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. 2021 Mar;9(3):e257-e266.
doi: 10.1016/S2214-109X(20)30544-1. Epub 2021 Jan 27.

SARS-CoV-2 antibody seroprevalence in India, August-September, 2020: findings from the second nationwide household serosurvey

Manoj V Murhekar  1 , Tarun Bhatnagar  2 , Sriram Selvaraju  3 , V Saravanakumar  2 , Jeromie Wesley Vivian Thangaraj  2 , Naman Shah  2 , Muthusamy Santhosh Kumar  2 , Kiran Rade  4 , R Sabarinathan  2 , Smita Asthana  5 , Rakesh Balachandar  6 , Sampada Dipak Bangar  7 , Avi Kumar Bansal  8 , Jyothi Bhat  9 , Vishal Chopra  10 , Dasarathi Das  11 , Alok Kumar Deb  12 , Kangjam Rekha Devi  13 , Gaurav Raj Dwivedi  14 , S Muhammad Salim Khan  15 , C P Girish Kumar  2 , M Sunil Kumar  16 , Avula Laxmaiah  17 , Major Madhukar  18 , Amarendra Mahapatra  11 , Suman Sundar Mohanty  19 , Chethana Rangaraju  20 , Alka Turuk  21 , Dinesh Kumar Baradwaj  17 , Ashrafjit S Chahal  10 , Falguni Debnath  12 , Inaamul Haq  15 , Arshad Kalliath  16 , Srikanta Kanungo  11 , Jaya Singh Kshatri  11 , G G J Naga Lakshmi  22 , Anindya Mitra  23 , A R Nirmala  24 , Ganta Venkata Prasad  22 , Mariya Amin Qurieshi  15 , Seema Sahay  7 , Ramesh Kumar Sangwan  19 , Krithikaa Sekar  3 , Vijay Kumar Shukla  25 , Prashant Kumar Singh  5 , Pushpendra Singh  9 , Rajeev Singh  14 , Dantuluri Sheethal Varma  22 , Ankit Viramgami  6 , Samiran Panda  21 , D C S Reddy  26 , Balram Bhargava  21 ; ICMR Serosurveillance Group
Collaborators, Affiliations

SARS-CoV-2 antibody seroprevalence in India, August-September, 2020: findings from the second nationwide household serosurvey

Manoj V Murhekar et al. Lancet Glob Health. 2021 Mar.

Abstract

Background: The first national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in India, done in May-June, 2020, among adults aged 18 years or older from 21 states, found a SARS-CoV-2 IgG antibody seroprevalence of 0·73% (95% CI 0·34-1·13). We aimed to assess the more recent nationwide seroprevalence in the general population in India.

Methods: We did a second household serosurvey among individuals aged 10 years or older in the same 700 villages or wards within 70 districts in India that were included in the first serosurvey. Individuals aged younger than 10 years and households that did not respond at the time of survey were excluded. Participants were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. 3-5 mL of venous blood was collected from each participant and blood samples were tested using the Abbott SARS-CoV-2 IgG assay. Seroprevalence was estimated after applying the sampling weights and adjusting for clustering and assay characteristics. We randomly selected one adult serum sample from each household to compare the seroprevalence among adults between the two serosurveys.

Findings: Between Aug 18 and Sept 20, 2020, we enrolled and collected serum samples from 29 082 individuals from 15 613 households. The weighted and adjusted seroprevalence of SARS-CoV-2 IgG antibodies in individuals aged 10 years or older was 6·6% (95% CI 5·8-7·4). Among 15 084 randomly selected adults (one per household), the weighted and adjusted seroprevalence was 7·1% (6·2-8·2). Seroprevalence was similar across age groups, sexes, and occupations. Seroprevalence was highest in urban slum areas followed by urban non-slum and rural areas. We estimated a cumulative 74·3 million infections in the country by Aug 18, 2020, with 26-32 infections for every reported COVID-19 case.

Interpretation: Approximately one in 15 individuals aged 10 years or older in India had SARS-CoV-2 infection by Aug 18, 2020. The adult seroprevalence increased approximately tenfold between May and August, 2020. Lower infection-to-case ratio in August than in May reflects a substantial increase in testing across the country.

Funding: Indian Council of Medical Research.

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Figures

Figure 1
Figure 1
Flowchart of participant enrolment
Figure 2
Figure 2
SARS-CoV-2 IgG seropositivity and incidence of reported COVID-19 cases per 1 million population by district, fitted with polynomial curves Points on the graph represent the 70 surveyed districts. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

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