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<p>The effectiveness of case isolation and contact quarantine depends critically on the extent of presymptomatic transmission. However, the capacity of influenza viruses for transmission before symptom onset remains uncertain. We developed an individual-based household transmission model that explicitly accounts for transmission occurring before symptom onset by marginalizing unobserved infection times. We analysed influenza household transmission studies of influenza A and B viruses in Hong Kong between 2008 and 2017 (493 and 255 households, respectively), estimating pathogen-specific presymptomatic transmission proportions and identifying factors affecting individual susceptibility and infectiousness. We estimated that 9.6% (95% credible interval: 5.9%, 14.7%) of influenza A transmission occurred &gt;0.5 days earlier than infectors’ symptom onset, while influenza B showed no evidence of presymptomatic transmission. Using an additional severe acute respiratory syndrome coronavirus 2 Omicron dataset in Hong Kong, our analysis confirmed substantial presymptomatic transmission (65.5%, 95% credible interval: 52.7%, 78.9%), validating our methodology. Our findings suggest symptom-based control measures may be feasible for influenza, although quarantine of presymptomatic contacts would provide limited additional benefit.</p>

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Frequent presymptomatic household transmission of influenza A but not influenza B virus

  • 期刊论文

  • 发表日期：

    2026年1月28日

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  • Chengyao Zhang,
  • Xiaotong Huang,
  • Vicky J. Fang,
  • Kwok-Hung Chan,
  • Gabriel M. Leung,
  • Dennis K. M. Ip,
  • J. S. Malik Peiris,
  • Benjamin J. Cowling,
  • Simon Cauchemez,
  • Tim K. Tsang

摘要

The effectiveness of case isolation and contact quarantine depends critically on the extent of presymptomatic transmission. However, the capacity of influenza viruses for transmission before symptom onset remains uncertain. We developed an individual-based household transmission model that explicitly accounts for transmission occurring before symptom onset by marginalizing unobserved infection times. We analysed influenza household transmission studies of influenza A and B viruses in Hong Kong between 2008 and 2017 (493 and 255 households, respectively), estimating pathogen-specific presymptomatic transmission proportions and identifying factors affecting individual susceptibility and infectiousness. We estimated that 9.6% (95% credible interval: 5.9%, 14.7%) of influenza A transmission occurred >0.5 days earlier than infectors’ symptom onset, while influenza B showed no evidence of presymptomatic transmission. Using an additional severe acute respiratory syndrome coronavirus 2 Omicron dataset in Hong Kong, our analysis confirmed substantial presymptomatic transmission (65.5%, 95% credible interval: 52.7%, 78.9%), validating our methodology. Our findings suggest symptom-based control measures may be feasible for influenza, although quarantine of presymptomatic contacts would provide limited additional benefit.