1887
Research Open Access
Like 0

Abstract

Background

Households appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%.

Aim

We aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK.

Methods

A prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases.

Results

We included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31–43%) with a mean serial interval of 4.67 days, an R of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days.

Conclusions

Rates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2022.27.15.2001551
2022-04-14
2024-12-22
/content/10.2807/1560-7917.ES.2022.27.15.2001551
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/27/15/eurosurv-27-15-6.html?itemId=/content/10.2807/1560-7917.ES.2022.27.15.2001551&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Coronavirus disease (COVID-19) situation report – 125. Geneva: WHO; 2020 . Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200524-covid-19-sitrep-125.pdf?sfvrsn=80e7d7f0_2
  2. World Health Organization (WHO). Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. Geneva: WHO; 2020.Available from: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
  3. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-7.  https://doi.org/10.1056/NEJMc2004973  PMID: 32182409 
  4. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis. 2020;20(8):911-9.  https://doi.org/10.1016/S1473-3099(20)30287-5  PMID: 32353347 
  5. Cheng HY, Jian SW, Liu DP, Ng TC, Huang WT, Lin HH, Taiwan COVID-19 Outbreak Investigation Team. Contact tracing assessment of COVID-19 transmission dynamics in Taiwan and risk at different exposure periods before and after symptom onset. JAMA Intern Med. 2020;180(9):1156-63.  https://doi.org/10.1001/jamainternmed.2020.2020  PMID: 32356867 
  6. Jing Q-L, Liu M-J, Yuan J, Zhang Z-B, Zhang A-R, Dean NE, et al. Household secondary attack rate of COVID-19 and associated determinants. medRxiv. 2020:2020.04.11.20056010 https://doi.org/10.1101/2020.04.11.20056010 
  7. COVID-19 National Emergency Response Center, Epidemiology and Case Management Team, Korea Centers for Disease Control and Prevention. Coronavirus disease-19: summary of 2,370 contact investigations of the first 30 cases in the Republic of Korea. Osong Public Health Res Perspect. 2020;11(2):81-4.  https://doi.org/10.24171/j.phrp.2020.11.2.04  PMID: 32257773 
  8. Li W, Zhang B, Lu J, Liu S, Chang Z, Peng C, et al. Characteristics of household transmission of COVID-19. Clin Infect Dis. 2020;71(8):1943-6.  https://doi.org/10.1093/cid/ciaa450  PMID: 32301964 
  9. Park SY, Kim YM, Yi S, Lee S, Na BJ, Kim CB, et al. Coronavirus disease outbreak in call center, South Korea. Emerg Infect Dis. 2020;26(8):1666-70.  https://doi.org/10.3201/eid2608.201274  PMID: 32324530 
  10. Wang Z, Ma W, Zheng X, Wu G, Zhang R. Household transmission of SARS-CoV-2. J Infect. 2020;81(1):179-82.  https://doi.org/10.1016/j.jinf.2020.03.040  PMID: 32283139 
  11. Wu J, Huang Y, Tu C, Bi C, Chen Z, Luo L, et al. Household transmission of SARS-CoV-2, Zhuhai, China, 2020. Clin Infect Dis. 2020;71(16):2099-108.  https://doi.org/10.1093/cid/ciaa557  PMID: 32392331 
  12. Liu Y, Eggo RM, Kucharski AJ. Secondary attack rate and superspreading events for SARS-CoV-2. Lancet. 2020;395(10227):e47.  https://doi.org/10.1016/S0140-6736(20)30462-1  PMID: 32113505 
  13. Boddington NL, Charlett A, Elgohari S, Walker JL, Mcdonald H, Byers C, et al. COVID-19 in Great Britain: epidemiological and clinical characteristics of the first few hundred (FF100) cases: a descriptive case series and case control analysis. medRxiv. 2020:2020.05.18.20086157 https://doi.org/10.1101/2020.05.18.20086157 
  14. de Lusignan S, Dorward J, Correa A, Jones N, Akinyemi O, Amirthalingam G, et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study. Lancet Infect Dis. 2020;20(9):1034-42.  https://doi.org/10.1016/S1473-3099(20)30371-6  PMID: 32422204 
  15. World Health Organization (WHO). The First Few X cases and contacts (FFX) investigation protocol for coronavirus disease 2019 (COVID-19). Version 2. Geneva: WHO; 2020. Available from: https://apps.who.int/iris/handle/10665/331235
  16. Wallinga J, Lipsitch M. How generation intervals shape the relationship between growth rates and reproductive numbers. Proc Biol Sci. 2007;274(1609):599-604.  https://doi.org/10.1098/rspb.2006.3754  PMID: 17476782 
  17. Fraser C. Estimating individual and household reproduction numbers in an emerging epidemic. PLoS One. 2007;2(8):e758.  https://doi.org/10.1371/journal.pone.0000758  PMID: 17712406 
  18. Du Z, Xu X, Wu Y, Wang L, Cowling BJ, Meyers LA. COVID-19 serial interval estimates based on confirmed cases in public reports from 86 Chinese cities. medRxiv. 2020:2020.04.23.20075796.  https://doi.org/10.1101/2020.04.23.20075796  https://doi.org/10.1101/2020.04.23.20075796 
  19. Nishiura H, Linton NM, Akhmetzhanov AR. Serial interval of novel coronavirus (COVID-19) infections. Int J Infect Dis. 2020;93:284-6.  https://doi.org/10.1016/j.ijid.2020.02.060  PMID: 32145466 
  20. Zhao S, Gao D, Zhuang Z, Chong M, Cai Y, Ran J, et al. Estimating the serial interval of the novel coronavirus disease (COVID-19): A statistical analysis using the public data in Hong Kong from January 16 to February 15, 2020. medRxiv. 2020:2020.02.21.20026559.
  21. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207.  https://doi.org/10.1056/NEJMoa2001316  PMID: 31995857 
  22. Kucharski AJ, Russell TW, Diamond C, Liu Y, Edmunds J, Funk S, et al. Early dynamics of transmission and control of COVID-19: a mathematical modelling study. Lancet Infect Dis. 2020;20(5):553-8.  https://doi.org/10.1016/S1473-3099(20)30144-4  PMID: 32171059 
  23. Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill. 2020;25(4):2000058.  https://doi.org/10.2807/1560-7917.ES.2020.25.4.2000058  PMID: 32019669 
  24. Imai N, Cori A, Dorigatti I, Baguelin M, Donnelly CA, Riley S, et al. Report 3: transmissibility of 2019-nCoV. London: Imperial College; 2020. Available from: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-3-transmissibility-of-covid-19
  25. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020;172(9):577-82.  https://doi.org/10.7326/M20-0504  PMID: 32150748 
  26. Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020;25(5):2000062.  https://doi.org/10.2807/1560-7917.ES.2020.25.5.2000062  PMID: 32046819 
  27. McAloon C, Collins Á, Hunt K, Barber A, Byrne AW, Butler F, et al. Incubation period of COVID-19: a rapid systematic review and meta-analysis of observational research. BMJ Open. 2020;10(8):e039652.  https://doi.org/10.1136/bmjopen-2020-039652  PMID: 32801208 
  28. Viner RM, Mytton OT, Bonell C, Melendez-Torres GJ, Ward JL, Hudson L, et al. Susceptibility to and transmission of COVID-19 amongst children and adolescents compared with adults: a systematic review and meta-analysis. medRxiv. 2020:2020.05.20.20108126.  https://doi.org/10.1101/2020.05.20.20108126 
  29. Zhu Y, Bloxham CJ, Hulme KD, Sinclair JE, Tong ZWM, Steele LE, et al. A meta-analysis on the role of children in severe acute respiratory syndrome coronavirus 2 in household transmission clusters. Clin Infect Dis. 2021;72(12):e1146-53.  https://doi.org/10.1093/cid/ciaa1825  PMID: 33283240 
  30. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-95.  https://doi.org/10.1111/apa.15270  PMID: 32202343 
  31. Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, Kociolek LK. Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19). JAMA Pediatr. 2020;174(9):902-3.  https://doi.org/10.1001/jamapediatrics.2020.3651  PMID: 32745201 
  32. Park YJ, Choe YJ, Park O, Park SY, Kim YM, Kim J, et al. Contact tracing during coronavirus disease outbreak, South Korea, 2020. Emerg Infect Dis. 2020;26(10):2465-8.  https://doi.org/10.3201/eid2610.201315  PMID: 32673193 
  33. Byambasuren O, Cardona M, Bell K, Clark J, McLaws M-L, Glasziou P. Estimating the extent of true asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis. Official Journal of the Association of Medical Microbiology and Infectious Disease Canada.2020;5(4):223-34.  https://doi.org/10.3138/jammi-2020-0030 
  34. Miller E, Waight PA, Andrews NJ, McOwat K, Brown KE, Höschler K, et al. Transmission of SARS-CoV-2 in the household setting: A prospective cohort study in children and adults in England. J Infect. 2021;83(4):483-9.  https://doi.org/10.1016/j.jinf.2021.07.037  PMID: 34348116 
/content/10.2807/1560-7917.ES.2022.27.15.2001551
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error