Association between population-level factors and household secondary attack rate of SARS-CoV-2: A systematic review and meta-analysis


 
 
 Accurate estimation of household secondary attack rate (SAR) is crucial to understand the transmissibility of SARS-CoV-2. The impact of population-level factors, such as transmission intensity in the community on SAR estimates are however rarely explored.
 
 
 
 In this study, we included articles with original data to compute the household SAR. To determine the impact of transmission intensity in the community on household SAR estimates, we explored the association between SAR estimates and the incidence rate of cases by country during the study period.
 
 
 
 We identified 163 studies to extract data on SARs from 326,031 cases and 2,009,859 household contacts. The correlation between incidence rate of cases during the study period and SAR estimates was 0.37 (95% CI: 0.24-0.49). We found that doubling incidence rate of cases during the study period was associated with a 1.2% (95% CI: 0.5%, 1.8%) higher household SAR.
 
 
 
 Our findings suggest that the incidence rate of cases during the study period is associated with higher SAR. Ignoring this factor may overestimate SARs, especially for regions with high incidences, which further impacts control policies and epidemiological characterization of emerging variants.
