{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T17:19:40Z","timestamp":1772212780312,"version":"3.50.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T00:00:00Z","timestamp":1636502400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"State of Utah","award":["AR3473"],"award-info":[{"award-number":["AR3473"]}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01CK000585"],"award-info":[{"award-number":["U01CK000585"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["I50HX001240"],"award-info":[{"award-number":["I50HX001240"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a high risk of transmission in close-contact indoor settings, which may include households. Prior studies have found a wide range of household secondary attack rates and may contain biases due to simplifying assumptions about transmission variability and test accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We compiled serological SARS-CoV-2 antibody test data and prior SARS-CoV-2 test reporting from members of 9,224 Utah households. We paired these data with a probabilistic model of household importation and transmission. We calculated a maximum likelihood estimate of the importation probability, mean and variability of household transmission probability, and sensitivity and specificity of test data. Given our household transmission estimates, we estimated the threshold of non-household transmission required for epidemic growth in the population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We estimated that individuals in our study households had a 0.41% (95% CI 0.32%\u2013 0.51%) chance of acquiring SARS-CoV-2 infection outside their household. Our household secondary attack rate estimate was 36% (27%\u2013 48%), substantially higher than the crude estimate of 16% unadjusted for imperfect serological test specificity and other factors. We found evidence for high variability in individual transmissibility, with higher probability of no transmissions or many transmissions compared to standard models. With household transmission at our estimates, the average number of non-household transmissions per case must be kept below 0.41 (0.33\u20130.52) to avoid continued growth of the pandemic in Utah.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that crude estimates of household secondary attack rate based on serology data without accounting for false positive tests may underestimate the true average transmissibility, even when test specificity is high. Our finding of potential high variability (overdispersion) in transmissibility of infected individuals is consistent with characterizing SARS-CoV-2 transmission being largely driven by superspreading from a minority of infected individuals. Mitigation efforts targeting large households and other locations where many people congregate indoors might curb continued spread of the virus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0259097","type":"journal-article","created":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T13:48:54Z","timestamp":1636552134000},"page":"e0259097","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["High variability in transmission of SARS-CoV-2 within households and implications for control"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7393-4814","authenticated-orcid":true,"given":"Damon J. A.","family":"Toth","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6656-0217","authenticated-orcid":true,"given":"Alexander B.","family":"Beams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay T.","family":"Keegan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Greene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Orleans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Seegert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Looney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen C.","family":"Alder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew H.","family":"Samore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,11,10]]},"reference":[{"key":"pone.0259097.ref001","doi-asserted-by":"crossref","first-page":"83","DOI":"10.12688\/wellcomeopenres.15889.2","article-title":"What settings have been linked to SARS-CoV-2 transmission clusters?","volume":"5","author":"QJ Leclerc","year":"2020","journal-title":"Wellcome Open Res"},{"key":"pone.0259097.ref002","article-title":"Closed environments facilitate secondary transmission of coranvirus disease 2019 (COVID-19)","author":"H Nishiura","year":"2020","journal-title":"MedRxiv"},{"key":"pone.0259097.ref003","doi-asserted-by":"crossref","DOI":"10.1111\/INA.12766\/v2\/response1","article-title":"Indoor transmission of SARS-CoV-2","author":"H Qian","year":"2020","journal-title":"Indoor Air"},{"issue":"11","key":"pone.0259097.ref004","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/S1473-3099(20)30553-3","article-title":"Association between mobility patterns and COVID-19 transmission in the USA: a mathematical modelling study","volume":"20","author":"HS Badr","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"pone.0259097.ref005","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.bbi.2020.05.009","article-title":"Home quarantine or centralized quarantine, which is more conducive to fighting COVID-19 pandemic?","volume":"87","author":"Y Zhu","year":"2020","journal-title":"Brain Behav Immun"},{"issue":"6","key":"pone.0259097.ref006","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.jinf.2020.08.033","article-title":"Household transmission of COVID-19-a systematic review and meta-analysis","volume":"81","author":"H Lei","year":"2020","journal-title":"J Infect"},{"key":"pone.0259097.ref007","first-page":"ciaa1558","article-title":"The household secondary attack rate of SARS-CoV-2: A rapid review","author":"HF Fung","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"12","key":"pone.0259097.ref008","doi-asserted-by":"crossref","first-page":"e2031756","DOI":"10.1001\/jamanetworkopen.2020.31756","article-title":"Household transmission of SARS-CoV-2: a systematic review and meta-analysis","volume":"3","author":"ZJ Madewell","year":"2020","journal-title":"JAMA Netw Open"},{"key":"pone.0259097.ref009","first-page":"ciaa1072","article-title":"A prospective cohort study in non-hospitalized household contacts with SARS-CoV-2 infection: symptom profiles and symptom change over time","author":"AR Yousaf","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pone.0259097.ref010","first-page":"ciaa799","article-title":"Loss of Taste and Smell as Distinguishing Symptoms of COVID-19","author":"P Dawson","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pone.0259097.ref011","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1093\/cid\/ciaa549","article-title":"COVID-19 Testing, Epidemic Features, Hospital Outcomes, and Household Prevalence, New York State-March 2020","volume":"71","author":"ES Rosenberg","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"44","key":"pone.0259097.ref012","first-page":"1631","article-title":"Transmission of SARS-COV-2 Infections in Households\u2014Tennessee and Wisconsin","volume":"69","author":"CG Grijalva","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"10250","key":"pone.0259097.ref013","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S0140-6736(20)31483-5","article-title":"Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study","volume":"396","author":"M Pollan","year":"2020","journal-title":"Lancet"},{"issue":"8","key":"pone.0259097.ref014","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1038\/s41591-020-0992-3","article-title":"Population-based surveys of antibodies against SARS-CoV-2 in Southern Brazil","volume":"26","author":"MF Silveira","year":"2020","journal-title":"Nat Med"},{"key":"pone.0259097.ref015","article-title":"Household Transmission of SARS-COV-2: Insights from a Population-based Serological Survey.","author":"Q Bi","year":"2020","journal-title":"MedRxiv"},{"key":"pone.0259097.ref016","article-title":"Individual variation in susceptibility or exposure to SARS-CoV-2","author":"MGM Gomes","year":"2020","journal-title":"lowers the herd immunity threshold. medRxiv"},{"issue":"7066","key":"pone.0259097.ref017","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1038\/nature04153","article-title":"Superspreading and the effect of individual variation on disease emergence","volume":"438","author":"JO Lloyd-Smith","year":"2005","journal-title":"Nature"},{"issue":"6","key":"pone.0259097.ref018","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.3201\/eid2606.200495","article-title":"Identifying and Interrupting Superspreading Events-Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2","volume":"26","author":"TR Frieden","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"239","key":"pone.0259097.ref019","article-title":"Implication of backward contact tracing in the presence of overdispersed transmission in COVID-19 outbreaks [version 1; peer review: 2 approved]","volume":"5","author":"Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group","year":"2020","journal-title":"Wellcome Open Res"},{"issue":"10227","key":"pone.0259097.ref020","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1016\/S0140-6736(20)30462-1","article-title":"Secondary attack rate and superspreading events for SARS-CoV-2","volume":"395","author":"Y Liu","year":"2020","journal-title":"Lancet"},{"key":"pone.0259097.ref021","doi-asserted-by":"crossref","first-page":"100430","DOI":"10.1016\/j.epidem.2020.100430","article-title":"Chopping the tail: how preventing superspreading can help to maintain COVID-19 control","volume":"34","author":"MP Kain","year":"2021","journal-title":"Epidemics"},{"key":"pone.0259097.ref022","doi-asserted-by":"crossref","first-page":"67","DOI":"10.12688\/wellcomeopenres.15842.3","article-title":"Estimating the overdispersion in COVID-19 transmission using outbreak sizes outside China","volume":"5","author":"Centre for the Mathematical Modelling of Infectious Diseases C-WG","year":"2020","journal-title":"Wellcome Open Res"},{"issue":"10","key":"pone.0259097.ref023","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17103705","article-title":"Evaluating Transmission Heterogeneity and Super-Spreading Event of COVID-19 in a Metropolis of China","volume":"17","author":"Y Zhang","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pone.0259097.ref024","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1038\/s41591-020-1092-0","article-title":"Clustering and superspreading potential of SARS-CoV-2 infections in Hong Kong","volume":"26","author":"DC Adam","year":"2020","journal-title":"Nat Med"},{"issue":"47","key":"pone.0259097.ref025","doi-asserted-by":"crossref","first-page":"29416","DOI":"10.1073\/pnas.2018490117","article-title":"Evidence that coronavirus superspreading is fat-tailed","volume":"117","author":"F Wong","year":"2020","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"1","key":"pone.0259097.ref026","doi-asserted-by":"crossref","first-page":"5006","DOI":"10.1038\/s41467-020-18836-4","article-title":"Inference of person-to-person transmission of COVID-19 reveals hidden super-spreading events during the early outbreak phase","volume":"11","author":"L Wang","year":"2020","journal-title":"Nat Commun"},{"issue":"1","key":"pone.0259097.ref027","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2307\/2530294","article-title":"Household and community transmission parameters from final distributions of infections in households","volume":"38","author":"I Longini","year":"1982","journal-title":"Biometrics"},{"key":"pone.0259097.ref028","article-title":"SARS-CoV-2 seroprevalence and detection fraction in Utah urban populations from a probability-based sample","author":"M Samore","year":"2020","journal-title":"MedRxiv"},{"issue":"2","key":"pone.0259097.ref029","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2307\/2529976","article-title":"An epidemic chain model","volume":"36","author":"N. Becker","year":"1980","journal-title":"Biometrics"},{"issue":"1","key":"pone.0259097.ref030","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1214\/aoap\/1034625252","article-title":"Epidemics with two levels of mixing","volume":"7","author":"F Ball","year":"1997","journal-title":"The Annals of Applied Probability"},{"issue":"1","key":"pone.0259097.ref031","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1186\/s12916-020-01790-9","article-title":"Reconstructing the early global dynamics of under-ascertained COVID-19 cases and infections","volume":"18","author":"TW Russell","year":"2020","journal-title":"BMC Med"},{"key":"pone.0259097.ref032","unstructured":"SARS-CoV-2 IgG Architect\u2014Instructions for Use. Available at: https:\/\/www.fda.gov\/media\/137383\/download. Accessed 1\/25\/2021."},{"key":"pone.0259097.ref033","article-title":"Heterogeneity in transmissibility and shedding SARS-CoV-2 via droplets and aerosols","volume":"10","author":"PZ Chen","year":"2021","journal-title":"Elife"},{"key":"pone.0259097.ref034","article-title":"Characterizing superspreading of SARS-CoV-2: from mechanism to measurement","author":"Z Susswein","year":"2020","journal-title":"medRxiv"},{"issue":"5","key":"pone.0259097.ref035","article-title":"Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing","volume":"5","author":"Y Wang","year":"2020","journal-title":"China. BMJ Glob Health"},{"issue":"37","key":"pone.0259097.ref036","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.15585\/mmwr.mm6937e3","article-title":"Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities\u2014Salt Lake City, Utah","volume":"69","author":"AS Lopez","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"8","key":"pone.0259097.ref037","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S1473-3099(20)30287-5","article-title":"Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study","volume":"20","author":"Q Bi","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pone.0259097.ref038","doi-asserted-by":"crossref","first-page":"011101","DOI":"10.7189\/jogh.10.011101","article-title":"The role of children in transmission of SARS-CoV-2: A rapid review.","volume":"10","author":"X Li","year":"2020","journal-title":"J Glob Health"},{"key":"pone.0259097.ref039","article-title":"Role of children in household transmission of COVID-19","author":"J Kim","year":"2020","journal-title":"Arch Dis Child"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,10]],"date-time":"2021-11-10T13:49:34Z","timestamp":1636552174000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259097"}},"subtitle":[],"editor":[{"given":"Muhammed","family":"Elhadi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,10]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0259097","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.741145687.793590059","asserted-by":"object"}],"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.01.29.20248797","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,10]]}}}