Epidemiological investigation of a COVID-19 family cluster outbreak transmitted by a 3-month-old infant

Lin, Guo-tian; Zhang, Yue-hua; Xiao, Mei-fang; Wei, Yong; Chen, Jin-ni; Lin, Dao-jiong; Wang, Jia-chong; Lin, Qiu-yu; Lei, Zhi-xian; Zeng, Zhen-qiong; Li, Ling; Li, Hong-ai; Zheng, Ying; Li, Qiu-qiong; Zhen, Huang-zhen; Jin, Yu-ming; Wu, Qing-xia; Zhang, Fan; Xiang, Wei

OBJECTIVE: To investigate the clinical characteristics, epidemiological characteristics, and transmissibility of coronavirus disease 2019 (COVID-19) in a family cluster outbreak transmitted by a 3-month-old confirmed positive infant. METHODS: Field-based epidemiological methods were used to investigate cases and their close contacts. Real-time fluorescent reverse transcription polymerase chain reaction (RT-PCR) was used to detect Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for all collected specimens. Serum SARS-CoV-2 IgM and IgG antibodies were detected by Chemiluminescence and Gold immnnochromatography (GICA). RESULTS: The outbreak was a family cluster with an attack rate of 80% (4/5). The first case in this family was a 3-month-old infant. The transmission chain was confirmed from infant to adults (her father, mother and grandmother). Fecal tests for SARS-CoV-2 RNA remained positive for 37 days after the infant was discharged. The infant’s grandmother was confirmed to be positive 2 days after the infant was discharged from hospital. Patients A (3-month-old female), B (patient A’s father), C (patient A’s grandmother), and D (patient A’s mother) had positive serum IgG and negative IgM, but patients A’s grandfather serum IgG and IgM were negative. CONCLUSION: SARS-CoV-2 has strong transmissibility within family settings and presence of viral RNA in stool raises concern for possible fecal–oral transmission. Hospital follow-up and close contact tracing are necessary for those diagnosed with COVID-19.