XPost: alt.health.virus.cure.alternatives, rec.sport.football.college   
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   The SARS-CoV-2 delta (B.1.617.2) variant is highly transmissible and   
   spreading globally, including in populations with high vaccination   
   rates. We aimed to investigate transmission and viral load kinetics   
   in vaccinated and unvaccinated individuals with mild delta variant   
   infection in the community.   
      
   Methods   
   Between Sept 13, 2020, and Sept 15, 2021, 602 community contacts   
   (identified via the UK contract-tracing system) of 471 UK COVID-19   
   index cases were recruited to the Assessment of Transmission and   
   Contagiousness of COVID-19 in Contacts cohort study and contributed   
   8145 upper respiratory tract samples from daily sampling for up to   
   20 days. Household and non-household exposed contacts aged 5 years   
   or older were eligible for recruitment if they could provide   
   informed consent and agree to self-swabbing of the upper respiratory   
   tract. We analysed transmission risk by vaccination status for 231   
   contacts exposed to 162 epidemiologically linked delta variant-   
   infected index cases. We compared viral load trajectories from fully   
   vaccinated individuals with delta infection (n=29) with unvaccinated   
   individuals with delta (n=16), alpha (B.1.1.7; n=39), and pre-alpha   
   (n=49) infections. Primary outcomes for the epidemiological analysis   
   were to assess the secondary attack rate (SAR) in household contacts   
   stratified by contact vaccination status and the index cases’   
   vaccination status. Primary outcomes for the viral load kinetics   
   analysis were to detect differences in the peak viral load, viral   
   growth rate, and viral decline rate between participants according   
   to SARS-CoV-2 variant and vaccination status.   
      
   Findings   
   The SAR in household contacts exposed to the delta variant was 25%   
   (95% CI 18–33) for fully vaccinated individuals compared with 38%   
   (24–53) in unvaccinated individuals. The median time between second   
   vaccine dose and study recruitment in fully vaccinated contacts was   
   longer for infected individuals (median 101 days [IQR 74–120]) than   
   for uninfected individuals (64 days [32–97], p=0·001). SAR among   
   household contacts exposed to fully vaccinated index cases was   
   similar to household contacts exposed to unvaccinated index cases   
   (25% [95% CI 15–35] for vaccinated vs 23% [15–31] for unvaccinated).   
   12 (39%) of 31 infections in fully vaccinated household contacts   
   arose from fully vaccinated epidemiologically linked index cases,   
   further confirmed by genomic and virological analysis in three index   
   case–contact pairs. Although peak viral load did not differ by   
   vaccination status or variant type, it increased modestly with age   
   (difference of 0·39 [95% credible interval –0·03 to 0·79] in peak   
   log10 viral load per mL between those aged 10 years and 50 years).   
   Fully vaccinated individuals with delta variant infection had a   
   faster (posterior probability >0·84) mean rate of viral load decline   
   (0·95 log10 copies per mL per day) than did unvaccinated individuals   
   with pre-alpha (0·69), alpha (0·82), or delta (0·79) variant   
   infections. Within individuals, faster viral load growth was   
   correlated with higher peak viral load (correlation 0·42 [95%   
   credible interval 0·13 to 0·65]) and slower decline (–0·44 [–0·67 to   
   –0·18]).   
      
   Interpretation   
   Vaccination reduces the risk of delta variant infection and   
   accelerates viral clearance. Nonetheless, fully vaccinated   
   individuals with breakthrough infections have peak viral load   
   similar to unvaccinated cases and can efficiently transmit infection   
   in household settings, including to fully vaccinated contacts.   
   Host–virus interactions early in infection may shape the entire   
   viral trajectory.   
      
   Funding   
   National Institute for Health Research.   
      
   https://www.thelancet.com/journals/laninf/article/PIIS1473-3099   
   (21)00648-4/fulltext   
      
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