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SARS-CoV-2 transmission in a highly vulnerable population of Brazil: a household cohort study - The Lancet

Mary Wilson

Well-known member
Published: June 18, 2024

DOI: https://doi.org/10.1016/j.lana.2024.100824

Lara E. Coelho, Paula M. Luz, Débora C. Pires, Emilia M. Jalil, Hugo Perazzo, Thiago S. Torres, et al.​

Summary

Background
Household transmission studies seek to understand the transmission dynamics of a pathogen by esti- mating the risk of infection from household contacts and community exposures. We estimated within/extra- household SARS-CoV-2 infection risk and associated factors in a household cohort study in one of the most vulnerable neighbourhoods in Rio de Janeiro city.

Methods
Individuals ≥1 years-old with suspected or confirmed COVID-19 in the past 30 days (index cases) and household members aged ≥1 year were enrolled and followed at 14 and 28 days (study period November/2020–December/2021). RT- PCR testing, COVID-19 symptoms, and SARS-CoV-2 serologies were ascertained in all visits. Chain binomial household transmission models were fitted using data from 2024 individuals (593 households).

Findings
Extra-household infection risk was 74.2% (95% credible interval [CrI] 70.3–77.8), while within-household infection risk was 11.4% (95% CrI 5.7–17.2). Participants reporting having received two doses of a COVID-19 vaccine had lower extra-household (68.9%, 95% CrI 57.3–77.6) and within-household (4.1%, 95% CrI 0.4–16.6) infection risk. Within-household infection risk was higher among participants aged 10–19 years, from overcrowded households, and with low family income. Contrastingly, extra-household infection risk was higher among participants aged 20–29 years, unemployed, and public transportation users.

Interpretation
Our study provides important insights into COVID-19 household/community transmission in a vulnerable population that resided in overcrowded households and who struggled to adhere to lockdown policies and social distancing measures. The high extra-household infection risk highlights the extreme social vulnerability of this population. Prioritising vaccination of the most socially vulnerable could protect these individuals and reduce widespread community transmission.

https://www.thelancet.com/action/showPdf?pii=S2667-193X(24)00151-0
 
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