Case-ascertained study of household transmission of seasonal influenza — South Africa, 2013
Identifieur interne : 000D39 ( Pmc/Corpus ); précédent : 000D38; suivant : 000D40Case-ascertained study of household transmission of seasonal influenza — South Africa, 2013
Auteurs : Preetha Iyengar ; Claire Von Mollendorf ; Stefano Tempia ; Alexandra Moerdyk ; Ziyaad Valley-Omar ; Orienka Hellferscee ; Neil Martinson ; Meera Chhagan ; Meredith Mcmorrow ; Manoj Gambhir ; Simon Cauchemez ; Ebrahim Variava ; Katlego Masonoke ; Adam L. Cohen ; Cheryl CohenSource :
- The Journal of infection [ 0163-4453 ] ; 2015.
Abstract
The household is important in influenza transmission due to intensity of contact. Previous studies reported secondary attack rates (SAR) of 4–10% for laboratory-confirmed influenza in the household. Few have been conducted in middle-income countries.
We performed a case-ascertained household transmission study during May–October 2013. Index cases were patients with influenza-like-illness (cough and self-reported or measured fever (≥38 °C)) with onset in the last 3 days and no sick household contacts, at clinics in South Africa. Household contacts of index cases with laboratory-confirmed influenza were followed for 12 days.
Thirty index cases in 30 households and 107/110 (97%) eligible household contacts were enrolled. Assuming those not enrolled were influenza negative, 21/110 household contacts had laboratory-confirmed influenza (SAR 19%); the mean serial interval was 2.1 days (SD = 0.35, range 2–3 days). Most (62/82; 76%) household contacts who completed the risk factor questionnaire never avoided contact and 43/82 (52%) continued to share a bed with the index case after illness onset.
SAR for laboratory-confirmed influenza in South Africa was higher than previously reported SARs. Household contacts did not report changing behaviors to prevent transmission. These results can be used to understand and predict influenza transmission in similar middle-income settings.
Url:
DOI: 10.1016/j.jinf.2015.09.001
PubMed: 26366941
PubMed Central: 4667753
Links to Exploration step
PMC:4667753Le document en format XML
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<author><name sortKey="Iyengar, Preetha" sort="Iyengar, Preetha" uniqKey="Iyengar P" first="Preetha" last="Iyengar">Preetha Iyengar</name>
<affiliation><nlm:aff id="A1">Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2">Global Disease Detection Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">US Public Health Service, 5600 Fishers Ln, Rockville, MD, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Von Mollendorf, Claire" sort="Von Mollendorf, Claire" uniqKey="Von Mollendorf C" first="Claire" last="Von Mollendorf">Claire Von Mollendorf</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A5">School of Public Health, Faculty of Health Science, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tempia, Stefano" sort="Tempia, Stefano" uniqKey="Tempia S" first="Stefano" last="Tempia">Stefano Tempia</name>
<affiliation><nlm:aff id="A6">Influenza Program, Centers for Disease Control and Prevention—South Africa, PO Box 9536, Pretoria, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A7">Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Moerdyk, Alexandra" sort="Moerdyk, Alexandra" uniqKey="Moerdyk A" first="Alexandra" last="Moerdyk">Alexandra Moerdyk</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Valley Omar, Ziyaad" sort="Valley Omar, Ziyaad" uniqKey="Valley Omar Z" first="Ziyaad" last="Valley-Omar">Ziyaad Valley-Omar</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hellferscee, Orienka" sort="Hellferscee, Orienka" uniqKey="Hellferscee O" first="Orienka" last="Hellferscee">Orienka Hellferscee</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Martinson, Neil" sort="Martinson, Neil" uniqKey="Martinson N" first="Neil" last="Martinson">Neil Martinson</name>
<affiliation><nlm:aff id="A8">Perinatal HIV Research Unit, University of the Witwatersrand, Johns Hopkins University Center for TB Research, 1550 Orleans Street, Baltimore, MD, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Chhagan, Meera" sort="Chhagan, Meera" uniqKey="Chhagan M" first="Meera" last="Chhagan">Meera Chhagan</name>
<affiliation><nlm:aff id="A9">Department of Pediatrics, University of KwaZulu-Natal, King George V Ave, Glenwood, Durban, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mcmorrow, Meredith" sort="Mcmorrow, Meredith" uniqKey="Mcmorrow M" first="Meredith" last="Mcmorrow">Meredith Mcmorrow</name>
<affiliation><nlm:aff id="A3">US Public Health Service, 5600 Fishers Ln, Rockville, MD, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A7">Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Gambhir, Manoj" sort="Gambhir, Manoj" uniqKey="Gambhir M" first="Manoj" last="Gambhir">Manoj Gambhir</name>
<affiliation><nlm:aff id="A10">Modeling Unit, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A11">Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cauchemez, Simon" sort="Cauchemez, Simon" uniqKey="Cauchemez S" first="Simon" last="Cauchemez">Simon Cauchemez</name>
<affiliation><nlm:aff id="A12">Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 28 rue du Docteur Roux, Paris, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Variava, Ebrahim" sort="Variava, Ebrahim" uniqKey="Variava E" first="Ebrahim" last="Variava">Ebrahim Variava</name>
<affiliation><nlm:aff id="A13">Department of Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Corner of OR Tambo and John Orr Street, Klerksdorp, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Masonoke, Katlego" sort="Masonoke, Katlego" uniqKey="Masonoke K" first="Katlego" last="Masonoke">Katlego Masonoke</name>
<affiliation><nlm:aff id="A8">Perinatal HIV Research Unit, University of the Witwatersrand, Johns Hopkins University Center for TB Research, 1550 Orleans Street, Baltimore, MD, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cohen, Adam L" sort="Cohen, Adam L" uniqKey="Cohen A" first="Adam L." last="Cohen">Adam L. Cohen</name>
<affiliation><nlm:aff id="A3">US Public Health Service, 5600 Fishers Ln, Rockville, MD, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A6">Influenza Program, Centers for Disease Control and Prevention—South Africa, PO Box 9536, Pretoria, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A7">Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cohen, Cheryl" sort="Cohen, Cheryl" uniqKey="Cohen C" first="Cheryl" last="Cohen">Cheryl Cohen</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A5">School of Public Health, Faculty of Health Science, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Case-ascertained study of household transmission of seasonal influenza — South Africa, 2013</title>
<author><name sortKey="Iyengar, Preetha" sort="Iyengar, Preetha" uniqKey="Iyengar P" first="Preetha" last="Iyengar">Preetha Iyengar</name>
<affiliation><nlm:aff id="A1">Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2">Global Disease Detection Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">US Public Health Service, 5600 Fishers Ln, Rockville, MD, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Von Mollendorf, Claire" sort="Von Mollendorf, Claire" uniqKey="Von Mollendorf C" first="Claire" last="Von Mollendorf">Claire Von Mollendorf</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A5">School of Public Health, Faculty of Health Science, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tempia, Stefano" sort="Tempia, Stefano" uniqKey="Tempia S" first="Stefano" last="Tempia">Stefano Tempia</name>
<affiliation><nlm:aff id="A6">Influenza Program, Centers for Disease Control and Prevention—South Africa, PO Box 9536, Pretoria, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A7">Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Moerdyk, Alexandra" sort="Moerdyk, Alexandra" uniqKey="Moerdyk A" first="Alexandra" last="Moerdyk">Alexandra Moerdyk</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Valley Omar, Ziyaad" sort="Valley Omar, Ziyaad" uniqKey="Valley Omar Z" first="Ziyaad" last="Valley-Omar">Ziyaad Valley-Omar</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hellferscee, Orienka" sort="Hellferscee, Orienka" uniqKey="Hellferscee O" first="Orienka" last="Hellferscee">Orienka Hellferscee</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Martinson, Neil" sort="Martinson, Neil" uniqKey="Martinson N" first="Neil" last="Martinson">Neil Martinson</name>
<affiliation><nlm:aff id="A8">Perinatal HIV Research Unit, University of the Witwatersrand, Johns Hopkins University Center for TB Research, 1550 Orleans Street, Baltimore, MD, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Chhagan, Meera" sort="Chhagan, Meera" uniqKey="Chhagan M" first="Meera" last="Chhagan">Meera Chhagan</name>
<affiliation><nlm:aff id="A9">Department of Pediatrics, University of KwaZulu-Natal, King George V Ave, Glenwood, Durban, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mcmorrow, Meredith" sort="Mcmorrow, Meredith" uniqKey="Mcmorrow M" first="Meredith" last="Mcmorrow">Meredith Mcmorrow</name>
<affiliation><nlm:aff id="A3">US Public Health Service, 5600 Fishers Ln, Rockville, MD, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A7">Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Gambhir, Manoj" sort="Gambhir, Manoj" uniqKey="Gambhir M" first="Manoj" last="Gambhir">Manoj Gambhir</name>
<affiliation><nlm:aff id="A10">Modeling Unit, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A11">Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Australia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cauchemez, Simon" sort="Cauchemez, Simon" uniqKey="Cauchemez S" first="Simon" last="Cauchemez">Simon Cauchemez</name>
<affiliation><nlm:aff id="A12">Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 28 rue du Docteur Roux, Paris, France</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Variava, Ebrahim" sort="Variava, Ebrahim" uniqKey="Variava E" first="Ebrahim" last="Variava">Ebrahim Variava</name>
<affiliation><nlm:aff id="A13">Department of Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Corner of OR Tambo and John Orr Street, Klerksdorp, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Masonoke, Katlego" sort="Masonoke, Katlego" uniqKey="Masonoke K" first="Katlego" last="Masonoke">Katlego Masonoke</name>
<affiliation><nlm:aff id="A8">Perinatal HIV Research Unit, University of the Witwatersrand, Johns Hopkins University Center for TB Research, 1550 Orleans Street, Baltimore, MD, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cohen, Adam L" sort="Cohen, Adam L" uniqKey="Cohen A" first="Adam L." last="Cohen">Adam L. Cohen</name>
<affiliation><nlm:aff id="A3">US Public Health Service, 5600 Fishers Ln, Rockville, MD, USA</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A6">Influenza Program, Centers for Disease Control and Prevention—South Africa, PO Box 9536, Pretoria, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A7">Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cohen, Cheryl" sort="Cohen, Cheryl" uniqKey="Cohen C" first="Cheryl" last="Cohen">Cheryl Cohen</name>
<affiliation><nlm:aff id="A4">Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A5">School of Public Health, Faculty of Health Science, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">The Journal of infection</title>
<idno type="ISSN">0163-4453</idno>
<idno type="eISSN">1532-2742</idno>
<imprint><date when="2015">2015</date>
</imprint>
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<front><div type="abstract" xml:lang="en"><title>Summary</title>
<sec id="S1"><title>Objectives</title>
<p id="P2">The household is important in influenza transmission due to intensity of contact. Previous studies reported secondary attack rates (SAR) of 4–10% for laboratory-confirmed influenza in the household. Few have been conducted in middle-income countries.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P3">We performed a case-ascertained household transmission study during May–October 2013. Index cases were patients with influenza-like-illness (cough and self-reported or measured fever (≥38 °C)) with onset in the last 3 days and no sick household contacts, at clinics in South Africa. Household contacts of index cases with laboratory-confirmed influenza were followed for 12 days.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">Thirty index cases in 30 households and 107/110 (97%) eligible household contacts were enrolled. Assuming those not enrolled were influenza negative, 21/110 household contacts had laboratory-confirmed influenza (SAR 19%); the mean serial interval was 2.1 days (SD = 0.35, range 2–3 days). Most (62/82; 76%) household contacts who completed the risk factor questionnaire never avoided contact and 43/82 (52%) continued to share a bed with the index case after illness onset.</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P5">SAR for laboratory-confirmed influenza in South Africa was higher than previously reported SARs. Household contacts did not report changing behaviors to prevent transmission. These results can be used to understand and predict influenza transmission in similar middle-income settings.</p>
</sec>
</div>
</front>
</TEI>
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<journal-id journal-id-type="pubmed-jr-id">4825</journal-id>
<journal-id journal-id-type="nlm-ta">J Infect</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Infect.</journal-id>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
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<title-group><article-title>Case-ascertained study of household transmission of seasonal influenza — South Africa, 2013</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Iyengar</surname>
<given-names>Preetha</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A2">b</xref>
<xref ref-type="aff" rid="A3">c</xref>
<xref rid="FN1" ref-type="author-notes">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>von Mollendorf</surname>
<given-names>Claire</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tempia</surname>
<given-names>Stefano</given-names>
</name>
<xref ref-type="aff" rid="A6">f</xref>
<xref ref-type="aff" rid="A7">g</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Moerdyk</surname>
<given-names>Alexandra</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Valley-Omar</surname>
<given-names>Ziyaad</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hellferscee</surname>
<given-names>Orienka</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Martinson</surname>
<given-names>Neil</given-names>
</name>
<xref ref-type="aff" rid="A8">h</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chhagan</surname>
<given-names>Meera</given-names>
</name>
<xref ref-type="aff" rid="A9">i</xref>
</contrib>
<contrib contrib-type="author"><name><surname>McMorrow</surname>
<given-names>Meredith</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
<xref ref-type="aff" rid="A7">g</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gambhir</surname>
<given-names>Manoj</given-names>
</name>
<xref ref-type="aff" rid="A10">j</xref>
<xref ref-type="aff" rid="A11">k</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cauchemez</surname>
<given-names>Simon</given-names>
</name>
<xref ref-type="aff" rid="A12">l</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Variava</surname>
<given-names>Ebrahim</given-names>
</name>
<xref ref-type="aff" rid="A13">m</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Masonoke</surname>
<given-names>Katlego</given-names>
</name>
<xref ref-type="aff" rid="A8">h</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cohen</surname>
<given-names>Adam L.</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
<xref ref-type="aff" rid="A6">f</xref>
<xref ref-type="aff" rid="A7">g</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cohen</surname>
<given-names>Cheryl</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
<xref ref-type="aff" rid="A5">e</xref>
<xref rid="FN2" ref-type="author-notes">**</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>a</label>
Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</aff>
<aff id="A2"><label>b</label>
Global Disease Detection Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</aff>
<aff id="A3"><label>c</label>
US Public Health Service, 5600 Fishers Ln, Rockville, MD, USA</aff>
<aff id="A4"><label>d</label>
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Rd, Sandringham, Johannesburg, South Africa</aff>
<aff id="A5"><label>e</label>
School of Public Health, Faculty of Health Science, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, South Africa</aff>
<aff id="A6"><label>f</label>
Influenza Program, Centers for Disease Control and Prevention—South Africa, PO Box 9536, Pretoria, South Africa</aff>
<aff id="A7"><label>g</label>
Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</aff>
<aff id="A8"><label>h</label>
Perinatal HIV Research Unit, University of the Witwatersrand, Johns Hopkins University Center for TB Research, 1550 Orleans Street, Baltimore, MD, USA</aff>
<aff id="A9"><label>i</label>
Department of Pediatrics, University of KwaZulu-Natal, King George V Ave, Glenwood, Durban, South Africa</aff>
<aff id="A10"><label>j</label>
Modeling Unit, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, USA</aff>
<aff id="A11"><label>k</label>
Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Australia</aff>
<aff id="A12"><label>l</label>
Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 28 rue du Docteur Roux, Paris, France</aff>
<aff id="A13"><label>m</label>
Department of Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Corner of OR Tambo and John Orr Street, Klerksdorp, South Africa</aff>
<author-notes><corresp id="FN1"><label>*</label>
Corresponding author. Save the Children, 2000 L St NW Suite 500, Washington DC 20036, USA. Tel.: +1 202 640 6863. <email>piyengar@gmail.com</email>
(P. Iyengar)</corresp>
<corresp id="FN2"><label>**</label>
Corresponding author. Centre for Respiratory Diseases and Meningitis (CRDM), National Institute for Communicable Diseases, 1 Modderfontein Rd Sandringham, Johannesburg 2193, South Africa. Tel.: +27 11 386 6593. <email>cherylc@nicd.ac.za</email>
(C. Cohen)</corresp>
<fn id="FN4" fn-type="conflict"><p><bold>Conflict of interest</bold>
</p>
<p>The authors declare no commercial or other associations that might pose a conflict of interest.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>25</day>
<month>11</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub"><day>11</day>
<month>9</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="ppub"><month>11</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>11</month>
<year>2016</year>
</pub-date>
<volume>71</volume>
<issue>5</issue>
<fpage>578</fpage>
<lpage>586</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/j.jinf.2015.09.001</pmc-comment>
<abstract><title>Summary</title>
<sec id="S1"><title>Objectives</title>
<p id="P2">The household is important in influenza transmission due to intensity of contact. Previous studies reported secondary attack rates (SAR) of 4–10% for laboratory-confirmed influenza in the household. Few have been conducted in middle-income countries.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P3">We performed a case-ascertained household transmission study during May–October 2013. Index cases were patients with influenza-like-illness (cough and self-reported or measured fever (≥38 °C)) with onset in the last 3 days and no sick household contacts, at clinics in South Africa. Household contacts of index cases with laboratory-confirmed influenza were followed for 12 days.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P4">Thirty index cases in 30 households and 107/110 (97%) eligible household contacts were enrolled. Assuming those not enrolled were influenza negative, 21/110 household contacts had laboratory-confirmed influenza (SAR 19%); the mean serial interval was 2.1 days (SD = 0.35, range 2–3 days). Most (62/82; 76%) household contacts who completed the risk factor questionnaire never avoided contact and 43/82 (52%) continued to share a bed with the index case after illness onset.</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P5">SAR for laboratory-confirmed influenza in South Africa was higher than previously reported SARs. Household contacts did not report changing behaviors to prevent transmission. These results can be used to understand and predict influenza transmission in similar middle-income settings.</p>
</sec>
</abstract>
<kwd-group><kwd>Influenza</kwd>
<kwd>Secondary infection risk</kwd>
<kwd>Household transmission</kwd>
<kwd>Serial interval</kwd>
<kwd>South Africa</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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