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Transmission of SARS-CoV-2 in standardised first few X cases and household transmission investigations: A systematic review and meta-analysis.

Hannah C LewisAdrian J MarcatoNiamh MeagherMarta ValencianoJuan Pablo Villanueva-CabezasVioleta SpirkoskaJames E FieldingAmalia KarahaliosLorenzo SubissiAnthony NardoneBrianna ChengSoatiana Cathycia RajatonirinaJoseph Chukwudi OkeibunorEman Abdelkreem AlyAmal BarakatPernille JorgensenTasnim AzimPushpa Ranjan WijesingheLinh-Vi LeAngel RodriguezAndrea VicariMaria D Van KerkhoveJodie McVernonRichard G PebodyDavid J PriceIsabel Bergerinull nullLubna Al AriqiMikias A AlemuYasir AlviElizabeth A BukusiPui Shan ChungDavaalkham DambadarjaaAyan K DasTimothée DubDiba DulachaFaiqa EbrahimMaritza A González-DuarteDinuka GurugeJean-Michel HeraudDamaris C Heredia-MeloAmy Herman-RoloffBelinda L HerringFrancis Y InbanathanFarzana IslamKamal Chandima JeewandaraShashi KantWasiq KhanRichard LakoJuliana LeiteGathsaurie Neelika MalavigeUndram MandakhWarisha MariamTsogt MendValerie A MizeSanjin MusaHanna NohynekOlushayo O OluMay B Osorio-MerchánDmitriy PereyaslovRindra Vatosoa RandremananaMamy Jean de Dieu RandriaJames RansomSonal SaxenaPragya SharmaAswathy SreedeviMini SatheeshK J SubhashiniBeth A Tippet-BarrAnuja UshaJoseph F WamalaShambel H WatareKapil Yadav
Published in: Influenza and other respiratory viruses (2022)
We aimed to estimate the household secondary infection attack rate (hSAR) of SARS-CoV-2 in investigations aligned with the WHO Unity Studies Household Transmission Investigations (HHTI) protocol. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for "Unity-aligned" First Few X cases (FFX) and HHTIs published 1 December 2019 to 26 July 2021. Standardised early results were shared by WHO Unity Studies collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta-analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by Unity Studies collaborators) were retained in the systematic review; 62 were included in the primary meta-analysis. hSAR point estimates ranged from 2% to 90% (95% prediction interval: 3%-71%; I 2  = 99.7%); I 2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. FFX and HHTI remain critical epidemiological tools for early and ongoing characterisation of novel infectious pathogens. The large, unexplained variance in hSAR estimates emphasises the need to further support standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs in time and place, to guide evidence-based pandemic preparedness and response efforts for SARS-CoV-2, influenza and future novel respiratory viruses.
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