Household Transmission of SARS-CoV-2 from Children and Adolescents

  • Public health surveillance
  • Vaccine preventable diseases
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Background:
A better understanding of SARS-CoV-2 transmission from children and adolescents is crucial for informing public health mitigation strategies.

Methods:
We conducted a retrospective cohort study among household contacts of primary cases (i.e., children and adolescents aged 7-19 years with laboratory evidence of SARS-CoV-2 infection acquired during an overnight camp outbreak). Among household contacts, we defined secondary cases using the Council of State and Territorial Epidemiologists definition. We described secondary attack rates (SAR) and calculated odds ratios (OR) using generalized estimating equations to examine characteristics of primary cases and contacts associated with transmission.

Results:
Among 526 household contacts of 224 primary cases, 48 secondary cases were identified (SAR, 9%; 95% confidence interval [CI], 7%–12%). Age of the primary case was not associated with transmission (aged 7–10 vs. 16–19 years: adjusted OR [aOR], 0.7; 95% CI: 0.2–2.9). Among primary cases, 33% always wore masks around contacts and 65% isolated (remained ≥6 feet apart from contacts, with a separate sleeping space and bathroom) during their infectious period; both behaviors increased with age. Mask use by primary cases was associated with decreased transmission in the univariable (OR, 0.2; 95% CI, 0.1–0.6) and multivariable (aOR, 0.5; 95% CI, 0.2–1.3) models, although not significantly in the latter. Transmission decreased when primary cases isolated (aOR, 0.4; 95% CI, 0.1–0.9).

Conclusions:
Children and adolescents can transmit SARS-CoV-2 in a household setting. Transmission decreased when primary cases isolated. When feasible, children and adolescents with COVID-19 should isolate to mitigate SARS-CoV-2 transmission.

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