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Mugglestone MA, Ratnaraja NV, Bak A, Islam J, Wilson JA, Bostock J, Moses SE, Price JR, Weinbren M, Loveday HP, Rivett L, Stoneham SM, Wilson APR. Presymptomatic, asymptomatic and post-symptomatic transmission of SARS-CoV-2: joint British Infection Association (BIA), Healthcare Infection Society (HIS), Infection Prevention Society (IPS) and Royal College of Pathologists (RCPath) guidance. BMC Infect Dis 2022; 22:453. [PMID: 35549902 PMCID: PMC9096060 DOI: 10.1186/s12879-022-07440-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/04/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Natasha V Ratnaraja
- British Infection Association, Preston, UK.,University Hospitals Coventry & Warwickshire NHS Trust, Warwickshire, UK.,Warwick Medical School, Warwick, UK
| | - Aggie Bak
- Healthcare Infection Society, London, UK
| | - Jasmin Islam
- Healthcare Infection Society, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | - Jennie A Wilson
- Infection Prevention Society, Seafield, UK.,Richard Wells Research Centre, University of West London, London, UK
| | | | - Samuel E Moses
- British Infection Association, Preston, UK.,East Kent Hospitals University NHS Foundation Trust, Kent, UK.,Royal College of Pathologists, London, UK
| | - James R Price
- Healthcare Infection Society, London, UK.,Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - Michael Weinbren
- Healthcare Infection Society, London, UK.,Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - Heather P Loveday
- Infection Prevention Society, Seafield, UK.,Richard Wells Research Centre, University of West London, London, UK
| | - Lucy Rivett
- Healthcare Infection Society, London, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon M Stoneham
- Healthcare Infection Society, London, UK.,Imperial College London, London, UK
| | - A Peter R Wilson
- Healthcare Infection Society, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
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Bak A, Mugglestone MA, Ratnaraja NV, Wilson JA, Rivett L, Stoneham SM, Bostock J, Moses SE, Price JR, Weinbren M, Loveday HP, Islam J, Wilson APR. SARS-CoV-2 routes of transmission and recommendations for preventing acquisition: joint British Infection Association (BIA), Healthcare Infection Society (HIS), Infection Prevention Society (IPS) and Royal College of Pathologists (RCPath) guidance. J Hosp Infect 2021; 114:79-103. [PMID: 33940093 PMCID: PMC8087584 DOI: 10.1016/j.jhin.2021.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Affiliation(s)
- A Bak
- Healthcare Infection Society, UK.
| | | | - N V Ratnaraja
- British Infection Association, UK; University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - J A Wilson
- Infection Prevention Society, UK; Richard Wells Research Centre, University of West London, UK
| | - L Rivett
- Healthcare Infection Society, UK; Cambridge University NHS Hospitals Foundation Trust, UK
| | - S M Stoneham
- Healthcare Infection Society, UK; Brighton and Sussex University Hospitals NHS Trust, UK
| | | | - S E Moses
- British Infection Association, UK; Royal College of Pathologists, UK; East Kent Hospitals University NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, UK; Imperial College Healthcare NHS Trust, UK
| | - M Weinbren
- Healthcare Infection Society, UK; Sherwood Forest Hospitals NHS Foundation Trust, UK
| | - H P Loveday
- Infection Prevention Society, UK; Richard Wells Research Centre, University of West London, UK
| | - J Islam
- Healthcare Infection Society, UK; Brighton and Sussex University Hospitals NHS Trust, UK
| | - A P R Wilson
- Healthcare Infection Society, UK; University College London Hospitals NHS Foundation Trust, UK
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Yanes-Lane M, Winters N, Fregonese F, Bastos M, Perlman-Arrow S, Campbell JR, Menzies D. Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis. PLoS One 2020; 15:e0241536. [PMID: 33141862 PMCID: PMC7608887 DOI: 10.1371/journal.pone.0241536] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. METHODS We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). RESULTS Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. CONCLUSIONS Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Winters
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | - Federica Fregonese
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mayara Bastos
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Perlman-Arrow
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathon R. Campbell
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | - Dick Menzies
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
- Division of Respiratory Medicine, Department of Medicine, McGill University, Quebec, Canada
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Liu T, Gong D, Xiao J, Hu J, He G, Rong Z, Ma W. Cluster infections play important roles in the rapid evolution of COVID-19 transmission: A systematic review. Int J Infect Dis 2020; 99:374-380. [PMID: 32768702 PMCID: PMC7405860 DOI: 10.1016/j.ijid.2020.07.073] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To summarise the major types of SARS-CoV-2 cluster infections worldwide through a comprehensive systematic review. METHODS All studies published between 01 January-15 June 2020 on COVID-19 cluster infections in English electronic databases were searched, including PubMed, Embase, Web of Knowledge, and Scopus. All included studies were independently screened and evaluated by two authors, and information from each study was extracted using a standard form. RESULTS Sixty-five studies were included, which involved 108 cluster infections from 13 countries, areas or territories. Seventy-two (66.7%) of the cluster infections were reported in China. The major types of cluster infections were families, community transmission, nosocomial infection, gatherings, transportation, shopping malls, conferences, tourists, religious organisations, workers, prisons, offices, and nursing homes. CONCLUSIONS The SARS-CoV-2 can be transmitted in various circumstances, and cluster infections play an important role in the rapid evolution of COVID-19 transmission. Prevention and control measures such as social distancing must be strictly implemented to contain these cluster infections.
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Affiliation(s)
- Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Dexin Gong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Guanhao He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China.
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