Transmission risk of asymptomatic SARS-CoV-2 infection:a systematic review and meta-analysis

Background:Global evidence on the transmission of asymptomatic SARS-CoV-2 infection needs to be synthesized.Methods:A search of 4 electronic databases(PubMed,EMBASE,Cochrane Library,and Web of Science databases)as of January 24,2021 was performed.Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines were followed.Studies which reported the transmission rate among close contacts with asymptomatic SARS-CoV-2 cases were included,and transmission activities occurred were considered.The trans-mission rates were pooled by zero-inflated beta distribution.The risk ratios(RRs)were calculated using random-effects models.Results:Of 4923 records retrieved and reviewed,15 studies including 3917 close contacts with asymptomatic indexes were eligible.The pooled transmission rates were 1.79 per 100 person-days(or 1.79%,95%confidence interval[CI]0.41%-3.16%)by asymptomatic index,which is significantly lower than by presymptomatic(5.02%,95%CI 2.37%-7.66%;p<0.001),and by symptomatic(5.27%,95%CI 2.40%-8.15%;p<0.001).Subgroup anal-yses showed that the household transmission rate of asymptomatic index was(4.22%,95%CI 0.91%-7.52%),four times significantly higher than non-household transmission(1.03%,95%CI 0.73%-1.33%;p=0.03),and the asymptomatic transmission rate in China(1.82%,95%CI 0.11%-3.53%)was lower than in other countries(2.22%,95%CI 0.67%-3.77%;p=0.01).Conclusions:People with asymptomatic SARS-CoV-2 infection are at risk of transmitting the virus to their close contacts,particularly in household settings.The transmission potential of asymptomatic infection is lower than symptomatic and presymptomatic infections.This meta-analysis provides evidence for predict-ing the epidemic trend and promulgating vaccination and other control measures.Registered with PROS-PERO International Prospective Register of Systematic Reviews,CRD42021269446;https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269446.