What is already known about this topic? The SARS-CoV-2 B.1.1.529 (Omicron) Variants contributed to a surge of SARS-CoV-2 infections in the U.S. during December 2021–January 2022.

What is added by this report? In a study of household Transmission in four U.S. jurisdictions, Omicron infection resulted in high Transmission among household contacts, particularly among those who lived with index patients who were not vaccinated or who did not take measures to reduce the risk of Transmission to household contacts.

What are the implications for public health practice? Multicomponent COVID-19 Prevention strategies, including up-to-date vaccination, isolation of infected persons, and mask use at home, are important to reduce Omicron Transmission in household settings.

The B.1.1.529 (Omicron) Variants, first detected in November 2021, was responsible for a surge in U.S. infections with SARS-CoV-2, the Virus that causes COVID-19, during December 2021–January 2022 (1). To investigate the effectiveness of Prevention strategies in household settings, CDC partnered with four U.S. jurisdictions to describe Omicron household Transmission during November 2021–February 2022. Persons with sequence-confirmed Omicron infection and their household contacts were interviewed. Omicron Transmission occurred in 124 (67.8%) of 183 households. Among 431 household contacts, 227 were classified as having a case of COVID-19 (attack rate [AR] = 52.7%).† The ARs among household contacts of index patients who had received a COVID-19 booster dose, of fully vaccinated index patients who completed their COVID-19 primary series within the previous 5 months, and of unvaccinated index patients were 42.7% (47 of 110), 43.6% (17 of 39), and 63.9% (69 of 108), respectively. The AR was lower among household contacts of index patients who isolated (41.2%, 99 of 240) compared with those of index patients who did not isolate (67.5%, 112 of 166) (p-value <0.01). Similarly, the AR was lower among household contacts of index patients who ever wore a mask at home during their potentially infectious period (39.5%, 88 of 223) compared with those of index patients who never wore a mask at home (68.9%, 124 of 180) (p-value <0.01). Multicomponent COVID-19 Prevention strategies, including up-to-date vaccination, isolation of infected persons, and mask use at home, are critical to reducing Omicron Transmission in household settings.

Persons with sequence-confirmed Omicron Variants infections during November 2021–February 2022 were identified from four U.S. jurisdictions (Chicago, Illinois; Connecticut; Milwaukee, Wisconsin; and Utah) and contacted by telephone to assess eligibility of the household to participate in the investigation.§ A household was eligible if the index patient did not live in a congregate setting and did live with at least one other person for most of their potentially infectious period, defined as 2 days before through 10 days after the index date (the date of the index patient’s positive SARS-CoV-2 nucleic acid amplification test result or antigen test result or symptom onset, whichever occurred first). Index patients were defined as the first person within each household to recently experience COVID-19–compatible symptoms¶ or have a positive SARS-CoV-2 test result. Household contacts were defined as any persons who spent one or more overnights in the residence with the index patient during their potentially infectious period. If it was unclear who within the household was the index patient (e.g., if multiple persons developed COVID-19–compatible symptoms in the household on the same day or had the same SARS-CoV-2 exposure) or if household contacts had confirmed or probable cases and were known to have a SARS-CoV-2 exposure to someone other than the index patient, the household was excluded from analyses.

Suggested citation for this article: Baker JM, Nakayama JY, O’Hegarty M, et al. SARS-CoV-2 B.1.1.529 (Omicron) Variant Transmission Within Households — Four U.S. Jurisdictions, November 2021–February 2022. MMWR Morb Mortal Wkly Rep. ePub: 25 February 2022.

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