"Low-risk groups" deserve more attention than "high-risk groups" in imported COVID-19 cases.

OBJECTIVE: To estimate the optimal quarantine period for inbound travelers and identify key risk factors to provide scientific reference for emerging infectious diseases. METHODS: A parametric survival analysis model was used to calculate the time interval between entry and first positive nucleic acid test of imported cases in Guangzhou, to identify the influencing factors. And the COVID-19 epidemic risk prediction model based on multiple risk factors among inbound travelers was constructed. RESULTS: The approximate 95th percentile of the time interval was 14 days. Multivariate analysis found that the mean time interval for inbound travelers in entry/exit high-risk occupations was 29% shorter (OR 0.29, 95% CI 0.18-0.46, p < 0.0001) than that of low-risk occupations, those from Africa were 37% shorter (OR 0.37, 95% CI 0.17-0.78, p = 0.01) than those from Asia, those who were fully vaccinated were 1.88 times higher (OR 1.88, 95% CI 1.13-3.12, p = 0.01) than that of those who were unvaccinated, and those in other VOC periods were lower than in the Delta period. Decision tree analysis showed that a combined entry/exit low-risk occupation group with Delta period could create a high indigenous epidemic risk by 0.24. CONCLUSION: Different strata of imported cases can result in varying degrees of risk of indigenous outbreaks. "low-risk groups" with entry/exit low-risk occupations, fully vaccinated, or from Asia deserve more attention than "high-risk groups."