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Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China : A Prospective Cohort Study.
Luo, Lei; Liu, Dan; Liao, Xinlong; Wu, Xianbo; Jing, Qinlong; Zheng, Jiazhen; Liu, Fanghua; Yang, Shigui; Bi, Hua; Li, Zhihao; Liu, Jianping; Song, Weiqi; Zhu, Wei; Wang, Zhenghe; Zhang, Xiru; Huang, Qingmei; Chen, Peiliang; Liu, Huamin; Cheng, Xin; Cai, Miaochun; Yang, Pei; Yang, Xingfen; Han, Zhigang; Tang, Jinling; Ma, Yu; Mao, Chen.
  • Luo L; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Liu D; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Liao X; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Wu X; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Jing Q; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Zheng J; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Liu F; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Yang S; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou, China (S.Y.).
  • Bi H; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Li Z; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Liu J; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Song W; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Zhu W; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Wang Z; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Zhang X; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Huang Q; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Chen P; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Liu H; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Cheng X; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Cai M; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Yang P; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Yang X; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
  • Han Z; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Tang J; Clinical Data Center and Guangdong Provincial Children's Medical Research Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China (J.T.).
  • Ma Y; Guangzhou Center for Disease Control and Prevention, Guangzhou, China (L.L., X.L., Q.J., F.L., H.B., J.L., W.Z., Z.H., Y.M.).
  • Mao C; School of Public Health, Southern Medical University, Guangzhou, China (D.L., X.W., J.Z., Z.L., W.S., Z.W., X.Z., Q.H., P.C., H.L., X.C., M.C., P.Y., X.Y., C.M.).
Ann Intern Med ; 173(11): 879-887, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-713765
ABSTRACT

BACKGROUND:

Risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to close contacts of infected persons has not been well estimated.

OBJECTIVE:

To evaluate the risk for transmission of SARS-CoV-2 to close contacts in different settings.

DESIGN:

Prospective cohort study.

SETTING:

Close contacts of persons infected with SARS-CoV-2 in Guangzhou, China.

PARTICIPANTS:

3410 close contacts of 391 index cases were traced between 13 January and 6 March 2020. Data on the setting of the exposure, reverse transcriptase polymerase chain reaction testing, and clinical characteristics of index and secondary cases were collected. MEASUREMENT Coronavirus disease 2019 (COVID-19) cases were confirmed by guidelines issued by China. Secondary attack rates in different settings were calculated.

RESULTS:

Among 3410 close contacts, 127 (3.7% [95% CI, 3.1% to 4.4%]) were secondarily infected. Of these 127 persons, 8 (6.3% [CI, 2.1% to 10.5%]) were asymptomatic. Of the 119 symptomatic cases, 20 (16.8%) were defined as mild, 87 (73.1%) as moderate, and 12 (10.1%) as severe or critical. Compared with the household setting (10.3%), the secondary attack rate was lower for exposures in health care settings (1.0%; odds ratio [OR], 0.09 [CI, 0.04 to 0.20]) and on public transportation (0.1%; OR, 0.01 [CI, 0.00 to 0.08]). The secondary attack rate increased with the severity of index cases, from 0.3% (CI, 0.0% to 1.0%) for asymptomatic to 3.3% (CI, 1.8% to 4.8%) for mild, 5.6% (CI, 4.4% to 6.8%) for moderate, and 6.2% (CI, 3.2% to 9.1%) for severe or critical cases. Index cases with expectoration were associated with higher risk for secondary infection (13.6% vs. 3.0% for index cases without expectoration; OR, 4.81 [CI, 3.35 to 6.93]).

LIMITATION:

There was potential recall bias regarding symptom onset among patients with COVID-19, and the symptoms and severity of index cases were not assessed at the time of exposure to contacts.

CONCLUSION:

Household contact was the main setting for transmission of SARS-CoV-2, and the risk for transmission of SARS-CoV-2 among close contacts increased with the severity of index cases. PRIMARY FUNDING SOURCE Guangdong Province Higher Vocational Colleges and Schools Pearl River Scholar Funded Scheme.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Contact Tracing / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Child / Child, preschool / Female / Humans / Infant / Male / Middle aged Country/Region as subject: Asia Language: English Journal: Ann Intern Med Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Contact Tracing / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Child / Child, preschool / Female / Humans / Infant / Male / Middle aged Country/Region as subject: Asia Language: English Journal: Ann Intern Med Year: 2020 Document Type: Article