PDF(Pubmed)
Abstract：
BACKGROUND: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth.
OBJECTIVE: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic.
METHODS: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases.
RESULTS: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74).
CONCLUSIONS: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants.
OBJECTIVE: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic.
METHODS: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases.
RESULTS: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74).
CONCLUSIONS: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants.
摘要：
背景：主要由于缺乏可用的监测数据，导致美国家庭内SARS-CoV-2传播的时间变化的相关性研究不足。具体来说,SARS-CoV-2家庭二次发作率（SAR）的早期分析样本量较小，并且是横截面进行的，在单个时间点。从他们那里,在正在进行的COVID-19大流行的不同阶段，很难评估不同风险因素对家庭内疾病传播的作用，特别是在儿童和青年。
目的：评估SARS-CoV-2在美国儿童和年轻成人指数病例（0-25岁）中的传播动态和传染性。
方法：使用行政索赔，我们分析了2020年1月至2021年2月的1900万条SARS-CoV-2测试记录。我们确定了36241户儿科指数病例，并计算了家庭SARs，由完整的病例信息组成。使用回顾性队列设计，我们估计了4个指数年龄组（0-4，5-11，12-17和18-25）之间的家庭SARS-CoV-2传播，同时调整性别，家庭大小,首次SARS-CoV-2阳性记录的季度，和居住区的指数案例。
结果：在过滤了家庭中多于一个成员的所有家庭记录和缺失信息之后，只有0.85%的家庭(n=36241)仍在分析中。0-17岁的指数病例占总指数病例的少数(11%)。SARS-CoV-2的总体SAR为23.04%(95%CI21.88-24.19)。作为比较,所有年龄段(0~65岁以上)的SAR为32.4%,95%CI为32.1~32.8,高于0~25岁人群的SAR.最高的SAR（％）是在2020年4月（38.3，95％CI31.6-45.0），而最低的是在2020年9月（15.6，95％CI13.9-17.3）。SAR（%）持续下降，从32%到21.1%，随着指数组年龄的增加。在多元逻辑回归分析中，我们发现,与年龄最大的儿童组(18~25岁)相比,年龄最小的儿童组(0~4岁)发生SARS-CoV-2传染给任何家庭成员的几率是其1.69倍(95%CI1.42~2.00).家庭大小与家庭病毒传播显着相关（比值比2.66，95％CI2.58-2.74）。
结论：使用回顾性索赔数据，在美国SARS-CoV-2初波期间,SARS-CoV-2的儿科指数传播与位置和家庭特征相关.所有年龄组的儿童SAR（0-25岁）均小于SAR。在回顾性研究中，只有不到1%的家庭数据被保留在完整病例分析中，也许会对我们的发现产生偏见.我们提供了基线家庭儿科传播的措施，以跟踪和比较后来的SARS-CoV-2变体的传染性。
背景：
目的：评估SARS-CoV-2在美国儿童和年轻成人指数病例（0-25岁）中的传播动态和传染性。
方法：使用行政索赔，我们分析了2020年1月至2021年2月的1900万条SARS-CoV-2测试记录。我们确定了36241户儿科指数病例，并计算了家庭SARs，由完整的病例信息组成。使用回顾性队列设计，我们估计了4个指数年龄组（0-4，5-11，12-17和18-25）之间的家庭SARS-CoV-2传播，同时调整性别，家庭大小,首次SARS-CoV-2阳性记录的季度，和居住区的指数案例。
结果：在过滤了家庭中多于一个成员的所有家庭记录和缺失信息之后，只有0.85%的家庭(n=36241)仍在分析中。0-17岁的指数病例占总指数病例的少数(11%)。SARS-CoV-2的总体SAR为23.04%(95%CI21.88-24.19)。作为比较,所有年龄段(0~65岁以上)的SAR为32.4%,95%CI为32.1~32.8,高于0~25岁人群的SAR.最高的SAR（％）是在2020年4月（38.3，95％CI31.6-45.0），而最低的是在2020年9月（15.6，95％CI13.9-17.3）。SAR（%）持续下降，从32%到21.1%，随着指数组年龄的增加。在多元逻辑回归分析中，我们发现,与年龄最大的儿童组(18~25岁)相比,年龄最小的儿童组(0~4岁)发生SARS-CoV-2传染给任何家庭成员的几率是其1.69倍(95%CI1.42~2.00).家庭大小与家庭病毒传播显着相关（比值比2.66，95％CI2.58-2.74）。
结论：使用回顾性索赔数据，在美国SARS-CoV-2初波期间,SARS-CoV-2的儿科指数传播与位置和家庭特征相关.所有年龄组的儿童SAR（0-25岁）均小于SAR。在回顾性研究中，只有不到1%的家庭数据被保留在完整病例分析中，也许会对我们的发现产生偏见.我们提供了基线家庭儿科传播的措施，以跟踪和比较后来的SARS-CoV-2变体的传染性。
背景：
