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. 2021 Oct 5;73(7):1805-1813.
doi: 10.1093/cid/ciaa1166.

Household Transmission of Severe Acute Respiratory Syndrome Coronavirus-2 in the United States

Nathaniel M Lewis  1   2   3 , Victoria T Chu  1   2 , Dongni Ye  1 , Erin E Conners  1   2 , Radhika Gharpure  1   2 , Rebecca L Laws  1 , Hannah E Reses  1 , Brandi D Freeman  1   4 , Mark Fajans  1 , Elizabeth M Rabold  1   2 , Patrick Dawson  1   2 , Sean Buono  1   4 , Sherry Yin  1 , Daniel Owusu  1   2 , Ashutosh Wadhwa  1   4 , Mary Pomeroy  1   2 , Anna Yousaf  1   2 , Eric Pevzner  1 , Henry Njuguna  1 , Katherine A Battey  1 , Cuc H Tran  1 , Victoria L Fields  1   2 , Phillip Salvatore  1   2 , Michelle O'Hegarty  1 , Jeni Vuong  1 , Rebecca Chancey  1 , Christopher Gregory  1 , Michelle Banks  1 , Jared R Rispens  1   2 , Elizabeth Dietrich  1 , Perrine Marcenac  1   2 , Almea M Matanock  1 , Lindsey Duca  1   2 , Allison Binder  1 , Garrett Fox  1 , Sandra Lester  1 , Lisa Mills  1 , Susan I Gerber  1 , John Watson  1 , Amy Schumacher  1 , Lucia Pawloski  1 , Natalie J Thornburg  1 , Aron J Hall  1 , Tair Kiphibane  5 , Sarah Willardson  6 , Kim Christensen  3 , Lindsey Page  7 , Sanjib Bhattacharyya  7 , Trivikram Dasu  7 , Ann Christiansen  8 , Ian W Pray  1   2   9 , Ryan P Westergaard  9 , Angela C Dunn  3 , Jacqueline E Tate  1 , Scott A Nabity  1 , Hannah L Kirking  1
Affiliations

Household Transmission of Severe Acute Respiratory Syndrome Coronavirus-2 in the United States

Nathaniel M Lewis et al. Clin Infect Dis. .

Abstract

Background: The evidence base for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission.

Methods: We recruited patients with laboratory-confirmed SARS-CoV-2 infection and their household contacts in Utah and Wisconsin during 22 March 2020-25 April 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (ORs) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test.

Results: Thirty-two (55%) of 58 households secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI], 23%-36%) overall, 42% among children (aged <18 years) of the COVID-19 patient and 33% among spouses/partners. Household contacts to COVID-19 patients with immunocompromised conditions and household contacts who themselves had diabetes mellitus had increased odds of infection with ORs 15.9 (95% CI, 2.4-106.9) and 7.1 (95% CI: 1.2-42.5), respectively.

Conclusions: We found substantial evidence of secondary infections among household contacts. People with COVID-19, particularly those with immunocompromising conditions or those with household contacts with diabetes, should take care to promptly self-isolate to prevent household transmission.

Keywords: COVID-19; SARS-CoV-2; contact tracing; household; transmission.

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