Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China
Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China
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DOI：
10.1136/bmjgh-2020-002794
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发表时间：
2020-05-01
影响因子：
8.1
通讯作者：
MacIntyre, C. Raina
中科院分区：
文献类型：
--
作者：
Wang, Yu;Tian, Huaiyu;MacIntyre, C. Raina
COVID-19在家庭和密切接触者之间的传播占流行病增长的大部分。人们认为在社区佩戴口罩、洗手和保持社交距离是有效的，但几乎没有证据可以告知或支持社区成员在家庭中减少COVID-19风险。方法于2020年2月28日至3月27日在中国北京对124个家庭的335人进行回顾性队列研究，这些家庭至少有1例实验室确诊的COVID-19病例。关注的结果是严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）在家庭内的继发性传播。分析了原发性病例、良好家庭接触者和家庭卫生习惯的特征和做法，作为继发性传播的预测因素。结果家族继发发病率为23.0%（77/335）。原发病例和原发病例出现症状前的家庭接触者使用口罩减少传播的有效性为79% （OR=0.21, 95% CI 0.06至0.79）。家庭日常使用含氯或乙醇消毒剂的有效性为77% （or =0.23, 95% CI 0.07至0.84）。原发病例发病后佩戴口罩没有明显的保护作用。每日频繁与原发病例密切接触的家庭传播风险高出18倍（OR=18.26, 95% CI 3.93至84.79），如果原发病例患有腹泻，家庭传播风险高出4倍（OR=4.10, 95% CI 1.08至15.60）。家庭拥挤程度不显著。结论本研究证实了在出现症状之前传播的风险最高，首次证明了使用口罩、消毒和保持社交距离对预防COVID-19的有效性。我们还发现了粪便传播的证据。这可以为COVID-19严重流行环境下的社区预防指南提供信息。
Introduction Transmission of COVID-19 within families and close contacts accounts for the majority of epidemic growth. Community mask wearing, hand washing and social distancing are thought to be effective but there is little evidence to inform or support community members on COVID-19 risk reduction within families.Methods A retrospective cohort study of 335 people in 124 families and with at least one laboratory confirmed COVID-19 case was conducted from 28 February to 27 March 2020, in Beijing, China. The outcome of interest was secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the family. Characteristics and practices of primary cases, of well family contacts and household hygiene practices were analysed as predictors of secondary transmission.Results The secondary attack rate in families was 23.0% (77/335). Face mask use by the primary case and family contacts before the primary case developed symptoms was 79% effective in reducing transmission (OR=0.21, 95% CI 0.06 to 0.79). Daily use of chlorine or ethanol based disinfectant in households was 77% effective (OR=0.23, 95% CI 0.07 to 0.84). Wearing a mask after illness onset of the primary case was not significantly protective. The risk of household transmission was 18 times higher with frequent daily close contact with the primary case (OR=18.26, 95% CI 3.93 to 84.79), and four times higher if the primary case had diarrhoea (OR=4.10, 95% CI 1.08 to 15.60). Household crowding was not significant.Conclusion The study confirms the highest risk of transmission prior to symptom onset, and provides the first evidence of the effectiveness of mask use, disinfection and social distancing in preventing COVID-19. We also found evidence of faecal transmission. This can inform guidelines for community prevention in settings of intense COVID-19 epidemics.