Abstract
Household transmission plays a key role in the spread of COVID-19 through populations. In this paper, we report on the transmission of COVID-19 within households in a metropolitan area in Australia, examine the impact of various factors and highlight priority areas for future public health responses. We collected and reviewed retrospective case report data and follow-up interview responses from households with a positive case of the Delta COVID-19 variant in Queensland in 2021. The overall secondary attack rate (SAR) among household contacts was 29.6% and the mean incubation period for secondary cases was 4.3 days. SAR was higher where the index case was male (57.9% vs. 14.3%) or aged ≤12 years (38.7% vs. 17.4%) but similar for adult contacts that were double vaccinated (35.7%) and unvaccinated (33.3%). Most interview participants emphasised the importance of clear, consistent and compassionate health advice as a key priority for managing outbreaks in the home. The overall rate of household transmission was slightly higher than that reported in previous studies on the wild COVID-19 variant and secondary infections developed more rapidly. While vaccination did not appear to affect the risk of transmission to adult subjects, uptake in the sample was ultimately high.