The role of asymptomatic and pre-symptomatic infection in SARS-CoV-2 transmission—a living systematic review
Open accessPublished version of a preprint
Abstract
Background Reports suggest that asymptomatic individuals (those with no symptoms at all throughout infection) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are infectious, but the extent of transmission based on symptom status requires further study.Purpose This living review aims to critically appraise available data about secondary attack rates from people with asymptomatic, pre-symptomatic and symptomatic SARS-CoV-2 infection.Data sources Medline, EMBASE, China Academic Journals full-text database (CNKI), and pre-print servers were searched from 30 December 2019 to 3 July 2020 using relevant MESH terms.Study selection Studies that report on contact tracing of index cases with SARS-CoV-2 infection in either English or Chinese were included.Data extraction Two authors independently extracted data and assessed study quality and risk of bias. We calculated the secondary attack rate as the number of contacts with SARS-CoV-2, divided by the number of contacts tested.Data synthesis Of 927 studies identified, 80 were included. Summary secondary attack rate estimates were 1% (95% CI 0%-2%) with a prediction interval of 0%-10% for asymptomatic index cases in ten studies, 7% (95% CI 3%-11%) with a prediction interval of 1%-40% for pre-symptomatic cases in 11 studies and 6% (95% CI 5%-8%) with a prediction interval of 5%-38% for symptomatic index cases in 40 studies. The highest secondary attack rates were found in contacts who lived in the same household as the index case. Other activities associated with transmission were group activities such as sharing meals or playing board games with the index case, regardless of the disease status of the index case.Limitations We excluded some studies because the index case or number of contacts were unclear.Conclusion Asymptomatic patients can transmit SARS-CoV-2 to others, but our findings indicate that such individuals are responsible for fewer secondary infections than people with symptoms.Systematic review registration PROSPERO CRD42020188168.
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Emary, K. R. W., Golubchik, T., Aley, P. K., Ariani, C. V., Angus, B., Bibi, S., Blane, B., Bonsall, D., Cicconi, P., Charlton, S., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00628-0 · Cited by 603 · see citing works
Vaccination with BNT162b2 reduces transmission of SARS-CoV-2 to household contacts in Israel
Prunas, O., Warren, J. L., Crawford, F. W., Gazit, S., Patalon, T., Weinberger, D. M., & Pitzer, V. E. (2022) · Science · doi:10.1126/science.abl4292 · Cited by 153 · see citing works
- Authors
- Qiu, X., Nergiz, A. I., Maraolo, A. E., Bogoch, I. I., Low, N., & Cevik, M.
- Affiliations
- Harvard University (US)
- Ospedale D. Cotugno (IT)
- University of Toronto (CA)
- University of Bern (CH)
- Venue
- Clinical Microbiology and Infection
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 27
- Issue
- 4
- Pages
- 511-519
- ISSN
- 1198-743X (ISSN-L)
- PMC
- PMC7825872
- OpenAlex
- W3122351745
- Cited by
- 135
- References
- 84
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 9 · 2023: 20 · 2022: 37 · 2021: 54 · 2020: 4
- FWCI
- 2.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Microbiology and Infection (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- Open Access CRIS of the University of Bern
- Funders
- University of St Andrews
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Keywords
- SARS-CoV-2, COVID-19 pandemic, asymptomatic infection, pre-symptomatic infection, secondary attack rate, transmission, household transmission, contact tracing, symptomatic infection
- MeSH terms
- COVID-19, Family Characteristics, Humans, Incidence, Contact Tracing, Asymptomatic Infections
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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