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. 2020;152(1 & 2):48-60.
doi: 10.4103/ijmr.IJMR_3290_20.

Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May-June 2020

Manoj V Murhekar  1 , Tarun Bhatnagar  2 , Sriram Selvaraju  3 , Kiran Rade  4 , V Saravanakumar  5 , Jeromie Wesley Vivian Thangaraj  2 , Muthusamy Santhosh Kumar  2 , Naman Shah  6 , R Sabarinathan  5 , Alka Turuk  7 , Parveen Kumar Anand  8 , Smita Asthana  9 , Rakesh Balachandar  10 , Sampada Dipak Bangar  11 , Avi Kumar Bansal  12 , Jyothi Bhat  13 , Debjit Chakraborty  14 , Chethana Rangaraju  15 , Vishal Chopra  16 , Dasarathi Das  17 , Alok Kumar Deb  14 , Kangjam Rekha Devi  18 , Gaurav Raj Dwivedi  19 , S Muhammad Salim Khan  20 , Inaamul Haq  20 , M Sunil Kumar  21 , Avula Laxmaiah  22 , Madhuka  23 , Amarendra Mahapatra  17 , Anindya Mitra  24 , A R Nirmala  25 , Avinash Pagdhune  26 , Mariya Amin Qurieshi  20 , Tekumalla Ramarao  27 , Seema Sahay  28 , Y K Sharma  29 , Marinaik Basavegowdanadoddi Shrinivasa  30 , Vijay Kumar Shukla  29 , Prashant Kumar Singh  31 , Ankit Viramgami  26 , Vimith Cheruvathoor Wilson  3 , Rajiv Yadav  13 , C P Girish Kumar  32 , Hanna Elizabeth Luke  33 , Uma Devi Ranganathan  34 , Subash Babu  35 , Krithikaa Sekar  3 , Pragya D Yadav  36 , Gajanan N Sapkal  37 , Aparup Das  38 , Pradeep Das  39 , Shanta Dutta  40 , Rajkumar Hemalatha  41 , Ashwani Kumar  42 , Kanwar Narain  43 , Somashekar Narasimhaiah  44 , Samiran Panda  45 , Sanghamitra Pati  17 , Shripad Patil  46 , Kamalesh Sarkar  47 , Shalini Singh  48 , Rajni Kant  19 , Srikanth Tripathy  49 , G S Toteja  50 , Giridhara R Babu  51 , Shashi Kant  52 , J P Muliyil  53 , Ravindra Mohan Pandey  54 , Swarup Sarkar  55 , Sujeet K Singh  56 , Sanjay Zodpey  57 , Raman R Gangakhedkar  55 , D C S Reddy  58 , Balram Bhargava  59
Affiliations

Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May-June 2020

Manoj V Murhekar et al. Indian J Med Res. 2020.

Abstract

Background & objectives: Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India.

Methods: From May 11 to June 4, 2020, a randomly sampled, community-based survey was conducted in 700 villages/wards, selected from the 70 districts of the 21 States of India, categorized into four strata based on the incidence of reported COVID-19 cases. Four hundred adults per district were enrolled from 10 clusters with one adult per household. Serum samples were tested for IgG antibodies using COVID Kavach ELISA kit. All positive serum samples were re-tested using Euroimmun SARS-CoV-2 ELISA. Adjusting for survey design and serial test performance, weighted seroprevalence, number of infections, infection to case ratio (ICR) and infection fatality ratio (IFR) were calculated. Logistic regression was used to determine the factors associated with IgG positivity.

Results: Total of 30,283 households were visited and 28,000 individuals were enrolled. Population-weighted seroprevalence after adjusting for test performance was 0.73 per cent [95% confidence interval (CI): 0.34-1.13]. Males, living in urban slums and occupation with high risk of exposure to potentially infected persons were associated with seropositivity. A cumulative 6,468,388 adult infections (95% CI: 3,829,029-11,199,423) were estimated in India by the early May. The overall ICR was between 81.6 (95% CI: 48.3-141.4) and 130.1 (95% CI: 77.0-225.2) with May 11 and May 3, 2020 as plausible reference points for reported cases. The IFR in the surveyed districts from high stratum, where death reporting was more robust, was 11.72 (95% CI: 7.21-19.19) to 15.04 (9.26-24.62) per 10,000 adults, using May 24 and June 1, 2020 as plausible reference points for reported deaths.

Interpretation & conclusions: Seroprevalence of SARS-CoV-2 was low among the adult population in India around the beginning of May 2020. Further national and local serosurveys are recommended to better inform the public health strategy for containment and mitigation of the epidemic in various parts of the country.

Keywords: Antibody; COVID-19; ELISA; IgG; India; SARS-CoV-2; seroepidemiology; seroprevalence; serosurveillance.

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Conflict of interest statement

None

References

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