Symptom prevalence and secondary attack rate of SARS‐CoV‐2 in rural Kenyan households: A prospective cohort study

BACKGROUND: We estimated the secondary attack rate of SARS‐CoV‐2 among household contacts of PCR‐confirmed cases of COVID‐19 in rural Kenya and analysed risk factors for transmission. METHODS: We enrolled incident PCR‐confirmed cases and their household members. At baseline, a questionnaire, a blood sample, and naso‐oropharyngeal swabs were collected. Household members were followed 4, 7, 10, 14, 21 and 28 days after the date of the first PCR‐positive in the household; naso‐oropharyngeal swabs were collected at each visit and used to define secondary cases. Blood samples were collected every 1–2 weeks. Symptoms were collected in a daily symptom diary. We used binomial regression to estimate secondary attack rates and survival analysis to analyse risk factors for transmission. RESULTS: A total of 119 households with at least one positive household member were enrolled between October 2020 and September 2022, comprising 503 household members; 226 remained in follow‐up at day 14 (45%). A total of 43 secondary cases arose within 14 days of identification of the primary case, and 81 household members remained negative. The 7‐day secondary attack rate was 4% (95% CI 1%–10%), the 14‐day secondary attack rate was 28% (95% CI 17%–40%). Of 38 secondary cases with data, eight reported symptoms (21%, 95% CI 8%–34%). Antibody to SARS‐CoV‐2 spike protein at enrolment was not associated with risk of becoming a secondary case. CONCLUSION: Households in our setting experienced a lower 7‐day attack rate than a recent meta‐analysis indicated as the global average (23%–43% depending on variant), and infection is mostly asymptomatic in our setting.