Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 11, 2022
Date Accepted: Oct 29, 2023
Date Submitted to PubMed: Nov 15, 2023
Pediatric and Young Adult Household Transmission of Initial Waves of SARS-CoV-2 in the United States: An Administrative Claims Study
ABSTRACT
Background:
The correlates responsible for the temporal changes of intra-household SARS-CoV-2 transmission in the U.S. have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-Cov-2 household secondary attack rate (SAR) were small in sample size and conducted cross-sectionally, at single time points. From them, it has been difficult to assess the role that different risk factors have had on intra-household disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth.
Objective:
To estimate the transmission dynamic and infectivity of SARS-Cov-2 among pediatric and young adult index cases (age 0-25 years) in the U.S 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 valid households with pediatric index cases and calculated household SARs. Using a case-control design, we estimated the household SARS-Cov-2 transmission between four index age groups (0-4, 5-11, 12-17, and 18-25) while adjusting for sex, family size, quarter of first SARS-Cov-2 positive record, and residential regions of the index cases.
Results:
Index cases aged 0-17 were a minority of total index cases (11%). The overall SAR of SARS-Cov-2 was 23.04% (95% CI 21.88-24.19). The highest SAR (%) was in April 2020 (38.3, 95% CI 31.6-45.0) while the lowest was observed in September 2020 (15.6, 95% CI 13.9-17.3). SAR (%) 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 (0-4) 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 (18-25). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74).
Conclusions:
Pediatric index transmission of SARS-Cov-2 in the U.S. varies by different factors, including location and family characteristics. Our systematic analyses provided robust quantitative measures of baseline household pediatric transmission for tracking and comparing the infectivity of emerging SARS-Cov-2 variants. Clinical Trial: nil
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.