Improving Estimates of Social Contact Patterns for Airborne Transmission of Respiratory Pathogens

Nicky McCreesh; Mbali Mohlamonyane; Anita Edwards; Stephen Olivier; Keabetswe Dikgale; Njabulo Dayi; Dickman Gareta; Robin Wood; Alison D. Grant; Richard G. White; Keren Middelkoop


Emerging Infectious Diseases. 2022;28(10):2016-2026. 

In This Article

Abstract and Introduction


Data on social contact patterns are widely used to parameterize age-mixing matrices in mathematical models of infectious diseases. Most studies focus on close contacts only (i.e., persons spoken with face-to-face). This focus may be appropriate for studies of droplet and short-range aerosol transmission but neglects casual or shared air contacts, who may be at risk from airborne transmission. Using data from 2 provinces in South Africa, we estimated age mixing patterns relevant for droplet transmission, nonsaturating airborne transmission, and Mycobacterium tuberculosis transmission, an airborne infection where saturation of household contacts occurs. Estimated contact patterns by age did not vary greatly between the infection types, indicating that widespread use of close contact data may not be resulting in major inaccuracies. However, contact in persons ≥50 years of age was lower when we considered casual contacts, and therefore the contribution of older age groups to airborne transmission may be overestimated.


Mathematical models of infectious disease transmission are widely used to help develop infectious disease policy, estimate the potential effect of interventions, and provide insight into disease dynamics and natural history. Many models incorporate patterns of mixing between different sections of the population, most commonly between different age groups. Simulated mixing patterns can have a considerable effect on model dynamics,[1] underscoring the importance of simulating realistic mixing patterns. Mixing patterns are frequently shaped by social contact data (i.e., empirical data collected from respondents about the persons with whom they had contact during a set period).[2]

Most social contact data collection has focused on close contacts, using a definition of contacts that required a 2-way face-to-face conversation of ≥3 words, close proximity (e.g., within 2 meters), physical contact, or some combination of those criteria.[2] Those types of contact may approximate reasonably well the types of contact that are relevant for infections that are transmitted primarily through direct contact, short range aerosols, droplets, or some combination of these modes. For obligate, preferential, or opportunistic airborne infections such as measles, Mycobacterium tuberculosis, and SARS-CoV-2, however, this definition probably excludes many potentially effective contacts because transmission of airborne infections can occur between anybody sharing air in inadequately ventilated indoor spaces, regardless of whether conversation occurs, and over distances >2 meters.[3] For airborne infections, estimates of casual contact time may therefore be more appropriate, calculated as the time spent in indoor locations multiplied by the number of other persons present.

Tuberculosis also differs from most respiratory infections in terms of the long periods during which persons are potentially infectious; an estimated 9–36 months elapses between disease development and diagnosis (or notification) in 11 countries with high tuberculosis incidences.[4] Therefore, transmission to repeated contacts can partially saturate (even allowing for reinfection), making the relationship between contact time and infection risk nonlinear.[5] This effect is most pronounced for contact between household members.[5] Household membership and repeated contacts are rarely explicitly simulated in mathematical models, and therefore the effects of contact saturation need to be incorporated into the mixing matrices used to parameterize the models.

In this article, we describe methods for estimating age-mixing patterns relevant for nonsaturating airborne transmission and M. tuberculosis transmission by using a novel weighted approach to incorporate the effects of household contact saturation into our estimates for M. tuberculosis. We generate estimates of age mixing using data on close and casual contacts from 2 communities in South Africa and compare the estimated mixing patterns with those typically used in mathematical modeling studies (i.e., generated using close contact numbers, and more suitable for droplet or short range aerosol transmission).