Transmission of COVID-19 and its Determinants among Close Contacts of COVID-19 Patients Running title.

ABSTRACT

BACKGROUND: This study aimed to determine the secondary attack rate (SAR) and its determinants to describe the clinical features and epidemiological aspects of patients and determine the risk factors of COVID-19 among household contacts in Hamadan Province, west of Iran. STUDY DESIGN: A cohort study. METHODS: In this cohort study, a total of 323 index cases and 989 related close contacts ages more than 15 years old (family members, relatives, and co-workers) were enrolled using a manual contact tracing approach, and all participants were tested by reverse transcription polymerase chain reaction test. In this research, the frequency of symptoms was assessed, the SAR among contacts of index cases was calculated, and the risk factors of COVID-19 were evaluated by the logistic regression model. RESULTS: The secondary attack rate for total household members of index cases was estimated at 31.7% (95% CI 28.8-34.7). It was found that among household contacts, the highest SARs were related to spouses 47.1% (95% CI 38.7-55.7) and grandparents/parents 39.3% (95% CI 29.4, 49.9) of index cases, who had also higher risks to become secondary cases (adjusted odds ratio [OR]=2.98, 95% CI 1.31-6.75 and adjusted OR=2.76, 95% CI 1.18-6.44, respectively). Considering the occupation of contacts, unemployed and retired people and housewives were most susceptible for transmission of COVID-19. It was revealed that cough was the most prevalent symptom among index and secondary cases. CONCLUSION: Our findings indicated that spouses and grandparents/parents of index cases were the most susceptible individuals for COVID-19 transmission. Prolonged exposure with index case before COVID-19 diagnosis raised the chance of infection among secondary cases.