Comparative transmissibility of SARS-CoV-2, influenza virus, and common human coronaviruses in the post-pandemic era: a community- and household-based prospective cohort study in China

Comparative transmissibility of SARS-CoV-2, influenza virus, and common human coronaviruses in the post-pandemic era: a community- and household-based prospective cohort study in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Comparative transmissibility of SARS-CoV-2, influenza virus, and common human coronaviruses in the post-pandemic era: a community- and household-based prospective cohort study in China Hualei Xin, Chuchu Ye, Jianxing Yu, Liqun Fang, Shengjie Lai, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9045299/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted You are reading this latest preprint version Abstract Despite continuous viral evolution, it remains unclear whether SARS-CoV-2 has transitioned to transmission dynamics resembling those of other endemic respiratory pathogens in the post-pandemic era. During 2023–2025, we compared post-pandemic SARS-CoV-2 transmissibility with influenza virus (IFV) and common human coronaviruses (HCoV) transmissibility and SARS-CoV-2 transmissibility during and after the pandemic. Among 7,399 participants in 1,764 households, there were 704 acute-respiratory-infection index cases and 2,684 household contacts. Healthcare-seeking was higher for SARS-CoV-2 (17.6%) and IFV (28.1%) than HCoVs (9.8%). Post-pandemic SARS-CoV-2 household secondary attack risk (HSAR) (7.9%) was comparable to IFV (7.0%) and higher than HCoV (4.4%;P<0.05). Older adults had highest SARS-CoV-2 and HCoV transmissibility; children had highest IFV transmissibility, correlated with peak viral loads. Post-pandemic SARS-CoV-2 HSAR was lower than pandemic-period Omicron HSAR (adjusted odds ratio:3.30;95%CI:1.82–5.98) and Delta-period HSAR (aOR:2.46;95%CI:1.27–4.79). Pre-symptomatic transmission was observed for all three pathogens, highest for SARS-CoV-2 (35.7%). Our findings indicate that SARS-CoV-2 maintains high household transmissibility and requires substantial medical resources in the post-pandemic era, and non-pharmaceutical interventions and vaccination strategies that account for age-specific transmissibility and susceptibility merit study and consideration. Health sciences/Diseases/Infectious diseases/Viral infection Health sciences/Risk factors Full Text Additional Declarations Yes there is potential Competing Interest. BJC consults for AstraZeneca, Fosun Pharma, GlaxoSmithKline, Moderna, Pfizer, Roche and Sanofi Pasteur. The other authors report no other potential conflicts of interest. We confirm that this study was approved by the Institutional Review Board of the Chinese Academy of Medical Sciences & Peking Union Medical College (Approval No. CAMS&PUMC-IEC-2024-068). Written informed consent was obtained from all adult participants and from parents or legal guardians for minors prior to enrollment. Supplementary Files Supplementary.docx Supplementary materials for the manuscript. Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9045299","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":603352798,"identity":"2b25a070-6537-4a31-872e-b41294a5c671","order_by":0,"name":"Hualei Xin","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Hualei","middleName":"","lastName":"Xin","suffix":""},{"id":603352799,"identity":"24020484-a949-4d81-9f41-d30002bbad0a","order_by":1,"name":"Chuchu Ye","email":"","orcid":"","institution":"Shanghai Pudong New Area Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Chuchu","middleName":"","lastName":"Ye","suffix":""},{"id":603352800,"identity":"fb960c07-6dcc-47c3-bb52-73ac090a3f3a","order_by":2,"name":"Jianxing Yu","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jianxing","middleName":"","lastName":"Yu","suffix":""},{"id":603352801,"identity":"6df00f9c-075d-4335-90b2-dc288695031c","order_by":3,"name":"Liqun Fang","email":"","orcid":"https://orcid.org/0000-0002-4981-1483","institution":"State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Liqun","middleName":"","lastName":"Fang","suffix":""},{"id":603352802,"identity":"c31fe0b0-ca2d-4bc1-806c-beb50453c260","order_by":4,"name":"Shengjie Lai","email":"","orcid":"https://orcid.org/0000-0001-9781-8148","institution":"University of Southampton","correspondingAuthor":false,"prefix":"","firstName":"Shengjie","middleName":"","lastName":"Lai","suffix":""},{"id":603352803,"identity":"6109e1b4-b890-41a7-9f45-fd168fa634ad","order_by":5,"name":"Zhanwei Du","email":"","orcid":"","institution":"Southern University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Zhanwei","middleName":"","lastName":"Du","suffix":""},{"id":603352804,"identity":"c302e4fe-e7ac-4758-8ade-3f78621f5160","order_by":6,"name":"Li Zhang","email":"","orcid":"","institution":"Shanghai Pudong New Area Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhang","suffix":""},{"id":603352805,"identity":"d462d18f-8c3b-4168-854a-ddbe859f5659","order_by":7,"name":"Zhe Wang","email":"","orcid":"","institution":"Hangzhou Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Zhe","middleName":"","lastName":"Wang","suffix":""},{"id":603352806,"identity":"10561246-3926-4823-a87a-8e1f7219717a","order_by":8,"name":"Benjamin Cowling","email":"","orcid":"https://orcid.org/0000-0002-6297-7154","institution":"University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"","lastName":"Cowling","suffix":""},{"id":603352807,"identity":"4d7ca51d-6968-4fbe-acd5-4d0fe6cf899f","order_by":9,"name":"Peng Wu","email":"","orcid":"https://orcid.org/0000-0003-1157-9401","institution":"The University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Peng","middleName":"","lastName":"Wu","suffix":""},{"id":603352808,"identity":"c42caeca-b2f4-4b7d-8962-76b83a9a7585","order_by":10,"name":"Tim Tsang","email":"","orcid":"","institution":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Tim","middleName":"","lastName":"Tsang","suffix":""},{"id":603352809,"identity":"76812d9a-09e9-4628-84ac-3751d5b9ca40","order_by":11,"name":"Nancy H.L. 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BJC consults for AstraZeneca, Fosun Pharma, GlaxoSmithKline, Moderna, Pfizer, Roche and Sanofi Pasteur. The other authors report no other potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003eWe confirm that this study was approved by the Institutional Review Board of the Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College (Approval No. CAMS\u0026amp;PUMC-IEC-2024-068). 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