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Background Comparative data are limited on the transmission of respiratory infections positive and negative for SARS-CoV-2 in households with children. Methods In June to August 2020, we recruited 700 participants (175 households, 376 children, 324 adults) to be prospectively followed for all respiratory tract infections. Follow-up lasted from recruitment until April 2022. Daily symptoms were monitored by weekly electronic questionnaires. SARS-CoV-2 polymerase chain reaction testing from nasopharyngeal specimens was performed for symptomatic participants and twice (1-week interval) for the household members of positive participants. Clinical features and secondary attack rates (SARs) based on the onset of symptoms were compared between respiratory infections that were SARS-CoV-2 positive and negative. Results Most SARS-CoV-2 infections (90%) occurred from January to April 2022 when Omicron BA.1 and BA.2 were the dominant variants. SARS-CoV-2–positive infections were transmitted more often than SARS-CoV-2–negative infections (SAR, 41% vs 24%; P <.001). SARS-CoV-2 transmission was similar for child and adult index cases (SAR, 40% vs 43%; P =.47), but the transmission of SARS-CoV-2–negative infections was higher for child index cases (SAR, 27% vs 18%; P <.001). Conclusions Our findings demonstrate that SARS-CoV-2 Omicron viruses spread more effectively within households as compared with other respiratory infections. [ABSTRACT FROM AUTHOR]