 36.0 (17.0-54.0) years of age; 78 (47.8%) were white and 48 (29.5%) were Hispanic/LatinX. Of the fifty households with household contacts, at least one secondary case occurred in twenty-six households (52.0%) and forty-five household contacts (43.7%) were infected. Secondary attack rate was lowest among children of index cases (6/23, 26.1%). Modified Poisson regression identified that the risk of transmission to household contacts increases significantly with age (Risk ratio for each increase in years of age = 1.01, 95% CI = 1.00-1.02). Mixed effects regression models identified that participants with chronic diseases, such as asthma, diabetes, cancer, or cardiac disease, had higher Cts at baseline when compared to participants without chronic diseases (6.62, 95% CI: 1.46-11.77, p = 0.02) and show a slower rate of increase in Ct over time (-0.43, 95% CI: -0.77 to -0.09, p = 0.02).
This study suggests that HHT represents a key source of community-based infection of SARS-CoV-2. Allocation of resources for contact investigations and prevention interventions should focus on the individuals at highest risk of infection in households, especially those with higher density homes.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0305300</identifier><identifier>PMID: 39052659</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Age ; Aged ; Analysis ; Asthma ; Asymptomatic ; Biology and life sciences ; Child ; Child, Preschool ; Chronic diseases ; Chronic illnesses ; Comorbidity ; Consent ; Coronary artery disease ; Coronaviruses ; COVID-19 ; COVID-19 - epidemiology ; COVID-19 - transmission ; COVID-19 - virology ; Density ; Design factors ; Diabetes mellitus ; Disease transmission ; Epidemics ; Family Characteristics ; Female ; Health aspects ; Health risks ; Heart diseases ; Households ; Humans ; Male ; Medicine and health sciences ; Middle Aged ; Pandemics ; Polymerase chain reaction ; Prospective Studies ; Public health ; Quarantine ; Regression analysis ; Regression models ; Research and Analysis Methods ; Resource allocation ; Respiratory diseases ; Reverse transcription ; Risk allocation ; Risk Factors ; Sampling ; SARS-CoV-2 - isolation & purification ; Self report ; Severe acute respiratory syndrome ; Severe acute respiratory syndrome coronavirus 2 ; Shedding ; Sociodemographics ; Viral diseases ; Virus Shedding ; Young Adult</subject><ispartof>PloS one, 2024-07, Vol.19 (7), p.e0305300</ispartof><rights>Copyright: © 2024 Altamirano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2024 Public Library of Science</rights><rights>2024 Altamirano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Altamirano et al 2024 Altamirano et al</rights><rights>2024 Altamirano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c572t-83730e4f7f19f6dc8d299142143b91deb0d444930b9a803e771c1ce42d5484c43</cites><orcidid>0000-0003-0065-2204 ; 0009-0009-1453-5181 ; 0000-0002-4304-4017 ; 0000-0002-0968-3333 ; 0000-0001-5308-1439 ; 0000-0001-8751-4810</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271927/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11271927/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39052659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Wu, Peng</contributor><creatorcontrib>Altamirano, Jonathan</creatorcontrib><creatorcontrib>Govindarajan, Prasanthi</creatorcontrib><creatorcontrib>Blomkalns, Andra L</creatorcontrib><creatorcontrib>Leary, Sean</creatorcontrib><creatorcontrib>Robinson, India</creatorcontrib><creatorcontrib>Chun, Leanne X</creatorcontrib><creatorcontrib>Shaikh, Nuzhat J</creatorcontrib><creatorcontrib>Robinson, Makeda L</creatorcontrib><creatorcontrib>Lopez, Marcela</creatorcontrib><creatorcontrib>Tam, Grace K-Y</creatorcontrib><creatorcontrib>Carrington, Yuan J</creatorcontrib><creatorcontrib>De Araujo, Monique B</creatorcontrib><creatorcontrib>Walter, Katharine S</creatorcontrib><creatorcontrib>Andrews, Jason R</creatorcontrib><creatorcontrib>Burns, Julianne</creatorcontrib><creatorcontrib>Hogan, Catherine</creatorcontrib><creatorcontrib>Pinsky, Benjamin A</creatorcontrib><creatorcontrib>Maldonado, Yvonne</creatorcontrib><title>Natural history of shedding and household transmission of severe acute respiratory syndrome coronavirus 2 using intensive high-resolution sampling</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The COVID-19 pandemic has led to 775 million documented cases and over 7 million deaths worldwide as of March 2024 and is an ongoing health crisis. To limit viral spread within households and in the community, public health officials have recommended self-isolation, self-quarantine of exposed household contacts, and mask use. Yet, risk of household transmission (HHT) may be underestimated due to low frequency of sampling, and risk factors for HHT are not well understood.
To estimate the secondary attack rate of SARS-CoV-2 within households and to define the risk factors for new infections in household members who are in close contact with the index case.
In this prospective cohort study, from March 2020-December 2021 we enrolled 60 households with index cases who tested positive for SARS-CoV-2. All household contacts and index cases were tested daily for SARS-CoV-2 via reverse transcription polymerase chain reaction (RT-PCR) using self-collected anterior nares specimens. Households were followed until all study participants in the household tested negative for SARS-CoV-2 for seven consecutive days. We collected sex, age, race/ethnicity, comorbidities, and relationship to index case for secondary contacts, household level characteristics including primary income, household density, and square feet per person on property. We compared the sociodemographic variables between COVID-19 positive and negative household members and between households where secondary transmission did and did not occur.
Daily anterior nares swabs were tested for SARS-CoV-2 using RT-PCR, in order to assess duration of nasal shedding of SARS-CoV-2, as well as risk of transmission to secondary household contacts.
Of the 163 participants in this study, 84 (51.5%) were women; median age (IQR) was 36.0 (17.0-54.0) years of age; 78 (47.8%) were white and 48 (29.5%) were Hispanic/LatinX. Of the fifty households with household contacts, at least one secondary case occurred in twenty-six households (52.0%) and forty-five household contacts (43.7%) were infected. Secondary attack rate was lowest among children of index cases (6/23, 26.1%). Modified Poisson regression identified that the risk of transmission to household contacts increases significantly with age (Risk ratio for each increase in years of age = 1.01, 95% CI = 1.00-1.02). Mixed effects regression models identified that participants with chronic diseases, such as asthma, diabetes, cancer, or cardiac disease, had higher Cts at baseline when compared to participants without chronic diseases (6.62, 95% CI: 1.46-11.77, p = 0.02) and show a slower rate of increase in Ct over time (-0.43, 95% CI: -0.77 to -0.09, p = 0.02).
This study suggests that HHT represents a key source of community-based infection of SARS-CoV-2. Allocation of resources for contact investigations and prevention interventions should focus on the individuals at highest risk of infection in households, especially those with higher density homes.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Analysis</subject><subject>Asthma</subject><subject>Asymptomatic</subject><subject>Biology and life sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Chronic diseases</subject><subject>Chronic illnesses</subject><subject>Comorbidity</subject><subject>Consent</subject><subject>Coronary artery disease</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - transmission</subject><subject>COVID-19 - virology</subject><subject>Density</subject><subject>Design factors</subject><subject>Diabetes mellitus</subject><subject>Disease transmission</subject><subject>Epidemics</subject><subject>Family Characteristics</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Heart diseases</subject><subject>Households</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine and health sciences</subject><subject>Middle Aged</subject><subject>Pandemics</subject><subject>Polymerase chain reaction</subject><subject>Prospective Studies</subject><subject>Public health</subject><subject>Quarantine</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Research and Analysis Methods</subject><subject>Resource allocation</subject><subject>Respiratory diseases</subject><subject>Reverse transcription</subject><subject>Risk allocation</subject><subject>Risk Factors</subject><subject>Sampling</subject><subject>SARS-CoV-2 - isolation & purification</subject><subject>Self report</subject><subject>Severe acute respiratory syndrome</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Shedding</subject><subject>Sociodemographics</subject><subject>Viral diseases</subject><subject>Virus Shedding</subject><subject>Young 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history of shedding and household transmission of severe acute respiratory syndrome coronavirus 2 using intensive high-resolution sampling</title><author>Altamirano, Jonathan ; Govindarajan, Prasanthi ; Blomkalns, Andra L ; Leary, Sean ; Robinson, India ; Chun, Leanne X ; Shaikh, Nuzhat J ; Robinson, Makeda L ; Lopez, Marcela ; Tam, Grace K-Y ; Carrington, Yuan J ; De Araujo, Monique B ; Walter, Katharine S ; Andrews, Jason R ; Burns, Julianne ; Hogan, Catherine ; Pinsky, Benjamin A ; Maldonado, Yvonne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c572t-83730e4f7f19f6dc8d299142143b91deb0d444930b9a803e771c1ce42d5484c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Analysis</topic><topic>Asthma</topic><topic>Asymptomatic</topic><topic>Biology and life 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models</topic><topic>Research and Analysis Methods</topic><topic>Resource allocation</topic><topic>Respiratory diseases</topic><topic>Reverse transcription</topic><topic>Risk allocation</topic><topic>Risk Factors</topic><topic>Sampling</topic><topic>SARS-CoV-2 - isolation & purification</topic><topic>Self report</topic><topic>Severe acute respiratory syndrome</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Shedding</topic><topic>Sociodemographics</topic><topic>Viral diseases</topic><topic>Virus Shedding</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Altamirano, Jonathan</creatorcontrib><creatorcontrib>Govindarajan, Prasanthi</creatorcontrib><creatorcontrib>Blomkalns, Andra L</creatorcontrib><creatorcontrib>Leary, Sean</creatorcontrib><creatorcontrib>Robinson, India</creatorcontrib><creatorcontrib>Chun, Leanne X</creatorcontrib><creatorcontrib>Shaikh, Nuzhat 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Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Altamirano, Jonathan</au><au>Govindarajan, Prasanthi</au><au>Blomkalns, Andra L</au><au>Leary, Sean</au><au>Robinson, India</au><au>Chun, Leanne X</au><au>Shaikh, Nuzhat J</au><au>Robinson, Makeda L</au><au>Lopez, Marcela</au><au>Tam, Grace K-Y</au><au>Carrington, Yuan J</au><au>De Araujo, Monique B</au><au>Walter, Katharine S</au><au>Andrews, Jason R</au><au>Burns, Julianne</au><au>Hogan, Catherine</au><au>Pinsky, Benjamin A</au><au>Maldonado, Yvonne</au><au>Wu, Peng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Natural history of shedding and household transmission of severe acute respiratory syndrome coronavirus 2 using intensive high-resolution sampling</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2024-07-25</date><risdate>2024</risdate><volume>19</volume><issue>7</issue><spage>e0305300</spage><pages>e0305300-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The COVID-19 pandemic has led to 775 million documented cases and over 7 million deaths worldwide as of March 2024 and is an ongoing health crisis. To limit viral spread within households and in the community, public health officials have recommended self-isolation, self-quarantine of exposed household contacts, and mask use. Yet, risk of household transmission (HHT) may be underestimated due to low frequency of sampling, and risk factors for HHT are not well understood.
To estimate the secondary attack rate of SARS-CoV-2 within households and to define the risk factors for new infections in household members who are in close contact with the index case.
In this prospective cohort study, from March 2020-December 2021 we enrolled 60 households with index cases who tested positive for SARS-CoV-2. All household contacts and index cases were tested daily for SARS-CoV-2 via reverse transcription polymerase chain reaction (RT-PCR) using self-collected anterior nares specimens. Households were followed until all study participants in the household tested negative for SARS-CoV-2 for seven consecutive days. We collected sex, age, race/ethnicity, comorbidities, and relationship to index case for secondary contacts, household level characteristics including primary income, household density, and square feet per person on property. We compared the sociodemographic variables between COVID-19 positive and negative household members and between households where secondary transmission did and did not occur.
Daily anterior nares swabs were tested for SARS-CoV-2 using RT-PCR, in order to assess duration of nasal shedding of SARS-CoV-2, as well as risk of transmission to secondary household contacts.
Of the 163 participants in this study, 84 (51.5%) were women; median age (IQR) was 36.0 (17.0-54.0) years of age; 78 (47.8%) were white and 48 (29.5%) were Hispanic/LatinX. Of the fifty households with household contacts, at least one secondary case occurred in twenty-six households (52.0%) and forty-five household contacts (43.7%) were infected. Secondary attack rate was lowest among children of index cases (6/23, 26.1%). Modified Poisson regression identified that the risk of transmission to household contacts increases significantly with age (Risk ratio for each increase in years of age = 1.01, 95% CI = 1.00-1.02). Mixed effects regression models identified that participants with chronic diseases, such as asthma, diabetes, cancer, or cardiac disease, had higher Cts at baseline when compared to participants without chronic diseases (6.62, 95% CI: 1.46-11.77, p = 0.02) and show a slower rate of increase in Ct over time (-0.43, 95% CI: -0.77 to -0.09, p = 0.02).
This study suggests that HHT represents a key source of community-based infection of SARS-CoV-2. Allocation of resources for contact investigations and prevention interventions should focus on the individuals at highest risk of infection in households, especially those with higher density homes.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>39052659</pmid><doi>10.1371/journal.pone.0305300</doi><orcidid>https://orcid.org/0000-0003-0065-2204</orcidid><orcidid>https://orcid.org/0009-0009-1453-5181</orcidid><orcidid>https://orcid.org/0000-0002-4304-4017</orcidid><orcidid>https://orcid.org/0000-0002-0968-3333</orcidid><orcidid>https://orcid.org/0000-0001-5308-1439</orcidid><orcidid>https://orcid.org/0000-0001-8751-4810</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2024-07, Vol.19 (7), p.e0305300 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_3084712154 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adult Age Aged Analysis Asthma Asymptomatic Biology and life sciences Child Child, Preschool Chronic diseases Chronic illnesses Comorbidity Consent Coronary artery disease Coronaviruses COVID-19 COVID-19 - epidemiology COVID-19 - transmission COVID-19 - virology Density Design factors Diabetes mellitus Disease transmission Epidemics Family Characteristics Female Health aspects Health risks Heart diseases Households Humans Male Medicine and health sciences Middle Aged Pandemics Polymerase chain reaction Prospective Studies Public health Quarantine Regression analysis Regression models Research and Analysis Methods Resource allocation Respiratory diseases Reverse transcription Risk allocation Risk Factors Sampling SARS-CoV-2 - isolation & purification Self report Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Shedding Sociodemographics Viral diseases Virus Shedding Young Adult |
| title | Natural history of shedding and household transmission of severe acute respiratory syndrome coronavirus 2 using intensive high-resolution sampling |
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