Household transmission of SARS-CoV-2 in a rural area in South Africa
Background. Patterns of SARS‐CoV‐2 spread have varied by geolocation, with differences in seroprevalence between urban and rural areas, and between waves. Household spread of SARS‐CoV‐2 is a known source of new COVID‐19 infections, with rural areas in sub‐Saharan Africa being more prone than ur...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
South African Medical Association
2024-02-01
|
| Series: | South African Medical Journal |
| Subjects: | |
| Online Access: | https://samajournals.co.za/index.php/samj/article/view/1159 |
| _version_ | 1797194719204212736 |
|---|---|
| author | G Maimela C E Martin M Chersich B Bello J Mauti T Bäernighausen S Kohler A Almuedo-Riera S Luchters S Sawry |
| author_facet | G Maimela C E Martin M Chersich B Bello J Mauti T Bäernighausen S Kohler A Almuedo-Riera S Luchters S Sawry |
| author_sort | G Maimela |
| collection | DOAJ |
| description |
Background. Patterns of SARS‐CoV‐2 spread have varied by geolocation, with differences in seroprevalence between urban and rural areas, and between waves. Household spread of SARS‐CoV‐2 is a known source of new COVID‐19 infections, with rural areas in sub‐Saharan Africa being more prone than urban areas to COVID‐19 transmission because of limited access to water in some areas, delayed health‐ seeking behaviour and poor access to care.
Objectives. To explore SARS‐CoV‐2 infection incidence and transmission in rural households in South Africa (SA).
Methods. We conducted a prospective household cluster investigation between 13 April and 21 July 2021 in the Matjhabeng subdistrict, a rural area in Free State Province, SA. Adults with SARS‐CoV‐2 confirmed by polymerase chain reaction (PCR) tests (index cases, ICs) and their household contacts (HCs) were enrolled. Household visits conducted at enrolment and on days 7, 14 and 28 included interviewer‐ administered questionnaires and respiratory and blood sample collection for SARS‐CoV‐2 PCR and SARS‐CoV‐2 immunoglobulin G serological testing, respectively. Co‐primary cases were HCs with a positive SARS‐CoV‐2 PCR test at enrolment. The incidence rate (IR), using the Poisson distribution, was HCs with a new positive PCR and/or serological test per 1 000 person‐days. Associations between outcomes and HC characteristics were adjusted for intra‐cluster correlation using robust standard errors. The secondary infection rate (SIR) was the proportion of new COVID‐19 infections among susceptible HCs.
Results. Among 23 ICs and 83 HCs enrolled, 10 SARS‐CoV‐2 incident cases were identified, giving an IR of 5.8 per 1 000 person‐days (95% confidence interval (CI) 3.14 ‐ 11.95). Households with a co‐primary case had higher IRs than households without a co‐primary case (crude IR 14.16 v. 1.75, respectively; p=0.054). HIV infection, obesity and the presence of chronic conditions did not materially alter the crude IR. The SIR was 15.9% (95% CI 7.90 ‐ 29.32). Households with a lower household density (fewer household members per bedroom) had a higher IR (IR 9.58; 95% CI 4.67 ‐ 21.71) than households with a higher density (IR 3.06; 95% CI 1.00 ‐ 12.35).
Conclusion. We found a high SARS‐CoV‐2 infection rate among HCs in a rural setting, with 48% of households having a co‐primary case at the time of enrolment. Households with co‐primary cases were associated with a higher seroprevalence and incidence of SARS‐CoV‐2. Sociodemographic and health characteristics were not associated with SARS‐CoV‐2 transmission in this study, and we did not identify any transmission risks inherent to a rural setting.
|
| first_indexed | 2024-04-24T06:00:45Z |
| format | Article |
| id | doaj.art-3e3c53462e87411380be1fdc282ad5ec |
| institution | Directory Open Access Journal |
| issn | 0256-9574 2078-5135 |
| language | English |
| last_indexed | 2024-04-24T06:00:45Z |
| publishDate | 2024-02-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj.art-3e3c53462e87411380be1fdc282ad5ec2024-04-23T07:47:52ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352024-02-01114210.7196/SAMJ.2024.v114i2.1159Household transmission of SARS-CoV-2 in a rural area in South AfricaG Maimela0https://orcid.org/0000-0002-7704-6803C E Martin1https://orcid.org/0000-0002-8177-1944M Chersich2https://orcid.org/0000-0002-4320-9168B Bello3https://orcid.org/0000-0001-9167-2045J Mauti4https://orcid.org/0000-0003-0949-4417T Bäernighausen5https://orcid.org/0000-0002-4182-4212S Kohler6https://orcid.org/0000-0003-1365-7506A Almuedo-Riera7https://orcid.org/0000-0003-4643-4456S Luchters8https://orcid.org/0000-0001-5235-5629S Sawry9https://orcid.org/0000-0002-3845-4863Wits RHI, University of the Witwatersrand, Johannesburg, South AfricaWits RHI, University of the Witwatersrand, Johannesburg, South AfricaWits RHI, University of the Witwatersrand, Johannesburg, South AfricaCentre for Statistical Analysis and Research, Johannesburg, South AfricaHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, GermanyHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, GermanyHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, GermanyISGlobal, Hospital Clinic, University of Barcelona, SpainCentre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Liverpool School of Tropical Medicine, Liverpool, UKWits RHI, University of the Witwatersrand, Johannesburg, South Africa Background. Patterns of SARS‐CoV‐2 spread have varied by geolocation, with differences in seroprevalence between urban and rural areas, and between waves. Household spread of SARS‐CoV‐2 is a known source of new COVID‐19 infections, with rural areas in sub‐Saharan Africa being more prone than urban areas to COVID‐19 transmission because of limited access to water in some areas, delayed health‐ seeking behaviour and poor access to care. Objectives. To explore SARS‐CoV‐2 infection incidence and transmission in rural households in South Africa (SA). Methods. We conducted a prospective household cluster investigation between 13 April and 21 July 2021 in the Matjhabeng subdistrict, a rural area in Free State Province, SA. Adults with SARS‐CoV‐2 confirmed by polymerase chain reaction (PCR) tests (index cases, ICs) and their household contacts (HCs) were enrolled. Household visits conducted at enrolment and on days 7, 14 and 28 included interviewer‐ administered questionnaires and respiratory and blood sample collection for SARS‐CoV‐2 PCR and SARS‐CoV‐2 immunoglobulin G serological testing, respectively. Co‐primary cases were HCs with a positive SARS‐CoV‐2 PCR test at enrolment. The incidence rate (IR), using the Poisson distribution, was HCs with a new positive PCR and/or serological test per 1 000 person‐days. Associations between outcomes and HC characteristics were adjusted for intra‐cluster correlation using robust standard errors. The secondary infection rate (SIR) was the proportion of new COVID‐19 infections among susceptible HCs. Results. Among 23 ICs and 83 HCs enrolled, 10 SARS‐CoV‐2 incident cases were identified, giving an IR of 5.8 per 1 000 person‐days (95% confidence interval (CI) 3.14 ‐ 11.95). Households with a co‐primary case had higher IRs than households without a co‐primary case (crude IR 14.16 v. 1.75, respectively; p=0.054). HIV infection, obesity and the presence of chronic conditions did not materially alter the crude IR. The SIR was 15.9% (95% CI 7.90 ‐ 29.32). Households with a lower household density (fewer household members per bedroom) had a higher IR (IR 9.58; 95% CI 4.67 ‐ 21.71) than households with a higher density (IR 3.06; 95% CI 1.00 ‐ 12.35). Conclusion. We found a high SARS‐CoV‐2 infection rate among HCs in a rural setting, with 48% of households having a co‐primary case at the time of enrolment. Households with co‐primary cases were associated with a higher seroprevalence and incidence of SARS‐CoV‐2. Sociodemographic and health characteristics were not associated with SARS‐CoV‐2 transmission in this study, and we did not identify any transmission risks inherent to a rural setting. https://samajournals.co.za/index.php/samj/article/view/1159COVID-19South Africahousehold transmissionincidencerural |
| spellingShingle | G Maimela C E Martin M Chersich B Bello J Mauti T Bäernighausen S Kohler A Almuedo-Riera S Luchters S Sawry Household transmission of SARS-CoV-2 in a rural area in South Africa South African Medical Journal COVID-19 South Africa household transmission incidence rural |
| title | Household transmission of SARS-CoV-2 in a rural area in South Africa |
| title_full | Household transmission of SARS-CoV-2 in a rural area in South Africa |
| title_fullStr | Household transmission of SARS-CoV-2 in a rural area in South Africa |
| title_full_unstemmed | Household transmission of SARS-CoV-2 in a rural area in South Africa |
| title_short | Household transmission of SARS-CoV-2 in a rural area in South Africa |
| title_sort | household transmission of sars cov 2 in a rural area in south africa |
| topic | COVID-19 South Africa household transmission incidence rural |
| url | https://samajournals.co.za/index.php/samj/article/view/1159 |
| work_keys_str_mv | AT gmaimela householdtransmissionofsarscov2inaruralareainsouthafrica AT cemartin householdtransmissionofsarscov2inaruralareainsouthafrica AT mchersich householdtransmissionofsarscov2inaruralareainsouthafrica AT bbello householdtransmissionofsarscov2inaruralareainsouthafrica AT jmauti householdtransmissionofsarscov2inaruralareainsouthafrica AT tbaernighausen householdtransmissionofsarscov2inaruralareainsouthafrica AT skohler householdtransmissionofsarscov2inaruralareainsouthafrica AT aalmuedoriera householdtransmissionofsarscov2inaruralareainsouthafrica AT sluchters householdtransmissionofsarscov2inaruralareainsouthafrica AT ssawry householdtransmissionofsarscov2inaruralareainsouthafrica |