A cluster of SARS-CoV-2 infection among Italian tourists visiting India, March 2020
Jeromie Wesley Vivian Thangaraj1, Manoj Murhekar1, Yatin Mehta2, Sushila Kataria3, Megha Brijwal4, Nitesh Gupta5, Aashish Choudhary4, Bharati Malhotra6, Madhavi Vyas6, Himanshu Sharma6, Naveen Yadav1, Tarun Bhatnagar1, Nivedita Gupta7, Lalit Dar4, Raman R Gangakhedkar7, Balram Bhargava8
1 ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
2 Institute of Critical Care & Anaesthesiology, Gurugram, Haryana, India
3 Department of Internal Medicine, Medanta Multi Super-specialty Hospital, Gurugram, Haryana, India
4 Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
5 Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
6 Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
7 Epidemiology & Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
8 Department of Health Research (ICMR), Ministry of Health and Family Welfare, New Delhi, India
ICMR-National Institute of Epidemiology, R127, TNHB, Ayapakkam, Chennai 600 007, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background & objectives: A cluster of SARS-CoV-2 infection occurred among Italian tourists visiting India. We report here the epidemiological, clinical, radiological and laboratory findings of the first cluster of SARS-CoV-2 infection among the tourists.
Methods: Information was collected on demographic details, travel and exposure history, comorbidities, timelines of events, date of symptom onset and duration of hospitalization from the 16 Italian tourists and an Indian with laboratory-confirmed SARS-CoV-2 infection. The clinical, laboratory, radiologic and treatment data was abstracted from their medical records and all tourists were followed up till their recovery or discharge or death. Throat and deep nasal swab specimens were collected on days 3, 8, 15, 18, 23 and 25 to evaluate viral clearance.
Results: A group of 23 Italian tourists reached New Delhi, India, on February 21, 2020 and along with three Indians visited several tourist places in Rajasthan. By March 3, 2020, 17 of the 26 (attack rate: 65.4%) had become positive for SARS-CoV-2 infection. Of these 17 patients, nine were symptomatic, while eight did not show any symptoms. Of the nine who developed symptoms, six were mild, one was severe and two were critically ill. The median duration between the day of confirmation for COVID-19 and RT-PCR negativity was 18 days (range: 12-23 days). Two patients died with a case fatality of 11.8 per cent.
Interpretation & conclusions: This study reconfirms higher rates of transmission among close contacts and therefore, public health measures such as physical distancing, personal hygiene and infection control measures are necessary to prevent transmission.