SARS-CoV-2 seroprevalence and transmission risk factors among high-risk close contacts: a retrospective cohort study.
SARS-CoV-2 seroprevalence and transmission risk factors among high-risk close contacts: a retrospective cohort study.
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SARS-CoV-2血清阳性率和高危密切接触者传播危险因素：回顾性队列研究
DOI：
10.1016/s1473-3099(20)30833-1
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Lee VJ
中科院分区：
文献类型：
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作者：
Ng OT;Marimuthu K;Koh V;Pang J;Linn KZ;Sun J;De Wang L;Chia WN;Tiu C;Chan M;Ling LM;Vasoo S;Abdad MY;Chia PY;Lee TH;Lin RJ;Sadarangani SP;Chen MI;Said Z;Kurupatham L;Pung R;Wang LF;Cook AR;Leo YS;Lee VJ
家庭和非家庭接触者中SARS-CoV-2无症状携带者和传播危险因素的比例尚不清楚。在新加坡，卫生部对每个确诊的COVID-19病例进行了广泛的接触者追踪，并对密切接触者进行了法律强制隔离和强化健康监测，这为确定COVID-19患者社区密切接触者的无症状发作率和SARS-CoV-2传播风险因素提供了难得的机会。这项回顾性队列研究涉及2020年1月23日至4月3日期间在新加坡确诊的COVID-19病例的所有密切接触者。家庭接触者被定义为与COVID-19指数病例共用住所的个人。非家庭密切接触者定义为在指示病例2米范围内接触至少30分钟者。新加坡的所有COVID-19患者都接受了住院治疗，仅限卫生保健人员进入。所有密切接触者均被隔离14天，每日3次电话监测症状。对有症状的接触者进行SARS-CoV-2 PCR检测。继发性临床发作率来源于密切接触者中经pcr确认的SARS-CoV-2的流行率。同意接触者接受血清学检测和详细的暴露风险评估。使用贝叶斯模型估计漏诊和无症状sars - cov -2阳性病例的患病率。采用单变量和多变量logistic回归模型确定SARS-CoV-2传播危险因素。2020年1月23日至4月3日期间，共发现与1114例pcr确诊指示病例相关的密切接触者7770人（家庭接触者1863人，工作接触者2319人，社会接触者3588人）。基于症状的PCR检测发现新冠肺炎病例188例，密切接触者7582人完成隔离，PCR检测未呈阳性。在7770例资料完整的密切接触者中，7518例（96.8%）家庭接触者中1779例继发临床发作率为5.9% (95% CI 4.9 ~ 7.1)，工作接触者中2231例为1.3%(0.9 ~ 1.9)，社会接触者中3508例为1.3%（1.0 ~ 1.7）。对来自1150名密切接触者（524名家庭接触者、207名工作接触者和419名社会接触者）的血清学和症状数据进行贝叶斯分析估计，基于症状的pcr检测策略漏诊了62%（95%可信区间55-69）的COVID-19诊断，36%（27-45）的SARS-CoV-2感染个体无症状。共用一间卧室（多变量优势比[OR] 5.38 [95% CI 1.82 - 15.84]; p= 0.0023）和与指示病例交谈30分钟或更长时间（7.86 [3.86 - 16.02];p< 0.0001）与家庭接触者之间的SARS-CoV-2传播相关。在非家庭接触者中，暴露于一个以上病例（多变量OR 3.92 [95% CI 2.07 - 7.40], p< 0.0001），与指示病例交谈30分钟或更长时间（2.67 [1.21 - 5.88];p= 0.015），以及与指示病例共用车辆（3.07[1.55 - 5.6·08];p= 0.0013）与SARS-CoV-2传播相关。在家庭和非家庭接触者中，间接接触、共餐和共用厕所与SARS-CoV-2传播没有独立的关联。有针对性的社区措施应包括保持身体距离和尽量减少口头互动。有必要对所有家庭接触者，包括无症状者进行检测。新加坡卫生部，新加坡国家研究基金会，中国国家自然科学基金。
The proportion of asymptomatic carriers and transmission risk factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among household and non-household contacts remains unclear. In Singapore, extensive contact tracing by the Ministry of Health for every diagnosed COVID-19 case, and legally enforced quarantine and intensive health surveillance of close contacts provided a rare opportunity to determine asymptomatic attack rates and SARS-CoV-2 transmission risk factors among community close contacts of patients with COVID-19. This retrospective cohort study involved all close contacts of confirmed COVID-19 cases in Singapore, identified between Jan 23 and April 3, 2020. Household contacts were defined as individuals who shared a residence with the index COVID-19 case. Non-household close contacts were defined as those who had contact for at least 30 min within 2 m of the index case. All patients with COVID-19 in Singapore received inpatient treatment, with access restricted to health-care staff. All close contacts were quarantined for 14 days with thrice-daily symptom monitoring via telephone. Symptomatic contacts underwent PCR testing for SARS-CoV-2. Secondary clinical attack rates were derived from the prevalence of PCR-confirmed SARS-CoV-2 among close contacts. Consenting contacts underwent serology testing and detailed exposure risk assessment. Bayesian modelling was used to estimate the prevalence of missed diagnoses and asymptomatic SARS-CoV-2-positive cases. Univariable and multivariable logistic regression models were used to determine SARS-CoV-2 transmission risk factors. Between Jan 23 and April 3, 2020, 7770 close contacts (1863 household contacts, 2319 work contacts, and 3588 social contacts) linked to 1114 PCR-confirmed index cases were identified. Symptom-based PCR testing detected 188 COVID-19 cases, and 7582 close contacts completed quarantine without a positive SARS-CoV-2 PCR test. Among 7518 (96·8%) of the 7770 close contacts with complete data, the secondary clinical attack rate was 5·9% (95% CI 4·9–7·1) for 1779 household contacts, 1·3% (0·9–1·9) for 2231 work contacts, and 1·3% (1·0–1·7) for 3508 social contacts. Bayesian analysis of serology and symptom data obtained from 1150 close contacts (524 household contacts, 207 work contacts, and 419 social contacts) estimated that a symptom-based PCR-testing strategy missed 62% (95% credible interval 55–69) of COVID-19 diagnoses, and 36% (27–45) of individuals with SARS-CoV-2 infection were asymptomatic. Sharing a bedroom (multivariable odds ratio [OR] 5·38 [95% CI 1·82–15·84]; p=0·0023) and being spoken to by an index case for 30 min or longer (7·86 [3·86–16·02]; p<0·0001) were associated with SARS-CoV-2 transmission among household contacts. Among non-household contacts, exposure to more than one case (multivariable OR 3·92 [95% CI 2·07–7·40], p<0·0001), being spoken to by an index case for 30 min or longer (2·67 [1·21–5·88]; p=0·015), and sharing a vehicle with an index case (3·07 [1·55–6·08]; p=0·0013) were associated with SARS-CoV-2 transmission. Among both household and non-household contacts, indirect contact, meal sharing, and lavatory co-usage were not independently associated with SARS-CoV-2 transmission. Targeted community measures should include physical distancing and minimising verbal interactions. Testing of all household contacts, including asymptomatic individuals, is warranted. Ministry of Health of Singapore, National Research Foundation of Singapore, and National Natural Science Foundation of China.