Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland.
Infectious Diseases and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland.
J Infect Dis. 2024 Oct 16;230(4):e824-e836. doi: 10.1093/infdis/jiae261.
Quantifying the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in indoor settings is crucial for developing effective non-vaccine prevention strategies and policies. However, summary evidence on the transmission risks in settings other than households, schools, elderly care, and health care facilities is limited. We conducted a systematic review to estimate the secondary attack rates (SARs) of SARS-CoV-2 and the factors modifying transmission risk in community indoor settings.
We searched Medline, Scopus, Web of Science, WHO COVID-19 Research Database, MedrXiv, and BiorXiv from 1 January 2020 to 20 February 2023. We included articles with original data for estimating SARS-CoV-2 SARs. We estimated the overall and setting-specific SARs using the inverse variance method for random-effects meta-analyses.
We included 34 studies with data on 577 index cases, 898 secondary cases, and 9173 contacts. The pooled SAR for community indoor settings was 20.4% (95% confidence interval [CI], 12.0%-32.5%). The setting-specific SARs were highest for singing events (SAR, 44.9%; 95% CI, 14.5%-79.7%), indoor meetings and entertainment venues (SAR, 31.9%; 95% CI, 10.4%-65.3%), and fitness centers (SAR, 28.9%; 95% CI, 9.9%-60.1%). We found no difference in SARs by index case, viral, and setting-specific characteristics.
The risk of SARS-CoV-2 transmission was highest in indoor settings where singing and exercising occurred. Effective mitigation measures such as assessing and improving ventilation should be considered to reduce the risk of transmission in high-risk settings. Future studies should systematically assess and report the host, viral, and setting-specific characteristics that may modify the transmission risks of SARS-CoV-2 and other respiratory viruses in indoor environments.
量化室内环境中严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）传播的风险对于制定有效的非疫苗预防策略和政策至关重要。然而，关于家庭、学校、老年护理和医疗机构以外环境中传播风险的综合证据有限。我们进行了一项系统评价，以估计 SARS-CoV-2 的二次攻击率（SAR）以及在社区室内环境中改变传播风险的因素。
我们从 2020 年 1 月 1 日至 2023 年 2 月 20 日，在 Medline、Scopus、Web of Science、世界卫生组织 COVID-19 研究数据库、MedrXiv 和 Biorxiv 上进行了搜索。我们纳入了有原始数据用于估计 SARS-CoV-2 SAR 的文章。我们使用随机效应荟萃分析的逆方差法估计总体和特定环境的 SAR。
我们纳入了 34 项研究，这些研究的数据涉及 577 例索引病例、898 例继发病例和 9173 例接触者。社区室内环境的 SAR 为 20.4%（95%置信区间[CI]，12.0%-32.5%）。特定环境的 SAR 最高的是唱歌活动（SAR，44.9%；95%CI，14.5%-79.7%）、室内会议和娱乐场所（SAR，31.9%；95%CI，10.4%-65.3%）和健身中心（SAR，28.9%；95%CI，9.9%-60.1%）。我们没有发现 SAR 因索引病例、病毒和特定环境特征而有所不同。
SARS-CoV-2 在发生唱歌和锻炼的室内环境中传播风险最高。应考虑采取有效的缓解措施，如评估和改善通风，以降低高风险环境中的传播风险。未来的研究应系统评估和报告可能改变 SARS-CoV-2 和其他呼吸道病毒在室内环境中传播风险的宿主、病毒和特定环境特征。
