Household transmission of SARS-CoV-2: a prospective observational study in Bosnia and Herzegovina, August–December 2020

Sanjin Musa*, Esther Kissling, Marta Valenciano, Faris Dizdar, Mia Blažević, Anes Jogunčić, Mirza Palo, Lore Merdrignac, Richard Pebody, Pernille Jorgensen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The secondary attack rate (SAR) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was estimated, and the risk factors for infection among members of households with a coronavirus disease 2019 (COVID-19) index case were identified to inform preventive measures. Methods: Between 3 August and 19 December 2020, a household transmission study was implemented based on a standardized World Health Organization protocol. Laboratory-confirmed cases of SARS-CoV-2 infection were recruited through the federal COVID-19 database. Trained contact tracers interviewed index cases and household members to collect information on demographic, clinical and behavioural factors. Contacts were followed up for 28 days to identify secondary infections. SAR was estimated and odds ratios (OR) were calculated for risk factors for transmission. Results: In total, 383 households and 793 contacts were included in this study. The overall SAR was 17% [95% confidence interval (CI) 14–21]. Contacts had higher risk for infection if the primary case had both cough and runny nose (OR 4.31, 95% CI 1.60–11.63), if the contact was aged 18–49 years (OR 4.67, 95% CI 1.83–11.93), if the contact kissed the primary case (OR 3.16, 95% CI 1.19–8.43), or if the contact shared a meal with the primary case (OR 3.10, 95% CI 1.17–8.27). Conclusions: These results add to the global literature by providing evidence from a middle-income setting. Standard preventive measures in households with positive cases remain critical to reduce transmission.

Original languageEnglish
Pages (from-to)352-361
Number of pages10
JournalInternational Journal of Infectious Diseases
Volume112
DOIs
Publication statusPublished - Nov 2021
Externally publishedYes

Bibliographical note

Funding Information:
This study was supported by WHO Unity Studies, a global sero-epidemiological standardization initiative, with funding to WHO by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and Development ( World Health Organization, 2020e ).

Funding Information:
The authors wish to thank all of the contact tracers for their efforts and dedication in conducting this study. In addition, the authors wish to thank Jasmin Durmi?evi? who was a member of the FBiH team during preparation of the study. Finally, the authors wish to thank Nikolaos Panagiotopoulos and Andre Charlett from Public Health England for their kind assistance on designing the analysis plan, and sharing their experience with implementation of COVID-19 household transmission studies in England. None declared. This study was supported by WHO Unity Studies, a global sero-epidemiological standardization initiative, with funding to WHO by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and Development ( World Health Organization, 2020e). The study was approved by the Ethics Committee of the Institute for Public Health of FBiH.

Publisher Copyright:
© 2021 The Authors

Keywords

  • Bosnia and Herzegovina
  • COVID-19
  • Household transmission
  • SARS-CoV-2

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