National sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in India: Protocol for community-based surveillance

Abstract

Conducting population-based serosurveillance for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) will estimate and monitor the trend of infection in the adult general population, determine the socio-demographic risk factors and delineate the geographical spread of the infection. For this purpose, a serial cross-sectional survey would be conducted with a sample size of 24,000 distributed equally across four strata of districts categorized on the basis of the incidence of reported cases of COVID-19. Sixty districts will be included in the survey. Simultaneously, the survey will be done in 10 high-burden hotspot cities. ELISA-based antibody tests would be used. Data collection will be done using a mobile-based application. Prevalence from the group of districts in each of the four strata will be pooled to estimate the population prevalence of COVID-19 infection, and similarly for the hotspot cities, after adjusting for demographic characteristics and antibody test performance. The total number of reported cases in the districts and hotspot cities will be adjusted using this seroprevalence to estimate the expected number of infected individuals in the area. Such serosurveys repeated at regular intervals can also guide containment measures in respective areas. State-specific context of disease burden, priorities and resources should guide the use of multifarious surveillance options for the current COVID-19 epidemic. Kumar Muthusamy 1 ICMR School of Public Health, Chennai Bhatnagar Tarun 2 ICMR School of Public Health, Chennai Manickam Ponnaiah 3 ICMR-National Institute of Epidemiology, Chennai Kumar V 4 Division of Epidemiology & Bio-Statistics, Chennai Rade Kiran 5 WHO Country Office for India, New Delhi Shah Naman 6 Jan Swasthya Sahyog, Bilaspur, Chhattisgarh Kant Shashi 7 Centre for Community Medicine, Bengaluru Babu Giridhara 8 Indian Institute of Public Health-Bengaluru Zodpey Sanjay 9 Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi Girish Kumar C 10 ICMR-National Institute of Epidemiology, Chennai Vivian Thangaraj Jeromie 11 ICMR-National Institute of Epidemiology, Chennai Chatterjee Pranab 12 Translational Global Health Policy Research Cell (Department of Health Research), Indian Council of Medical Research, New Delhi Kanungo Suman 13 ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal Pandey Ravindra 14 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi Murhekar Manoj 15 ICMR-National Institute of Epidemiology, Chennai Singh Sujeet 16 National Centre for Disease Control, Delhi Sarkar Swarup 17 Translational Global Health Policy Research Cell (Department of Health Research), Indian Council of Medical Research, New Delhi Muliyi J 18 Independent Consultant, Vellore, Tamil Nadu Gangakhedkar Raman 19 Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi Reddy D.C.S 20 Independent Consultant, Lucknow, Uttar Pradesh World Health Organization. Coronavirus disease 2019 (COVID-19) situation report-90. Geneva: WHO; 2020. World Health Organization. Global surveillance for COVID-19 caused by human infection with COVID-19 virus: Interim guidance, 20 March 2020. Geneva: WHO; 2020. World Health Organization. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19); 16-24 February 2020. Geneva: WHO; 2020. Heneghan C, Brassey J, Jefferson T. COVID-19: What proportion are asymptomatic? The Centre for Evidence-Based Medicine; 6 April, 2020. Available from: https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/">https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/, accessed on April 24, 2020. World Health Organization. Coordinated global research roadmap: 2019 novel coronavirus; March 2020. Geneva: WHO; 2020. Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of Covid-19-Studies needed. N Engl J Med 2020; 382 : 1194-6. World Health Organization. Population-based age-stratified seroepidemiological investigation protocol for COVID-19 virus infection. Available from: https://www.who.int/publications-detail/population-based-age-stratified-seroepidemiological-investigation-protocol-for-covid-19-virus-infection">https://www.who.int/publications-detail/population-based-age-stratified-seroepidemiological-investigation-protocol-for-covid-19-virus-infection, accessed on April 24, 2020. National Institutes of Health. NIH begins study to quantify undetected cases of coronavirus infection. Available from: https://www.nih.gov/news-events/news-releases/nih-begins-study-quantify-undetected-cases-coronavirus-infection,">https://www.nih.gov/news-events/news-releases/nih-begins-study-quantify-undetected-cases-coronavirus-infection, accessed on April 20, 2020. Mallapaty S. Antibody tests suggest that coronavirus infections vastly exceed official counts. Available from: https://www.nature.com/articles/d41586-020-01095-0">https://www.nature.com/articles/d41586-020-01095-0, accessed on April 20, 2020. Finnish Institute for Health and Welfare (THL). Number of people with coronavirus infections may be dozens of times higher than the number of confirmed cases. Available from: https://thl.fi/en/web/thlfi-en/-/number-of-people-with-coronavirus-infections-may-be-dozens-of-times-higher-than-the-number-of-confirmed-cases">https://thl.fi/en/web/thlfi-en/-/number-of-people-with-coronavirus-infections-may-be-dozens-of-times-higher-than-the-number-of-confirmed-cases, accessed on April 27, 2020. Preliminary results of USC-LA County COVID-19 study released. Available from: https://pressroom.usc.edu/preliminary-results-of-usc-la-county-covid-19-study-released/">https://pressroom.usc.edu/preliminary-results-of-usc-la-county-covid-19-study-released/, accessed on April 27, 2020. Bendavid E, Mulaney B, Sood N, Shah S, Ling E, Bromley-Dulfano R, et al. COVID-19 antibody seroprevalence in Santa Clara county, California. MedRxiv; April 17, 2020. doi: https://doi.org/10.1101/2020.04.14.20062463. Saltzman J. Nearly a third of 200 blood samples taken in Chelsea show exposure to coronavirus. Available from: https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/">https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/, accessed on April 27, 2020. Fontanet A, Tondeur L, Madec Y, Grant R, Besombes C, Jolly N, et al. Cluster of COVID-19 in Northern France: A retrospective closed cohort study. medRxiv 2020; doi:10.1101/2020.04.18.20071134. Streek H, Hartmann G, Exner M, Schmid M. [Preliminary results and conclusions of the COVID-19 case cluster study (Gangelt municipality)]; 2020. Available from: https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt_0.pdf,">https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt_0.pdf, accessed on April 27, 2020. Thompson C, Grayson N, Paton R, Lourenço J, Penman B, Lee LN, et al. Neutralising antibodies to SARS coronavirus 2 in Scottish blood donors-A pilot study of the value of serology to determine population exposure. medRxiv 2020, doi:10.1101/2020.04.13.20060467. Department of Public Health and Environment. First set of results for COVID-19 blood test; 2020. Available from: https://www.sanmiguelcountyco.gov/CivicAlerts.aspx?AID=492">https://www.sanmiguelcountyco.gov/CivicAlerts.aspx?AID=492, accessed on April 27, 2020. Norén A. [Here you test if the care staff is immune to covid-19]. Available from: https://www.svt.se/nyheter/inrikes/har-testar-man-om-vardpersonalen-ar-immun?cmpid=del:tw:20200420:har-testar-man-om-vardpersonalen-ar-immun:nyh:lp">https://www.svt.se/nyheter/inrikes/har-testar-man-om-vardpersonalen-ar-immun?cmpid=del:tw:20200420:har-testar-man-om-vardpersonalen-ar-immun:nyh:lp, accessed on April 27, 2020. In Robbio (Pv) 22% have or have had Coronavirus. The mayor: test for everyone. Available from: https://www.tgcom24.mediaset.it/cronaca/a-robbio-pv-il-22-ha-o-ha-avuto-il-coronavirus-ok-del-sindaco-ai-test-per-tutti_17285128-202002a.shtml,">https://www.tgcom24.mediaset.it/cronaca/a-robbio-pv-il-22-ha-o-ha-avuto-il-coronavirus-ok-del-sindaco-ai-test-per-tutti_17285128-202002a.shtml, accessed on April 27, 2020. San Miguel County Colorado COVID-19 Dashboard. Available from: https://sanmiguelco.maps.arcgis.com/apps/opsdashboard/index.html#/56e682135d1d4128bee1a0426 aed1d10">https://sanmiguelco.maps.arcgis.com/apps/opsdashboard/index.html#/56e682135d1d4128bee1a0426 aed1d10, accessed on April 27, 2020. Conarck B, Chang D. Miami-Dade has tens of thousands of missed coronavirus infections, UM survey finds. Miami Herald; 2020. Available from: https://www.miamiherald.com/news/coronavirus/article242260406.html">https://www.miamiherald.com/news/coronavirus/article242260406.html, accessed on April 27, 2020. Up to 2.7 Million in New York May Have Been Infected, Antibody Study Finds. New York. Available from: https://www.nbcnewyork.com/news/local/new-york-virus-deaths-top-15k-cuomo-expected-to-detail-plan-to-fight-nursing-home-outbreaks/2386556/">https://www.nbcnewyork.com/news/local/new-york-virus-deaths-top-15k-cuomo-expected-to-detail-plan-to-fight-nursing-home-outbreaks/2386556/, accessed on April 27, 2020. Flahault A. Has China faced only a herald wave of SARS-CoV-2? Lancet 2020; 395 : 947. Abbasi J. The promise and peril of antibody testing for COVID-19. JAMA 2020; 323 : 1881-3.