Household Secondary Attack Rates of SARS-CoV-2 by Variant and Vaccination Status: An Updated Systematic Review and Meta-analysis.
Household Secondary Attack Rates of SARS-CoV-2 by Variant and Vaccination Status: An Updated Systematic Review and Meta-analysis.
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DOI：
10.1001/jamanetworkopen.2022.9317
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发表时间：
2022-04-01
影响因子：
13.8
通讯作者：
Dean, Natalie E.
中科院分区：
文献类型：
--
作者：
Madewell, Zachary J.;Yang, Yang;Longini, Ira M., Jr.;Halloran, M. Elizabeth;Dean, Natalie E.
本系统性综述和荟萃分析评估了SARS-CoV-2变异和疫苗接种状态的家庭继发性发作率。关注的病毒变异和增加疫苗接种与SARS-CoV-2家庭传播率相关吗？在这项对36个国家135项研究（超过130万参与者）的系统性综述和荟萃分析中，家庭继发性发作率随时间推移而增加，Omicron（42.7%），Alpha（36.4%）和Delta（29.7%）变异高于先前报告的估计值（18.9%）。完全接种疫苗降低了易感性和传染性，但对阿尔法比德尔塔和奥密克隆更有效。这些发现表明，SARS-CoV-2疫苗接种通过向其他家庭成员提供间接保护而超越了对个人的保护，但对新出现的变体的保护程度似乎较低。先前报告的SARS-CoV-2的总体家庭二次发病率（SAR）为18.9%（95%CI，16.2%-22.0%），截至2021年6月17日。新出现的令人关切的变异和疫苗接种的增加影响了传播率。评价报告的家庭SAR如何随时间变化，以及SAR是否因病毒变体和指示病例以及接触性疫苗接种状态而变化。2021年6月18日至2022年3月8日的PubMed和medRxiv，以及合格文章的参考列表。预印本包括在内。报告感染人数和家庭接触者总数的原始数据的文章。检索词包括SARS-CoV-2、COVID-19、变异体、疫苗接种、二次发病率、二次感染率、家庭、指示病例、家庭接触者、密切接触者和家庭传播。遵循系统性综述和荟萃分析报告指南的首选报告项目。荟萃分析使用广义线性混合模型获得SAR估计值和95% CI。根据变异体、指示病例和接触性疫苗接种状态以及指示病例识别期，按协变量分层的SAR。SAR用于根据感染易感性的传播概率（VES，p）、给定感染的传染性（VEI，p）和疫苗总有效性（VET，p）来估计疫苗有效性。与截至2020年4月的63项研究（15.5%; 95%CI，13.2%至18.2%）相比，2021年至2022年中点的33项研究（37.3%; 95%CI，32.7%至42.1%）的家庭SAR更高。家庭SAR为42.7% Omicron（95% CI，35.4%-50.4%）（7项研究），36.4% α（11项研究）为29.7%（95% CI，33.4%至39.5%），Delta（16项研究）为29.7%（95% CI，23.0%至37.3%），Beta（3项研究）为22.5%（95% CI，18.6%至26.8%）。全程接种VES，p为78.6%（95% CI，76.0%至80.9%），α，56.4% Delta（95% CI，54.6%至58.1%）和18.1%（95% CI，−18.3%至43.3%），Omicron; VEI，p为75.3%（95% CI，69.9%至79.8%），α，21.9% Delta（95% CI，11.0%-31.5%）和18.2%（95% CI，0.6%-32.6%），Omicron; VET，α组p为94.7%（95% CI，93.3%-95.8%），Delta组p为64.4%（95% CI，58.0%-69.8%），Omicron组p为35.8%（95% CI，13.0%-52.6%）。这些结果表明，新出现的SARS-CoV-2变异的关注增加了传播性。完全接种疫苗与易感性和传染性的降低相关，但α比Delta和Omicron更明显。估计疫苗有效性的变化强调了开发伴随病毒进化的有效疫苗的挑战。
This systematic reviewe and meta-analysis evaluates household secondary attack rates of SARS-CoV-2 by variant and vaccination status. Are viral variants of concern and increased vaccination associated with SARS-CoV-2 household transmission rates? In this systemic review and meta-analysis of 135 studies with more than 1.3 million participants in 36 countries, household secondary attack rates increased over time and were higher for Omicron (42.7%), Alpha (36.4%), and Delta (29.7%) variants than previously reported estimates (18.9%). Full vaccination reduced susceptibility and infectiousness, but more so for Alpha than Delta and Omicron. These findings suggest vaccination for SARS-CoV-2 transcends protection of the individual by conferring indirect protection to other household members, but the degree of protection is seemingly lower for emerging variants. An overall household secondary attack rate (SAR) of 18.9% (95% CI, 16.2%-22.0%) through June 17, 2021 was previously reported for SARS-CoV-2. Emerging variants of concern and increased vaccination have affected transmission rates. To evaluate how reported household SARs changed over time and whether SARs varied by viral variant and index case and contact vaccination status. PubMed and medRxiv from June 18, 2021, through March 8, 2022, and reference lists of eligible articles. Preprints were included. Articles with original data reporting the number of infected and total number of household contacts. Search terms included SARS-CoV-2, COVID-19, variant, vaccination, secondary attack rate, secondary infection rate, household, index case, family contacts, close contacts, and family transmission. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. Meta-analyses used generalized linear mixed models to obtain SAR estimates and 95% CIs. SAR stratified by covariates according to variant, index case and contact vaccination status, and index case identification period. SARs were used to estimate vaccine effectiveness on the basis of the transmission probability for susceptibility to infection (VES,p), infectiousness given infection (VEI,p), and total vaccine effectiveness (VET,p). Household SARs were higher for 33 studies with midpoints in 2021 to 2022 (37.3%; 95% CI, 32.7% to 42.1%) compared with 63 studies with midpoints through April 2020 (15.5%; 95% CI, 13.2% to 18.2%). Household SARs were 42.7% (95% CI, 35.4% to 50.4%) for Omicron (7 studies), 36.4% (95% CI, 33.4% to 39.5%) for Alpha (11 studies), 29.7% (95% CI, 23.0% to 37.3%) for Delta (16 studies), and 22.5% (95% CI, 18.6% to 26.8%) for Beta (3 studies). For full vaccination, VES,p was 78.6% (95% CI, 76.0% to 80.9%) for Alpha, 56.4% (95% CI, 54.6% to 58.1%) for Delta, and 18.1% (95% CI, −18.3% to 43.3%) for Omicron; VEI,p was 75.3% (95% CI, 69.9% to 79.8%) for Alpha, 21.9% (95% CI, 11.0% to 31.5%) for Delta, and 18.2% (95% CI, 0.6% to 32.6%) for Omicron; and VET,p was 94.7% (95% CI, 93.3% to 95.8%) for Alpha, 64.4% (95% CI, 58.0% to 69.8%) for Delta, and 35.8% (95% CI, 13.0% to 52.6%) for Omicron. These results suggest that emerging SARS-CoV-2 variants of concern have increased transmissibility. Full vaccination was associated with reductions in susceptibility and infectiousness, but more so for Alpha than Delta and Omicron. The changes in estimated vaccine effectiveness underscore the challenges of developing effective vaccines concomitant with viral evolution.
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DOI：
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期刊：
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影响因子：
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DOI：
10.2807/1560-7917.es.2021.26.31.2100640
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10.1056/nejmoa2119451
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2022-04-21
期刊：
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