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Influenza and other respiratory viruses
Sep, 2023;17 (9): e13185.

Symptom prevalence and secondary attack rate of SARS-CoV-2 in rural Kenyan households: A prospective cohort study.

Katherine E Gallagher, Joyce Nyiro, Charles N Agoti, Eric Maitha, James Nyagwange, Angela Karani, Christian Bottomley, Nickson Murunga, George Githinji, Martin Mutunga, Lynette Isabella Ochola-Oyier, Ivy Kombe, Amek Nyaguara, E Wangeci Kagucia, George Warimwe, Ambrose Agweyu, Benjamin Tsofa, Philip Bejon, J Anthony G Scott, David James Nokes
Author Information
  1. Katherine E Gallagher: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya. ORCID
  2. Joyce Nyiro: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  3. Charles N Agoti: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  4. Eric Maitha: Ministry of Health, Government of Kenya, Nairobi, Kenya.
  5. James Nyagwange: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  6. Angela Karani: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  7. Christian Bottomley: Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
  8. Nickson Murunga: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  9. George Githinji: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  10. Martin Mutunga: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  11. Lynette Isabella Ochola-Oyier: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  12. Ivy Kombe: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  13. Amek Nyaguara: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  14. E Wangeci Kagucia: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya. ORCID
  15. George Warimwe: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  16. Ambrose Agweyu: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  17. Benjamin Tsofa: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  18. Philip Bejon: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  19. J Anthony G Scott: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.
  20. David James Nokes: KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya. ORCID
PMID: 37752066 DOI: 10.1111/irv.13185

Abstract

BACKGROUND: We estimated the secondary attack rate of SARS-CoV-2 among household contacts of PCR-confirmed cases of COVID-19 in rural Kenya and analysed risk factors for transmission.
METHODS: We enrolled incident PCR-confirmed cases and their household members. At baseline, a questionnaire, a blood sample, and naso-oropharyngeal swabs were collected. Household members were followed 4, 7, 10, 14, 21 and 28 days after the date of the first PCR-positive in the household; naso-oropharyngeal swabs were collected at each visit and used to define secondary cases. Blood samples were collected every 1-2 weeks. Symptoms were collected in a daily symptom diary. We used binomial regression to estimate secondary attack rates and survival analysis to analyse risk factors for transmission.
RESULTS: A total of 119 households with at least one positive household member were enrolled between October 2020 and September 2022, comprising 503 household members; 226 remained in follow-up at day 14 (45%). A total of 43 secondary cases arose within 14 days of identification of the primary case, and 81 household members remained negative. The 7-day secondary attack rate was 4% (95% CI 1%-10%), the 14-day secondary attack rate was 28% (95% CI 17%-40%). Of 38 secondary cases with data, eight reported symptoms (21%, 95% CI 8%-34%). Antibody to SARS-CoV-2 spike protein at enrolment was not associated with risk of becoming a secondary case.
CONCLUSION: Households in our setting experienced a lower 7-day attack rate than a recent meta-analysis indicated as the global average (23%-43% depending on variant), and infection is mostly asymptomatic in our setting.

Keywords

SARS-CoV-2 household transmission longitudinal cohort seroprevalence

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Grants

  1. /Wellcome Trust
  2. HHSN272201400008C/NIAID NIH HHS
  3. 220985/Wellcome Trust

MeSH Term

Humans
SARS-CoV-2
COVID-19
Incidence
Kenya
Prospective Studies
Prevalence
Spike Glycoprotein, Coronavirus

Chemicals

spike protein, SARS-CoV-2
Spike Glycoprotein, Coronavirus
Journal Article
Article has an altmetric score of 3

Word Cloud

Created with Highcharts 10.0.0secondaryhouseholdattackratecasesSARS-CoV-2memberscollectedrisktransmission95%CIPCR-confirmedruralfactorsenrollednaso-oropharyngealswabs14usedtotalremainedcase7-daysettingcohortBACKGROUND:estimatedamongcontactsCOVID-19KenyaanalysedMETHODS:incidentbaselinequestionnairebloodsampleHouseholdfollowed47102128 daysdatefirstPCR-positivevisitdefineBloodsamplesevery1-2 weeksSymptomsdailysymptomdiarybinomialregressionestimateratessurvivalanalysisanalyseRESULTS:119householdsleastonepositivememberOctober2020September2022comprising503226follow-upday45%43arosewithin14 daysidentificationprimary81negative4%1%-10%14-day28%17%-40%38dataeightreportedsymptoms21%8%-34%AntibodyspikeproteinenrolmentassociatedbecomingCONCLUSION:Householdsexperiencedlowerrecentmeta-analysisindicatedglobalaverage23%-43%dependingvariantinfectionmostlyasymptomaticSymptomprevalenceKenyanhouseholds:prospectivestudylongitudinalseroprevalence

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