Use of surveillance data to elucidate household clustering of SARS-CoV-2 in Fulton County, Georgia a major metropolitan area

• Type of Material: Article
• Authors: Carol Y Liu, Rollins School of Public Health; Sasha Smith, Fulton County Board of Health; Allison Chamberlain, Emory University; Neel Gandhi, Emory University; Fazle Khan, Fulton County Board of Health; Steve Williams, Fulton County Government, Atlanta; Sarita Shah, Emory University
• Language: English
• Date: 2022-12-01
• Publisher: Elsevier Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Published by Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annepidem.2022.09.010
• Title of Journal or Parent Work: Annals of Epidemiology
• Volume: 76
• Start Page: 121
• End Page: 127
• Keywords: Cluster Analysis; Humans; Georgia; Covid-19; Household transmission; Surveillance; COVID-19; Family Characteristics; Child; SARS-CoV-2; Aged
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Background: Households are important for SARS-CoV-2 transmission due to high intensity exposure in enclosed spaces over prolonged durations. We quantified and characterized household clustering of COVID-19 cases in Fulton County, Georgia. Methods: We used surveillance data to identify all confirmed COVID-19 cases in Fulton County. Household clustered cases were defined as cases with matching residential address. We described the proportion of COVID-19 cases that were clustered, stratified by age over time and explore trends in age of first diagnosed case within households and subsequent household cases. Results: Between June 1, 2020 and October 31, 2021, 31,449(37%) of 106,233 cases were clustered in households. Children were the most likely to be in household clusters than any other age group. Initially, children were rarely (∼ 10%) the first cases diagnosed in the household but increased to almost 1 of 3 in later periods. Discussion: One-third of COVID-19 cases in Fulton County were part of a household cluster. Increasingly children were the first diagnosed case, coinciding with temporal trends in vaccine roll-out among the elderly and the return to in-person schooling in Fall 2021. Limitations include restrictions to cases with a valid address and unit number and that the first diagnosed case may not be the infection source for the household.