What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors.
What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors.
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DOI：
10.1371/journal.pone.0240205
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Wong J
中科院分区：
文献类型：
--
作者：
Koh WC;Naing L;Chaw L;Rosledzana MA;Alikhan MF;Jamaludin SA;Amin F;Omar A;Shazli A;Griffith M;Pastore R;Wong J
目前的SARS-CoV-2遏制措施依赖于控制病毒传播。通过了解SARS-CoV-2传播动态可以确定有效的优先顺序。我们对家庭和医疗机构中的继发性发作率（SAR）进行了系统回顾和荟萃分析。我们还研究了家庭传播是否因指标病例、成人和儿童的症状状态以及与指标病例的关系而不同。我们检索了2020年1月1日至7月25日期间的PubMed、medRxiv和bioRxiv数据库。纳入了提供原始数据以计算点估计值和95%置信区间（CI）的高质量研究。构建随机效应模型，以汇总家庭和医疗保健环境中的SAR。发表偏倚通过漏斗图和Egger荟萃回归检验进行评估。43项研究符合家庭SAR的入选标准，18项符合医疗保健SAR的入选标准，17项符合其他环境的入选标准。汇总家庭SAR为18.1%（95% CI：15.7%，20.6%），研究间的显著异质性范围为3.9%-54.9%。有症状指数病例的SAR高于无症状病例（RR：3.23; 95%CI：1.46，7.14）。成人感染率高于儿童（RR：1.71; 95%CI：1.35，2.17）。与其他家庭接触者相比，指示病例的配偶更可能被感染（RR：2.39; 95% CI：1.79，3.19）。在医疗机构中，SAR估计为0.7%（95% CI：0.4%，1.0%）。虽然积极的接触者追踪策略在疫情早期可能是适当的，但随着疫情的发展，措施应过渡到考虑特定环境的传播风险。检疫可能需要覆盖整个社区，同时追踪转移情况，以确定传播热点和脆弱人群。在可能的情况下，确诊病例应与家庭隔离。
Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger’s meta-regression test. 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
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DOI：
10.3760/cma.j.issn.1001-0939.2020.0020
发表时间：
2020-02-20
期刊：
Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases
影响因子：
--
作者：
通讯作者：
--
影响因子：
4.5
作者：
Baker, Meghan A.;Rhee, Chanu;Klompas, Michael
通讯作者：
Klompas, Michael
影响因子：
11.8
作者：
Chu, Victoria T.;Freeman-Ponder, Brandi;Biggs, Holly M.
通讯作者：
Biggs, Holly M.
影响因子：
3.7
作者：
Casado, Itziar;Martinez-Baz, Ivan;Castilla, Jesus
通讯作者：
Castilla, Jesus
影响因子：
2
作者：
Chen, Yu-Luan;Wang, Weimin;Sunkaraneni, Soujanya
通讯作者：
Sunkaraneni, Soujanya