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Factors associated with transmission across three waves of SARS-COV-2 in a prospective community-based study of households with school-aged children -- Dane County, Wisconsin, 2020-2022
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  • Sethi AK,
  • Cristalyne Bell,
  • Derek Norton,
  • Maureen Goss,
  • Shari Barlow,
  • Guanhua Chen,
  • Amra Uzicanin,
  • Jonathan Temte
Sethi AK
University of Wisconsin-Madison Department of Population Health Sciences
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Cristalyne Bell
University of Wisconsin-Madison Department of Family Medicine and Community Health
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Derek Norton
University of Wisconsin-Madison Department of Biostatistics and Medical Informatics
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Maureen Goss
University of Wisconsin-Madison Department of Family Medicine and Community Health
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Shari Barlow
University of Wisconsin-Madison Department of Family Medicine and Community Health
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Guanhua Chen
University of Wisconsin-Madison Department of Biostatistics and Medical Informatics
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Amra Uzicanin
Centers for Disease Control and Prevention
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Jonathan Temte
University of Wisconsin-Madison Department of Family Medicine and Community Health

Corresponding Author:[email protected]

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Abstract

Background: Household transmission of SARS-CoV-2 is a driver of the ongoing COVID-19 pandemic. Understanding factors that contribute to secondary infection rates (SIR) can define changing trends and inform public health policies. Methods: The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) prospectively monitors respiratory viruses within the Oregon School District (OSD) in southcentral Wisconsin. Households with students who had ≥2 respiratory symptoms were eligible and opted to participate in ORCHARDS. Between October 28, 2020, and May 16, 2022, all household members provided self-collected nasal specimens on days 0, 7, and 14 for SARS-CoV-2 detection using real-time reverse-transcription-polymerase chain reaction. We used logistic regression to investigate individual- and household-level characteristics associated with SARS-CoV-2 transmission. Results: Overall, 127 households comprising 572 individuals (48% female; 52% male; 0.4% non-binary; 77% >18 years) had at least one detection of SARS-CoV-2. The overall SIR was 47% and decreased over time (pre-Delta=72% [95%CI: 58%-83%]; Delta=51% [40%-63%]; and Omicron=41% [36%-47%]. Odds of household transmission were 63% lower during the Omicron period compared to the pre-Delta period (OR=0.36 [95%CI: 0.13-0.94] P=0.037). Greater household density (members/bedroom) was significantly associated with household transmission during the Omicron period (OR=6.8, [2.19-21.37] P=0.001). Index case age, illness severity, and individual symptoms were not significantly associated with odds of household transmission. Conclusions: Greater household density was associated with higher risk of SARS-CoV-2 transmission, but the risk declined over time with subsequent variants. Interplay between variants, prior infection, and individual/household factors may identify modifiable factors (e.g., behavior, vaccination) to reduce future transmission risk.