Factors influencing the acquisition of COVID infection among high-risk contacts of COVID-19 patients in Madurai district-A case control study

Abstract

Introduction: COVID is a new disease; understanding the transmission dynamics and epidemiological characteristics may help in developing the effective control measures. The study is done 1. To determine the various factors influencing the acquisition of COVID-19 infection among high-risk contacts 2. To estimate the secondary attack rate among high-risk contacts 3. To determine the factors in COVID index cases influencing their secondary attack rate.

Methodology: Unmatched case control study was conducted from March to August 2020 among 139 COVID index cases in Madurai district from March-May (Reference period) and their 50 COVID positive (cases), 551 COVID negative (controls) high-risk contacts. Case investigation form* and contact tracing Proforma*were used to collect data. Chi-square test and independent sample t test were used to find out the association. Univariate* and Multivariate logistic regression* were used to predict the risk of various factors in acquisition of COVID infection with the help of adjusted and unadjusted odds ratio. P value < 0.05 was considered statistically significant.

Results: Male contacts (P = 0.005, OR = 2.520), overcrowding (P = 0.007, OR = 3.810), and duration of exposure to index case (for 4-7 days P = 0.014, OR = 2.902, for >7 days P = 0.001, OR = 6.748 and for > 12 hours/day P = 0.000, OR = 5.543) were significant factors predicted to be associated with acquisition of COVID infection among high-risk contacts. Reproductive number (R0)* estimated was 1.3. Secondary attack rate (SAR)* estimated among high-risk contacts was 8.32%. Index cases whose outcome was death (P = 0.026); symptomatic index cases (P = 0.000), cases with fever (P = 0.001); sorethroat (P = 0.019); breathlessness (P = 0.010); cough (P = 0.006) and running nose (P = 0.002) had significantly higher mean SAR than their counterparts.

Conclusion: Contacts with above said risk factors who were found to be more prone to infection could be given special focus to prevent the transmission in them.

Keywords: According to our study findings; Case investigation form; contact tracing proforma; multivariate logistic regression; reproductive number; secondary attack rate; univariate logistic regression; • Factors related to acquisition of COVID infection among high-risk contacts are presence of Overcrowding, increase in duration of exposure and Symptomatic status of Index cases.; • Knowledge on these risk factors may throw light in controlling future pandemic diseases following similar mode of transmission.; • Mass screening of the community for the symptoms like fever, cough, sore throat, running nose, and breathlessness at the primary level help in early diagnosis and isolation of affected individuals.; • Preventive measures like social distancing must be emphasized in the community as well as in the households having symptomatic family member..