1. Epidemiology and Global Health
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Social contact patterns and implications for infectious disease transmission: a systematic review and meta-analysis of contact surveys

  1. Andria Mousa  Is a corresponding author
  2. Peter Winskill
  3. Oliver John Watson
  4. Oliver Ratmann
  5. Mélodie Monod
  6. Marco Ajelli
  7. Aldiouma Diallo
  8. Peter J Dodd
  9. Carlos G Grijalva
  10. Moses Chapa Kiti
  11. Anand Krishnan
  12. Rakesh Kumar
  13. Supriya Kumar
  14. Kin O Kwok
  15. Claudio F Lanata
  16. Olivier le Polain de Waroux
  17. Kathy Leung
  18. Wiriya Mahikul
  19. Alessia Melegaro
  20. Carl D Morrow
  21. Joël Mossong
  22. Eleanor FG Neal
  23. D James Nokes
  24. Wirichada Pan-ngum
  25. Gail E Potter
  26. Fiona M Russell
  27. Siddhartha Saha
  28. Jonathan D Sugimoto
  29. Wan In Wei
  30. Robin R Wood
  31. Joseph Wu
  32. Juanjuan Zhang
  33. Patrick Walker
  34. Charles Whittaker  Is a corresponding author
  1. Imperial College London, United Kingdom
  2. Indiana University School of Public Health, United States
  3. VITROME, Institut de Recherche pour le Developpement, Senegal
  4. University of Sheffield, United Kingdom
  5. Vanderbilt University Medical Center, United States
  6. KEMRI-Wellcome Trust Research Programme, Kenya
  7. All India Institute of Medical Sciences, India
  8. Bill and Melinda Gates Foundation, United States
  9. Chinese University of Hong Kong, China
  10. Instituto de Investigación Nutricional, Peru
  11. London School of Hygiene and Tropical Medicine, United Kingdom
  12. The University of Hong Kong, Hong Kong
  13. Chulabhorn Royal Academy, Thailand
  14. Bocconi University, Italy
  15. University of Cape Town, South Africa
  16. Health Directorate, Luxembourg
  17. Murdoch Children's Research Institute, Australia
  18. Mahidol University, Thailand
  19. National Institute for Allergies and Infectious Diseases, National Institutes of Health, United States
  20. US Centers for Disease Control and Prevention, India
  21. United States Department of Veterans Affairs, United States
  22. The Chinese University of Hong Kong, China
  23. Fudan University, China
Research Article
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Cite this article as: eLife 2021;10:e70294 doi: 10.7554/eLife.70294

Abstract

Background: Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focussed on high-income settings.

Methods: Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys we explored how contact characteristics (number, location, duration and whether physical) vary across income settings.

Results: Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age-groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, with low-income settings characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income-strata on the frequency, duration and type of contacts individuals made.

Conclusions: These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens, as well as the effectiveness of different non-pharmaceutical interventions.

Funding: This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1).

Data availability

All individual-level data across all studies and analysis code are available at https://github.com/mrc-ide/contact_patterns (see Supplementary Text 4 for data dictionary).

The following previously published data sets were used
    1. Kumar S
    (2018) India contact mixing
    Osf, doi: 10.17605/OSF.IO/C2JTV.

Article and author information

Author details

  1. Andria Mousa

    MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
    For correspondence
    a.mousa17@imperial.ac.uk
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-9406-7481
  2. Peter Winskill

    MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
    Competing interests
    Peter Winskill, received funding from WHO and the Asian Development Bank via their institution to investigate COVID19 Vaccine modelling. The author has no other competing interests to declare..
  3. Oliver John Watson

    MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-2374-0741
  4. Oliver Ratmann

    Department of Mathematics, Imperial College London, London, United Kingdom
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-8667-4118
  5. Mélodie Monod

    Department of Mathematics, Imperial College London, London, United Kingdom
    Competing interests
    No competing interests declared.
  6. Marco Ajelli

    Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, United States
    Competing interests
    Marco Ajelli, has received research funding from Seqirus outside the submitted work..
  7. Aldiouma Diallo

    VITROME, Institut de Recherche pour le Developpement, Dakar, Senegal
    Competing interests
    No competing interests declared.
  8. Peter J Dodd

    School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
    Competing interests
    No competing interests declared.
  9. Carlos G Grijalva

    Division of Pharmacoepidemiology, Department of Health Policy, Vanderbilt University Medical Center, Nashville, United States
    Competing interests
    Carlos G Grijalva, has received funding from NIH, CDC, AHRQ, FDA, Campbell Alliance/Syneos Health and Sanofi, outside the current work. CGG has also received consulting fees from Pfizer, Merck and Sanofi. The author has no other competing interests to declare..
  10. Moses Chapa Kiti

    KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
    Competing interests
    No competing interests declared.
  11. Anand Krishnan

    Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
    Competing interests
    No competing interests declared.
  12. Rakesh Kumar

    Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
    Competing interests
    No competing interests declared.
  13. Supriya Kumar

    Bill and Melinda Gates Foundation, Seattle, WA, United States
    Competing interests
    No competing interests declared.
  14. Kin O Kwok

    JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
    Competing interests
    No competing interests declared.
  15. Claudio F Lanata

    Instituto de Investigación Nutricional, Lima, Peru
    Competing interests
    No competing interests declared.
  16. Olivier le Polain de Waroux

    London School of Hygiene and Tropical Medicine, London, United Kingdom
    Competing interests
    No competing interests declared.
  17. Kathy Leung

    School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-4777-388X
  18. Wiriya Mahikul

    Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
    Competing interests
    No competing interests declared.
  19. Alessia Melegaro

    Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Sciences, Bocconi University, Milano, Italy
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-2221-8898
  20. Carl D Morrow

    Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
    Competing interests
    No competing interests declared.
  21. Joël Mossong

    Health Directorate, Luxembourg, Luxembourg
    Competing interests
    No competing interests declared.
  22. Eleanor FG Neal

    Infection and Immunity, Murdoch Children's Research Institute, Victoria, Australia
    Competing interests
    No competing interests declared.
  23. D James Nokes

    KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
    Competing interests
    No competing interests declared.
  24. Wirichada Pan-ngum

    Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand
    Competing interests
    No competing interests declared.
  25. Gail E Potter

    National Institute for Allergies and Infectious Diseases, National Institutes of Health, Rockville, United States
    Competing interests
    Gail E Potter, was employed by the Emmes Company while analyzing the Niakhar Senegal social contact network data included in this study. The Emmes Company was contracted to perform data cleaning and data analysis of the Niakhar, Senegal clinical trial data (but not the social contact network data) for this study before GEP joined the Emmes Company (in October 2015). After GEP joined the Emmes Company, the sole support from Emmes for this manuscript was in the form of salary support for GEP. GEP also received travel support from Thomas Francis Jr. Travel Fellowship. The author has no other competing interests to declare.
  26. Fiona M Russell

    Infection and Immunity, Murdoch Children's Research Institute, Victoria, Australia
    Competing interests
    No competing interests declared.
  27. Siddhartha Saha

    US Centers for Disease Control and Prevention, New Delhi, India
    Competing interests
    No competing interests declared.
  28. Jonathan D Sugimoto

    Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs, Seattle, United States
    Competing interests
    Jonathan D Sugimoto, received travel support for this work from Thomas Francis, Jr. Scholarship Fund. JDS has also received consultancy fees from the International Vaccine Institute, Seoul, Republic of Korea, for work related to studies of typhoid fever burden and vaccine impact. JDS also participates on a DataSafety Monitoring Board for optimising infant immunisation schedules in Uganda & Nepal, University of Oxford, UK (ongoing). The author has no other competing interests to declare..
  29. Wan In Wei

    JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
    Competing interests
    No competing interests declared.
  30. Robin R Wood

    Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
    Competing interests
    No competing interests declared.
  31. Joseph Wu

    School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
    Competing interests
    No competing interests declared.
  32. Juanjuan Zhang

    School of Public Health, Fudan University, Shanghai, China
    Competing interests
    No competing interests declared.
  33. Patrick Walker

    MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
    Competing interests
    Patrick Walker, received consultancy fees from Pfizer for a lecture on statistical inference using infectious disease models and payment or honoraria from IS Global, Barcelona (for a lecture on statistical inference using infectious disease models) and Lancet Global Health (for reviewing an article). The author has no other competing interests to declare.
  34. Charles Whittaker

    MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
    For correspondence
    charles.whittaker16@imperial.ac.uk
    Competing interests
    No competing interests declared.

Funding

joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1)

  • Andria Mousa
  • Peter Winskill
  • Patrick Walker
  • Charles Whittaker

Australian National Health and Medical Research Council

  • Fiona M Russell

WHO

  • Fiona M Russell

Bill & Melinda Gates Foundation

  • Fiona M Russell

Wellcome Trust

  • Fiona M Russell

DFAT

  • Fiona M Russell

EPSRC through the EPSRC Centre for Doctoral Training in Modern Statistics and Statistical Machine Learning

  • Mélodie Monod

University of Washington

  • Jonathan D Sugimoto

US National Institutes of Health, NIAID

  • Jonathan D Sugimoto

NIH (K24AI148459)

  • Carlos G Grijalva

General Medical Sciences / National Institute of Health (U01-GM070749)

  • Gail E Potter

UK foreign Commonwealth and Development Office

  • Oliver John Watson

Emmes Company

  • Gail E Potter

CUHK Direct grant for research (2019.020)

  • Kin O Kwok

Health and Medical Research Fund (INF-CUHK-1,17160302,18170312)

  • Kin O Kwok

General Research Fund (14112818)

  • Kin O Kwok

Early Career Scheme (24104920)

  • Kin O Kwok

Wellcome Trust (200861/Z/16/Z)

  • Kin O Kwok

UK Medical Research Council. UK-funded award is part of the EDCTP2 programme supported by the EU (MR/P022081/1)

  • Peter J Dodd

Australian Government Research Training Program Scholarship

  • Eleanor FG Neal

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: All original studies included were approved by an institutional ethics review committee. Ethics approval was not required for the present study.

Reviewing Editor

  1. Isabel Rodriguez-Barraquer, University of California, San Francisco, United States

Publication history

  1. Received: May 12, 2021
  2. Accepted: November 24, 2021
  3. Accepted Manuscript published: November 25, 2021 (version 1)

Copyright

This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

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Further reading

    1. Epidemiology and Global Health
    2. Immunology and Inflammation
    Yansheng Li et al.
    Research Article Updated

    Influenza pandemics pose public health threats annually for lacking vaccine that provides cross-protection against novel and emerging influenza viruses. Combining conserved antigens that induce cross-protective antibody responses with epitopes that activate cross-protective T cell responses might be an attractive strategy for developing a universal vaccine. In this study, we constructed a recombinant protein named NMHC that consists of influenza viral conserved epitopes and a superantigen fragment. NMHC promoted the maturation of bone marrow-derived dendritic cells and induced CD4+ T cells to differentiate into Th1, Th2, and Th17 subtypes. Mice vaccinated with NMHC produced high levels of immunoglobulins that cross-bound to HA fragments from six influenza virus subtypes with high antibody titers. Anti-NMHC serum showed potent hemagglutinin inhibition effects to highly divergent group 1 (H1 subtype) and group 2 (H3 subtype) influenza virus strains. Furthermore, purified anti-NMHC antibodies bound to multiple HAs with high affinities. NMHC vaccination effectively protected mice from infection and lung damage when exposed to two subtypes of H1N1 influenza virus. Moreover, NMHC vaccination elicited CD4+ and CD8+ T cell responses that cleared the virus from infected tissues and prevented virus spread. In conclusion, this study provides proof of concept that NMHC vaccination triggers B and T cell immune responses against multiple influenza virus infections. Therefore, NMHC might be a candidate universal broad-spectrum vaccine for the prevention and treatment of multiple influenza viruses.

    1. Epidemiology and Global Health
    2. Microbiology and Infectious Disease
    Mark Ferris et al.
    Research Advance Updated

    Background:

    Respiratory protective equipment recommended in the UK for healthcare workers (HCWs) caring for patients with COVID-19 comprises a fluid-resistant surgical mask (FRSM), except in the context of aerosol generating procedures (AGPs). We previously demonstrated frequent pauci- and asymptomatic severe acute respiratory syndrome coronavirus 2 infection HCWs during the first wave of the COVID-19 pandemic in the UK, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020).

    Methods:

    Here, we use observational data and mathematical modelling to analyse infection rates amongst HCWs working on ‘red’ (coronavirus disease 2019, COVID-19) and ‘green’ (non-COVID-19) wards during the second wave of the pandemic, before and after the substitution of filtering face piece 3 (FFP3) respirators for FRSMs.

    Results:

    Whilst using FRSMs, HCWs working on red wards faced an approximately 31-fold (and at least fivefold) increased risk of direct, ward-based infection. Conversely, after changing to FFP3 respirators, this risk was significantly reduced (52–100% protection).

    Conclusions:

    FFP3 respirators may therefore provide more effective protection than FRSMs for HCWs caring for patients with COVID-19, whether or not AGPs are undertaken.

    Funding:

    Wellcome Trust, Medical Research Council, Addenbrooke’s Charitable Trust, NIHR Cambridge Biomedical Research Centre, NHS Blood and Transfusion, UKRI.