IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0241536.html
   My bibliography  Save this article

Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

Author

Listed:
  • Mercedes Yanes-Lane
  • Nicholas Winters
  • Federica Fregonese
  • Mayara Bastos
  • Sara Perlman-Arrow
  • Jonathon R Campbell
  • Dick Menzies

Abstract

Background: The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. Methods: We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). Results: Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. Conclusions: Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.

Suggested Citation

  • Mercedes Yanes-Lane & Nicholas Winters & Federica Fregonese & Mayara Bastos & Sara Perlman-Arrow & Jonathon R Campbell & Dick Menzies, 2020. "Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-21, November.
  • Handle: RePEc:plo:pone00:0241536
    DOI: 10.1371/journal.pone.0241536
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241536
    Download Restriction: no

    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0241536&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pone.0241536?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Christian Moser & Pierre Yared, 2022. "Pandemic Lockdown: The Role of Government Commitment," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 46, pages 27-50, October.
    2. Michal Brzoza-Brzezina & Marcin Kolasa & Krzysztof Makarski, 2022. "Monetary Policy and COVID-19," International Journal of Central Banking, International Journal of Central Banking, vol. 18(1), pages 41-80, March.
    3. Sara Barsanti & Virginia Sommati & Giulia Colombini, 2022. "Il vissuto degli operatori e l?emergenza Covid-19 nelle Residenze Sanitarie Assistenziali," MECOSAN, FrancoAngeli Editore, vol. 2022(122), pages 7-28.
    4. Holly Blake & Holly Knight & Ru Jia & Jessica Corner & Joanne R. Morling & Chris Denning & Jonathan K. Ball & Kirsty Bolton & Grazziela Figueredo & David E. Morris & Patrick Tighe & Armando Mendez Vil, 2021. "Students’ Views towards Sars-Cov-2 Mass Asymptomatic Testing, Social Distancing and Self-Isolation in a University Setting during the COVID-19 Pandemic: A Qualitative Study," IJERPH, MDPI, vol. 18(8), pages 1-19, April.
    5. Shoaib, Mohd & Mustafee, Navonil & Madan, Karan & Ramamohan, Varun, 2023. "Leveraging multi-tier healthcare facility network simulations for capacity planning in a pandemic," Socio-Economic Planning Sciences, Elsevier, vol. 88(C).
    6. Christian Moser & Pierre Yared, 2022. "Pandemic Lockdown: The Role of Government Commitment," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 46, pages 27-50, October.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. İlkay Unay-Gailhard & Mark A. Brennen, 2022. "How digital communications contribute to shaping the career paths of youth: a review study focused on farming as a career option," Agriculture and Human Values, Springer;The Agriculture, Food, & Human Values Society (AFHVS), vol. 39(4), pages 1491-1508, December.
    2. Mahin Ghafari & Vali Baigi & Zahra Cheraghi & Amin Doosti-Irani, 2016. "The Prevalence of Asymptomatic Bacteriuria in Iranian Pregnant Women: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-10, June.
    3. Elizabeth T Cafiero-Fonseca & Andrew Stawasz & Sydney T Johnson & Reiko Sato & David E Bloom, 2017. "The full benefits of adult pneumococcal vaccination: A systematic review," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-23, October.
    4. Santos Urbina & Sofía Villatoro & Jesús Salinas, 2021. "Self-Regulated Learning and Technology-Enhanced Learning Environments in Higher Education: A Scoping Review," Sustainability, MDPI, vol. 13(13), pages 1-12, June.
    5. Oded Berger-Tal & Alison L Greggor & Biljana Macura & Carrie Ann Adams & Arden Blumenthal & Amos Bouskila & Ulrika Candolin & Carolina Doran & Esteban Fernández-Juricic & Kiyoko M Gotanda & Catherine , 2019. "Systematic reviews and maps as tools for applying behavioral ecology to management and policy," Behavioral Ecology, International Society for Behavioral Ecology, vol. 30(1), pages 1-8.
    6. Nadine Desrochers & Adèle Paul‐Hus & Jen Pecoskie, 2017. "Five decades of gratitude: A meta‐synthesis of acknowledgments research," Journal of the Association for Information Science & Technology, Association for Information Science & Technology, vol. 68(12), pages 2821-2833, December.
    7. Maryono, Maryono & Killoes, Aditya Marendra & Adhikari, Rajendra & Abdul Aziz, Ammar, 2024. "Agriculture development through multi-stakeholder partnerships in developing countries: A systematic literature review," Agricultural Systems, Elsevier, vol. 213(C).
    8. Alene Sze Jing Yong & Yi Heng Lim & Mark Wing Loong Cheong & Ednin Hamzah & Siew Li Teoh, 2022. "Willingness-to-pay for cancer treatment and outcome: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(6), pages 1037-1057, August.
    9. Xue-Ying Xu & Hong Kong & Rui-Xiang Song & Yu-Han Zhai & Xiao-Fei Wu & Wen-Si Ai & Hong-Bo Liu, 2014. "The Effectiveness of Noninvasive Biomarkers to Predict Hepatitis B-Related Significant Fibrosis and Cirrhosis: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-16, June.
    10. Vicente Miñana-Signes & Manuel Monfort-Pañego & Javier Valiente, 2021. "Teaching Back Health in the School Setting: A Systematic Review of Randomized Controlled Trials," IJERPH, MDPI, vol. 18(3), pages 1-18, January.
    11. Agnieszka A. Tubis & Katarzyna Grzybowska, 2022. "In Search of Industry 4.0 and Logistics 4.0 in Small-Medium Enterprises—A State of the Art Review," Energies, MDPI, vol. 15(22), pages 1-26, November.
    12. Obsa Urgessa Ayana & Jima Degaga, 2022. "Effects of rural electrification on household welfare: a meta-regression analysis," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 69(2), pages 209-261, June.
    13. Caloffi, Annalisa & Colovic, Ana & Rizzoli, Valentina & Rossi, Federica, 2023. "Innovation intermediaries' types and functions: A computational analysis of the literature," Technological Forecasting and Social Change, Elsevier, vol. 189(C).
    14. García-Poole, Chloe & Byrne, Sonia & Rodrigo, María José, 2019. "How do communities intervene with adolescents at psychosocial risk? A systematic review of positive development programs," Children and Youth Services Review, Elsevier, vol. 99(C), pages 194-209.
    15. Jie Zhao & Ji Chen & Damien Beillouin & Hans Lambers & Yadong Yang & Pete Smith & Zhaohai Zeng & Jørgen E. Olesen & Huadong Zang, 2022. "Global systematic review with meta-analysis reveals yield advantage of legume-based rotations and its drivers," Nature Communications, Nature, vol. 13(1), pages 1-9, December.
    16. Qing Ye & Bao-Xin Qian & Wei-Li Yin & Feng-Mei Wang & Tao Han, 2016. "Association between the HFE C282Y, H63D Polymorphisms and the Risks of Non-Alcoholic Fatty Liver Disease, Liver Cirrhosis and Hepatocellular Carcinoma: An Updated Systematic Review and Meta-Analysis o," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-17, September.
    17. Bishal Mohindru & David Turner & Tracey Sach & Diana Bilton & Siobhan Carr & Olga Archangelidi & Arjun Bhadhuri & Jennifer A. Whitty, 2020. "Health State Utility Data in Cystic Fibrosis: A Systematic Review," PharmacoEconomics - Open, Springer, vol. 4(1), pages 13-25, March.
    18. Subramaniam, Mega & Pang, Natalie & Morehouse, Shandra & Asgarali-Hoffman, S. Nisa, 2020. "Examining vulnerability in youth digital information practices scholarship: What are we missing or exhausting?," Children and Youth Services Review, Elsevier, vol. 116(C).
    19. Neal R. Haddaway & Matthew J. Page & Chris C. Pritchard & Luke A. McGuinness, 2022. "PRISMA2020: An R package and Shiny app for producing PRISMA 2020‐compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(2), June.
    20. Ding Zhu & Mindan Wu & Yuan Cao & Shihua Lin & Nanxia Xuan & Chen Zhu & Wen Li & Huahao Shen, 2018. "Heated humidification did not improve compliance of positive airway pressure and subjective daytime sleepiness in obstructive sleep apnea syndrome: A meta-analysis," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-16, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0241536. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.