Household Transmission of Influenza A Viruses in 2021-2022
Authors: Rolfes Melissa A. , Talbot H. Keipp , McLean Huong Q. , Stockwell Melissa S. , Ellingson Katherine D. , Lutrick Karen , Bowman Natalie M. , Bendall Emily E. , Bullock Ayla , Chappell James D. , Deyoe Jessica E. , Gilbert Julie , Halasa Natasha B. , Hart Kimberly E. , Johnson Sheroi , Kim Ahra , Lauring Adam S. , Lin Jessica T. , Lindsell Christopher J. , McLaren Son H. , Meece Jennifer K. , Mellis Alexandra M. , Moreno Zivanovich Miriana , Ogokeh Constance E. , Rodriguez Michelle , Sano Ellen , Silverio Francisco Raul A. , Schmitz Jonathan E. , Vargas Celibell Y. , Yang Amy , Zhu Yuwei , Belongia Edward A. , Reed Carrie , Grijalva Carlos G. 
Published: January 2023

Importance

Influenza virus infections declined globally during the COVID-19 pandemic. Loss of natural immunity from lower rates of influenza infection and documented antigenic changes in circulating viruses may have resulted in increased susceptibility to influenza virus infection during the 2021-2022 influenza season.

Objective

To compare the risk of influenza virus infection among household contacts of patients with influenza during the 2021-2022 influenza season with risk of influenza virus infection among household contacts during influenza seasons before the COVID-19 pandemic in the US.

Design, Setting, and Participants

This prospective study of influenza transmission enrolled households in 2 states before the COVID-19 pandemic (2017-2020) and in 4 US states during the 2021-2022 influenza season. Primary cases were individuals with the earliest laboratory-confirmed influenza A(H3N2) virus infection in a household. Household contacts were people living with the primary cases who self-collected nasal swabs daily for influenza molecular testing and completed symptom diaries daily for 5 to 10 days after enrollment.

Exposures

Household contacts living with a primary case.

Main Outcomes and Measures

Relative risk of laboratory-confirmed influenza A(H3N2) virus infection in household contacts during the 2021-2022 season compared with prepandemic seasons. Risk estimates were adjusted for age, vaccination status, frequency of interaction with the primary case, and household density. Subgroup analyses by age, vaccination status, and frequency of interaction with the primary case were also conducted.

Results

During the prepandemic seasons, 152 primary cases (median age, 13 years; 3.9% Black; 52.0% female) and 353 household contacts (median age, 33 years; 2.8% Black; 54.1% female) were included and during the 2021-2022 influenza season, 84 primary cases (median age, 10 years; 13.1% Black; 52.4% female) and 186 household contacts (median age, 28.5 years; 14.0% Black; 63.4% female) were included in the analysis. During the prepandemic influenza seasons, 20.1% (71/353) of household contacts were infected with influenza A(H3N2) viruses compared with 50.0% (93/186) of household contacts in 2021-2022. The adjusted relative risk of A(H3N2) virus infection in 2021-2022 was 2.31 (95% CI, 1.86-2.86) compared with prepandemic seasons.

Conclusions and Relevance

Among cohorts in 5 US states, there was a significantly increased risk of household transmission of influenza A(H3N2) in 2021-2022 compared with prepandemic seasons. Additional research is needed to understand reasons for this association.