Second round statewide sentinel-based population survey for estimation of the burden of active infection and anti-SARS-CoV-2 IgG antibodies in the general population of Karnataka, India, during January-February 2021

Abstract

Objective: Demonstrate the feasibility of using the existing sentinel surveillance infrastructure to conduct the second round of the serial cross-sectional sentinel-based population survey. Assess active infection, seroprevalence, and their evolution in the general population across Karnataka. Identify local variations for locally appropriate actions. Additionally, assess the clinical sensitivity of the testing kit used on account of variability of antibody levels in the population.

Methods: The cross-sectional study of 41,228 participants across 290 healthcare facilities in all 30 districts of Karnataka was done among three groups of participants (low, moderate, and high-risk). The geographical spread was sufficient to capture local variations. Consenting participants were subjected to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, and antibody (IgG) testing. Clinical sensitivity was assessed by conducting a longitudinal study among participants identified as COVID-19 positive in the first survey round.

Results: Overall weighted adjusted seroprevalence of IgG was 15.6% (95% CI: 14.9-16.3), crude IgG prevalence was 15.0% and crude active infection was 0.5%. Statewide infection fatality rate (IFR) was estimated as 0.11%, and COVID-19 burden estimated between 26.1 to 37.7% (at 90% confidence). Further, Cases-to-infections ratio (CIR) varied 3-35 across units and IFR varied 0.04-0.50% across units. Clinical sensitivity of the IgG ELISA test kit was estimated as ≥38.9%.

Conclusion: We demonstrated the feasibility and simplicity of sentinel-based population survey in measuring variations in subnational and local data, useful for locally appropriate actions in different locations. The sentinel-based population survey thus helped identify districts that needed better testing, reporting, and clinical management. The state was far from attaining natural immunity during the survey and hence must step up vaccination coverage and enforce public health measures to prevent the spread of COVD-19.

Keywords: Karnataka; SARS-CoV-2; clinical sensitivity; sentinel survey; serosurvey.

Figure 1

Comparing Immunoglobulin G (IgG) prevalence across Round 1 and Round 2, IgG increased in about 21/38 units (above the line) while it decreased in 17/38 units (below the line).

Figure 2

Cases-to-infections ration (CIR) as a function of urbanisation. Observe that the higher the urbanisation value, the lower the CIR. Some locations with lesser urbanisation also have lower CIR. However, some others have higher CIR, suggesting that these units are missing regions of circulation of the virus and could benefit from increased surveillance.

Figure 3

The infection fatality rate (IFR) versus the cases-to-infections ratio (CIR) in the districts of Karnataka. Districts in the top-left quadrant, with low IFR and high CIR, may have to re-evaluate both their testing strategies and death reporting.