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Background: Households studies reflect the natural spread of SARS-CoV-2 in immunologically naive populations with limited preventive measures to control transmission.We hypothesise that seropositivity provides more accurate household attack rates than RT-PCR. Here, we investigated the importance of age in household transmission dynamics. Methods: We enroled 112 households (291 participants) in a case-ascertained study in Bergen, Norway from 28th February to 4th April 2020, collecting demographic and clinical data from index patients and household members. SARS-CoV-2-specific antibodies were measured in sera collected 6–8 weeks after index patient nasopharyngeal testing to define household attack rates. Findings: The overall attack rate was 45% (95% CI 38–53) assessed by serology, and 47% when also including seronegative RT-PCR positives. Serology identified a higher number of infected household members than RT-PCR. Attack rates were equally high in children (48%) and young adults (42%). The attack rate was 16% in asymptomatic household members and 42% in RT-PCR negative contacts. Older adults had higher antibody titres than younger adults. The risk of household transmission was higher when the index patient had fever (aOR 3.31 [95% CI 1.52–7.24]; p = 0.003) or dyspnoea (aOR 2.25 [95% CI 1.80–4.62]; p = 0.027) during acute illness. Interpretation: Serological assays provide more sensitive and robust estimates of household attack rates than RT-PCR. Children are equally susceptible to infection as young adults. Negative RT-PCR or lack of symptoms are not sufficient to rule out infection in household members. Funding: Helse Vest (F-11628), Trond Mohn Foundation (TMS2020TMT05). Abstrakt: Bakgrunn: Studier av husstander gjenspeiler den naturlige spredningen av SARS-CoV-2 blant ikke-immune populasjoner med begrensede tiltak for å forebygge smittespredning. Vår hypotese er at antistoff-påvisning gir mer nøyaktige angrepsrater i husstander sammenliknet med RT-PCR. Her undersøker vi betydnignenngen betydningen av alder i smittespredningen. Metoder: Vi rekrutterte 112 husstander (291 studiedeltakere) i en indeks kasus-bekreftet studie i Bergen, Norge fra 28.02.2020 til 04.04.2020, og samlet inn demografiske og kliniske data fra indekspasienter og deres husstandsmedlemmer. Angrepsrate i husstander ble beregnet ved å måle SARS-CoV-2-spesifikke antistoffer i sera samlet 6–8 uker etter nasofarynksprøve av indekspasienten. Funn: Den totale angrepsraten var 45% (95% KI 38–53) vurdert ved serologi, og 47% ved å inkludere antistoff negative, RT-PCR positive husstandsmedlemmer. Spesifikke antistoffer identifiserer en høyere andel infiserte husstandsmedlemmer sammenliknet med RT-PCR. Angrepsraten var like høy hos barn (48%) og unge voksne (42%). Angrepsraten var 16% hos personer uten symptomer og 42% hos RT-PCR negative husstandsmedlemmer. Eldre voksne hadde høyere antistoff titre enn yngre voksne. Risiko for smitte i husstander var høyere når indekspasienten hadde feber (aOR 3.31 [95% KI 1.52–7.24]; p = 0.003) eller dyspne (aOR 2.25 [95% KI 1.80–4.62]; p = 0.027) under akuttfasen. Tolkning: Serologiske analyser gir mer sensitive og robuste estimater av angrepsrate i husstander sammenliknet med RT-PCR. Barn er like utsatt for infeksjon som voksne. Negativ RT-PCR eller fravær av symptomer er ikke tilstrekkelige for å utelukke infeksjon blant husstandsmedlemmer. Finansiering: Helse Vest (F-11628), Trond Mohn Stiftelse (TMS2020TMT05).

Summary: A systematic infection control program is found to be an important tool to reduce hospital-associated infections (HAIs) and surveillance of infection is a significant part of it. The aim of this paper was to present the result from 17 years continuous prevalence studies after implementation of a systematic infection control program, to examine trends of hospital-associated infections and to study possible risk factors for different sites of infection.Data from 61 399 in-patients at Haukeland University Hospital, Norway, from 1994 to 2010 was included in the study. Overall prevalence of HAIs was 7.6%. There was a reduction in HAIs from 8.3% in 1994 to 7.1% in 2010 (relative decrease 14.4%), mostly attributable to a significant reduction in the prevalence of urinary tract infections (UTI). For surgical site infections (SSI) we found a borderline significant increase (p = 0.05). Male gender (except for UTI), urinary tract catheter and surgical operation were all strong predictors for HAIs. Higher age was a risk factor for all infection types, except for BSI.In conclusion, repeated prevalence surveys demonstrated a significant reduction in HAIs but no decrease in hospital-associated BSI, LRTI and SSI. There was, however, a rapid decline of UTI and other less severe HAIs. Keywords: Hospital-associated infection, Prevalence, Risk factors, Infection control program