{"doi":"10.1093/ofid/ofae065","title":"Overestimation of Severe Acute Respiratory Syndrome Coronavirus 2 Household Transmission in Settings of High Community Transmission: Insights From an Informal Settlement Community in Salvador, Brazil","abstract":"Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has spread globally. However, the contribution of community versus household transmission to the overall risk of infection remains unclear. Methods: Between November 2021 and March 2022, we conducted an active case-finding study in an urban informal settlement with biweekly visits across 1174 households with 3364 residents. Individuals displaying coronavirus disease 2019 (COVID-19)-related symptoms were identified, interviewed along with household contacts, and defined as index and secondary cases based on reverse-transcription polymerase chain reaction (RT-PCR) and symptom onset. Results: In 61 households, we detected a total of 94 RT-PCR-positive cases. Of 69 sequenced samples, 67 cases (97.1%) were attributed to the Omicron BA.1* variant. Among 35 of their households, the secondary attack rate was 50.0% (95% confidence interval [CI], 37.0%-63.0%). Women (relative risk [RR], 1.6 [95% CI, .9-2.7]), older individuals (median difference, 15 [95% CI, 2-21] years), and those reporting symptoms (RR, 1.73 [95% CI, 1.0-3.0]) had a significantly increased risk for SARS-CoV-2 secondary infection. Genomic analysis revealed substantial acquisition of viruses from the community even among households with other SARS-CoV-2 infections. After excluding community acquisition, we estimated a household secondary attack rate of 24.2% (95% CI, 11.9%-40.9%). Conclusions: These findings underscore the ongoing risk of community acquisition of SARS-CoV-2 among households with current infections. The observed high attack rate necessitates swift booster vaccination, rapid testing availability, and therapeutic options to mitigate the severe outcomes of COVID-19.","journal":"Open Forum Infectious Diseases","year":2024,"id":493933,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8603,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":478519,"name":"Nívison Nery","orcid":"0000-0002-8164-0602","position":1,"is_corresponding":false},{"id":60892,"name":"Matt D. T. Hitchings","orcid":"0000-0003-2327-3557","position":2,"is_corresponding":false},{"id":992176,"name":"Emilia M.M.A. Belitardo","orcid":null,"position":3,"is_corresponding":false},{"id":915572,"name":"Mariam O. Fofana","orcid":"0000-0002-2874-471X","position":4,"is_corresponding":false},{"id":1038273,"name":"Murilo Dorión","orcid":"0000-0001-5959-6345","position":5,"is_corresponding":false},{"id":916081,"name":"Renato Victoriano","orcid":null,"position":6,"is_corresponding":false},{"id":451241,"name":"Jaqueline S. Cruz","orcid":"0000-0003-4128-1008","position":7,"is_corresponding":false},{"id":960194,"name":"Juliet Oliveira Santana","orcid":"0000-0002-1034-6991","position":8,"is_corresponding":false},{"id":689817,"name":"Laíse de Moraes","orcid":"0000-0001-9095-5860","position":9,"is_corresponding":false},{"id":756077,"name":"Cristiane Wanderley Cardoso","orcid":"0000-0001-5432-1174","position":10,"is_corresponding":false},{"id":321434,"name":"Guilherme S. Ribeiro","orcid":"0000-0002-6798-2059","position":11,"is_corresponding":false},{"id":383929,"name":"Mitermayer Galvão dos Reis","orcid":"0000-0002-3051-9060","position":12,"is_corresponding":false},{"id":478517,"name":"Ricardo Khouri","orcid":"0000-0001-5664-4436","position":13,"is_corresponding":false},{"id":451242,"name":"Federico Costa","orcid":"0000-0001-6951-2336","position":14,"is_corresponding":false},{"id":60897,"name":"Albert I. Ko","orcid":"0000-0001-9023-2339","position":15,"is_corresponding":false},{"id":107139,"name":"Derek A. T. Cummings","orcid":"0000-0002-9437-1907","position":16,"is_corresponding":false},{"id":701079,"name":"Juan P. Aguilar Ticona","orcid":"0000-0002-6971-2677","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-19T02:09:07.920649Z","pmid":"38516384","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}