Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China : A Prospective Cohort Study

• Published in: Annals of internal medicine Vol. 173; no. 11; pp. 879 - 887
• Main Authors: Luo, Lei, Liu, Dan, Liao, Xinlong, Wu, Xianbo, Jing, Qinlong, Zheng, Jiazhen, Liu, Fanghua, Yang, Shigui, Bi, Hua, Li, Zhihao, Liu, Jianping, Song, Weiqi, Zhu, Wei, Wang, Zhenghe, Zhang, Xiru, Huang, Qingmei, Chen, Peiliang, Liu, Huamin, Cheng, Xin, Cai, Miaochun, Yang, Pei, Yang, Xingfen, Han, Zhigang, Tang, Jinling, Ma, Yu, Mao, Chen
• Format: Journal Article
• Language: English
• Published: United States American College of Physicians 01-12-2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; China - epidemiology; Cohort analysis; Contact Tracing; COVID-19; COVID-19 - epidemiology; COVID-19 - transmission; COVID-19 Testing; Disease transmission; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Original Research; Pandemics; Polymerase chain reaction; Prospective Studies; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; China
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/M20-2671

Risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to close contacts of infected persons has not been well estimated.
To evaluate the risk for transmission of SARS-CoV-2 to close contacts in different settings.
Prospective cohort study.
Close contacts of persons infected with SARS-CoV-2 in Guangzhou, China.
3410 close contacts of 391 index cases were traced between 13 January and 6 March 2020. Data on the setting of the exposure, reverse transcriptase polymerase chain reaction testing, and clinical characteristics of index and secondary cases were collected.
Coronavirus disease 2019 (COVID-19) cases were confirmed by guidelines issued by China. Secondary attack rates in different settings were calculated.
Among 3410 close contacts, 127 (3.7% [95% CI, 3.1% to 4.4%]) were secondarily infected. Of these 127 persons, 8 (6.3% [CI, 2.1% to 10.5%]) were asymptomatic. Of the 119 symptomatic cases, 20 (16.8%) were defined as mild, 87 (73.1%) as moderate, and 12 (10.1%) as severe or critical. Compared with the household setting (10.3%), the secondary attack rate was lower for exposures in health care settings (1.0%; odds ratio [OR], 0.09 [CI, 0.04 to 0.20]) and on public transportation (0.1%; OR, 0.01 [CI, 0.00 to 0.08]). The secondary attack rate increased with the severity of index cases, from 0.3% (CI, 0.0% to 1.0%) for asymptomatic to 3.3% (CI, 1.8% to 4.8%) for mild, 5.6% (CI, 4.4% to 6.8%) for moderate, and 6.2% (CI, 3.2% to 9.1%) for severe or critical cases. Index cases with expectoration were associated with higher risk for secondary infection (13.6% vs. 3.0% for index cases without expectoration; OR, 4.81 [CI, 3.35 to 6.93]).
There was potential recall bias regarding symptom onset among patients with COVID-19, and the symptoms and severity of index cases were not assessed at the time of exposure to contacts.
Household contact was the main setting for transmission of SARS-CoV-2, and the risk for transmission of SARS-CoV-2 among close contacts increased with the severity of index cases.
Guangdong Province Higher Vocational Colleges and Schools Pearl River Scholar Funded Scheme.