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Association between age of paediatric index cases and household SARS-CoV-2 transmission
Amanda Markelz1, Zachary Zirnhelt1, Keeley Morris1
1Infectious Disease Epidemiology, Prevention and Control (IDEPC) division at the Minnesota Department of Health, Saint Paul, MN, USA.
Insights
Older children, particularly teens aged 16-17, were more likely to spread SARS-CoV-2 within households during the Delta and Omicron waves. Vaccination and preventative measures are key to reducing household transmission.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Understanding SARS-CoV-2 transmission within households is crucial for effective control measures.
- Paediatric index cases (PICs) play a significant role in household outbreaks, but age-related transmission dynamics require further investigation.
Purpose of the Study:
- To examine the association between the age of a paediatric index case (PIC) and subsequent SARS-CoV-2 transmission within households.
- To compare transmission risks across different variant waves (Alpha, Delta, Omicron) and vaccination statuses.
Main Methods:
- Logistic regression analysis of household SARS-CoV-2 cases reported to the Minnesota Department of Health (March 2021-February 2022).
- Adjustment for covariates including race/ethnicity, sex, geographic region, disease severity, and vaccination status/time since vaccination.
- Stratification of analyses by variant wave.
Main Results:
- During the Alpha wave, PIC age did not significantly influence transmission odds.
- During Delta and Omicron waves, adolescents aged 16-17 had significantly higher odds of household transmission compared to younger children (0-4 years).
- Unvaccinated PICs showed higher transmission odds than vaccinated PICs during both Delta and Omicron waves.
Conclusions:
- Adolescent PICs (16-17 years) pose a higher risk for household SARS-CoV-2 transmission, especially during later variant waves.
- Vaccination status of the PIC is a significant factor in reducing household transmission.
- Targeted preventative strategies for older children and adolescents are recommended to mitigate household spread.
Abstract:
SARS-CoV-2 transmission dynamics within households involving children are complex. We examined the association between paediatric index case (PIC) age and subsequent household SARS-CoV-2 transmission among cases reported to the Minnesota Department of Health between March 2021 and February 2022. In our primary analysis, we used logistic regression to estimate odds ratios adjusted for race/ethnicity, sex, geographic region, and disease severity among households with an unvaccinated PIC. We performed a secondary analysis among households where the PIC was eligible for vaccination adjusting for the same covariates plus time since the last vaccination. Both analyses were stratified by variant wave. During the Alpha wave, PICs of all age groups had similar odds of subsequent transmission. During Delta and Omicron waves, PICs aged 16-17 had higher odds of subsequent transmission than PICs aged 0-4 (Delta OR, 1.32; [95% CI, 1.16-1.51], Omicron OR, 4.21; [95% CI, 3.25-5.45]). In the secondary analysis, unvaccinated PICs had higher odds of subsequent transmission than vaccinated PICs (Delta OR 2.89 [95% CI, 2.18-3.84], Omicron OR 1.35 [95% CI, 1.21-1.50]). Enhanced preventative measures, especially for 12-17-year-olds, may limit SARS-CoV-2 transmission within households involving children.
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