Household Transmission of SARS-CoV-2: A Systematic Review and Meta-analysis.
Household Transmission of SARS-CoV-2: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jamanetworkopen.2020.31756
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Dean NE
中科院分区：
文献类型：
--
作者：
Madewell ZJ;Yang Y;Longini IM Jr;Halloran ME;Dean NE
严重急性呼吸系统综合症冠状病毒2(SARS-CoV-2)的家庭二次发病率是多少？在这项对77名SARS 758名参与者的54项研究的荟萃分析中，估计的家庭总二次发病率为16.6%，高于观察到的 冠状病毒和中东呼吸综合征冠状病毒的二次发病率。控制不同研究之间的差异，从有症状指标病例到无症状指标病例，对成人接触者比对儿童接触者，对配偶比对其他家庭接触者，在有1次接触者的家庭中的继发性发病率高于对有3次或3次以上接触者的家庭。这些发现表明，即使在社区传播减少的地区，家庭现在是也将继续是重要的传播场所。这项系统的回顾和荟萃分析按几个协变量分析了严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)在家庭中传播的证据，并将其与其他冠状病毒进行比较。拥挤的室内环境是传播SARS-CoV-2的高危环境。检验SARS-CoV-2在家庭中传播的证据，按几个协变量分类，并与其他冠状病毒进行比较。PubMed，搜索到2020年10月19日。检索词为SARS-CoV-2或新冠肺炎继发率、家庭、密切接触者、接触者传播、接触者发病率或家庭传播。纳入所有具有估计家庭二次发病率原始数据的文章。侧重于个别家庭的病例报告和对密切接触者的研究没有报告家庭成员的二次发病率，不包括在内。Meta分析使用受限的最大似然估计器模型来产生每个被分析的子组的点估计和二次发作率的95%可信区间，每个研究都有随机效应。为了进行不同暴露类型的比较，研究被视为随机效应，暴露类型是固定的调节因素。遵循系统回顾和荟萃分析(PRISMA)报告指南的首选报告项目。SARS-CoV-2二次发病率，按协变量(即家庭或家庭接触者、指示病例症状状态、成人或儿童接触者、接触者性别、与指示病例的关系、成人或儿童指示病例、指示病例性别、家庭接触者数量)和其他冠状病毒分类。总共确定了54项相关研究，77名 758名参与者报告了家庭继发性传播。家庭二次发病率估计为16.6%(95%CI，14.0%-19.3%)，高于SARS-CoV(7.5%；95%CI，4.8%-10.7%)和MERS-CoV(4.7%；95%CI，0.9%-10.7%)。有症状体征病例(18.0%；95%CI，14.2%-22.1%)比无症状体征病例(0.7%；95%CI，0%-4.9%)、成人接触者(28.3%；95%CI，20.2%-37.1%)、儿童接触者(16.8%；95%CI，12.3%-21.7%)、配偶(37.8%；与其他家庭接触者(17.8%；95%CI，11.7%~24.8%)和有1个接触者(41.5%；95%CI，31.7%~51.7%)高于有3个或3个以上接触者(22.8%；95%CI，13.6%~33.5%)。这项研究的结果表明，鉴于疑似或确诊感染的患者正被转介到家中进行隔离，家庭将继续是SARS-CoV-2传播的重要场所。
What is the household secondary attack rate for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)? In this meta-analysis of 54 studies with 77 758 participants, the estimated overall household secondary attack rate was 16.6%, higher than observed secondary attack rates for SARS-CoV and Middle East respiratory syndrome coronavirus. Controlling for differences across studies, secondary attack rates were higher in households from symptomatic index cases than asymptomatic index cases, to adult contacts than to child contacts, to spouses than to other family contacts, and in households with 1 contact than households with 3 or more contacts. These findings suggest that households are and will continue to be important venues for transmission, even in areas where community transmission is reduced. This systematic review and meta-analysis examines evidence for household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), disaggregated by several covariates, and compares it with other coronaviruses Crowded indoor environments, such as households, are high-risk settings for the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To examine evidence for household transmission of SARS-CoV-2, disaggregated by several covariates, and to compare it with other coronaviruses. PubMed, searched through October 19, 2020. Search terms included SARS-CoV-2 or COVID-19 with secondary attack rate, household, close contacts, contact transmission, contact attack rate, or family transmission. All articles with original data for estimating household secondary attack rate were included. Case reports focusing on individual households and studies of close contacts that did not report secondary attack rates for household members were excluded. Meta-analyses were done using a restricted maximum-likelihood estimator model to yield a point estimate and 95% CI for secondary attack rate for each subgroup analyzed, with a random effect for each study. To make comparisons across exposure types, study was treated as a random effect, and exposure type was a fixed moderator. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Secondary attack rate for SARS-CoV-2, disaggregated by covariates (ie, household or family contact, index case symptom status, adult or child contacts, contact sex, relationship to index case, adult or child index cases, index case sex, number of contacts in household) and for other coronaviruses. A total of 54 relevant studies with 77 758 participants reporting household secondary transmission were identified. Estimated household secondary attack rate was 16.6% (95% CI, 14.0%-19.3%), higher than secondary attack rates for SARS-CoV (7.5%; 95% CI, 4.8%-10.7%) and MERS-CoV (4.7%; 95% CI, 0.9%-10.7%). Household secondary attack rates were increased from symptomatic index cases (18.0%; 95% CI, 14.2%-22.1%) than from asymptomatic index cases (0.7%; 95% CI, 0%-4.9%), to adult contacts (28.3%; 95% CI, 20.2%-37.1%) than to child contacts (16.8%; 95% CI, 12.3%-21.7%), to spouses (37.8%; 95% CI, 25.8%-50.5%) than to other family contacts (17.8%; 95% CI, 11.7%-24.8%), and in households with 1 contact (41.5%; 95% CI, 31.7%-51.7%) than in households with 3 or more contacts (22.8%; 95% CI, 13.6%-33.5%). The findings of this study suggest that given that individuals with suspected or confirmed infections are being referred to isolate at home, households will continue to be a significant venue for transmission of SARS-CoV-2.