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ORIGINAL ARTICLE
Year : 2020  |  Volume : 152  |  Issue : 1  |  Page : 48-60

Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May-June 2020

Manoj V Murhekar1, Tarun Bhatnagar2, Sriram Selvaraju3, Kiran Rade4, V Saravanakumar5, Jeromie Wesley Vivian Thangaraj2, Muthusamy Santhosh Kumar2, Naman Shah6, R Sabarinathan5, Alka Turuk7, Parveen Kumar Anand8, Smita Asthana9, Rakesh Balachandar10, Sampada Dipak Bangar11, Avi Kumar Bansal12, Jyothi Bhat13, Debjit Chakraborty14, Chethana Rangaraju15, Vishal Chopra16, Dasarathi Das17, Alok Kumar Deb14, Kangjam Rekha Devi18, Gaurav Raj Dwivedi19, S Muhammad Salim Khan20, Inaamul Haq20, M Sunil Kumar21, Avula Laxmaiah22, Madhuka23, Amarendra Mahapatra17, Anindya Mitra24, AR Nirmala25, Avinash Pagdhune26, Mariya Amin Qurieshi20, Tekumalla Ramarao27, Seema Sahay28, YK Sharma29, Marinaik Basavegowdanadoddi Shrinivasa30, Vijay Kumar Shukla29, Prashant Kumar Singh31, Ankit Viramgami26, Vimith Cheruvathoor Wilson3, Rajiv Yadav13, CP Girish Kumar32, Hanna Elizabeth Luke33, Uma Devi Ranganathan34, Subash Babu35, Krithikaa Sekar3, Pragya D Yadav36, Gajanan N Sapkal37, Aparup Das38, Pradeep Das39, Shanta Dutta40, Rajkumar Hemalatha41, Ashwani Kumar42, Kanwar Narain43, Somashekar Narasimhaiah44, Samiran Panda45, Sanghamitra Pati17, Shripad Patil46, Kamalesh Sarkar47, Shalini Singh48, Rajni Kant19, Srikanth Tripathy49, GS Toteja50, Giridhara R Babu51, Shashi Kant52, JP Muliyil53, Ravindra Mohan Pandey54, Swarup Sarkar55, Sujeet K Singh56, Sanjay Zodpey57, Raman R Gangakhedkar55, DC S. Reddy58, Balram Bhargava59
1 ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
2 ICMR School of Public Health, Chennai, Tamil Nadu, India
3 Divisions of Epidemiology, Chennai, Tamil Nadu, India
4 WHO Country Office for India, New Delhi, India
5 Division of Epidemiology, Chennai, Tamil Nadu, India
6 Jan Swasthya Sahyog, Bilaspur, India
7 Division of Epidemiology & Communicable Diseases, All India Institute of Medical Sciences, New Delhi, India
8 Division of Bio-Statistics, Jodhpur, Rajasthan, India
9 Divisions of Epidemiology & Biostatistics, Noida, India
10 Division of Clinical Epidemiology, Ahmedabad, Gujarat, India
11 Divisions of Epidemiology & Biostatistics, Pune, Maharashtra, India
12 Division of Epidemiology, Agra, India
13 Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
14 Division of Epidemiology, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
15 Division of Advocacy, Communication & Social Mobilisation, Bengaluru, Karnataka, India
16 State TB Training & Demonstration Centre, Patiala, Punjab, India
17 ICMRRegional Medical Research Centre, Bhubaneswar, Odisha, India
18 Division of Enteric Diseases, ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam, India
19 ICMR-Regional Medical Research Centre, Gorakhpur, India
20 Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir, India
21 State TB Training & Demonstration Centre, Thiruvananthapuram, Kerala, India
22 Division of Public Health Nutrition, ICMRNational Institute of Nutrition, Hyderabad, Telangana, India
23 Division of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
24 State TB Training & Demonstration Centre, Ranchi, Jharkhand, India
25 Lady Willingdon State TB Centre, Government of Karnataka, Bengaluru, Karnataka, India
26 Division of Clinical Epidemiology, ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
27 State TB Cell, Vijayawada, Andhra Pradesh, India
28 Social and Behavioural Research Sciences, Pune, Maharashtra, India
29 Directorate Health Services, Raipur, Chhattisgarh, India
30 Clinical Research, Chennai, Tamil Nadu, India
31 Preventive Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
32 Laboratory Division, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
33 HIV/AIDS, ICMR-National Institute for Research in Tuberculosis, Chennai, India
34 Immunology, ICMR-National Institute for Research in Tuberculosis, Chennai, India
35 NIH-ICER (International Centers for Excellence in Research) Program, Chennai, India
36 Maximum Containment Laboratory, Pune, Maharashtra, India
37 Diagnostic Virology Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
38 ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
39 ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
40 ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
41 ICMRNational Institute of Nutrition, Hyderabad, Telangana, India
42 ICMR-Vector Control Research Centre, Puducherry, India
43 ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam, India
44 National Tuberculosis Institute, Bengaluru, Karnataka, India
45 ICMR-National AIDS Research Institute, Jabalpur, Madhya Pradesh, India
46 ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
47 ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
48 ICMR-National Institute of Cancer Prevention & Research, Noida, India
49 ICMR-National Institute for Research in Tuberculosis, Chennai, India
50 ICMR-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
51 Indian Institute of Public Health, Bengaluru, Karnataka, India
52 Centre for Community Medicine, New Delhi, India
53 Independent Consultant, Vellore, Tamil Nadu, India
54 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
55 Division of Epidemiology & Communicable Diseases, New Delhi, India
56 National Centre for Disease Control, Delhi, India
57 Indian Institute of Public Health, Delhi, India
58 Independent Consultant, Lucknow, Uttar Pradesh, India
59 Indian Council of Medical Research (DHR), Ministry of Health & Family Welfare, New Delhi, India

Correspondence Address:
Manoj V Murhekar
ICMR-National Institute of Epidemiology, Ayapakkam, Chennai 600 077, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_3290_20

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Background & objectives: Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India. Methods: From May 11 to June 4, 2020, a randomly sampled, community-based survey was conducted in 700 villages/wards, selected from the 70 districts of the 21 States of India, categorized into four strata based on the incidence of reported COVID-19 cases. Four hundred adults per district were enrolled from 10 clusters with one adult per household. Serum samples were tested for IgG antibodies using COVID Kavach ELISA kit. All positive serum samples were re-tested using Euroimmun SARS-CoV-2 ELISA. Adjusting for survey design and serial test performance, weighted seroprevalence, number of infections, infection to case ratio (ICR) and infection fatality ratio (IFR) were calculated. Logistic regression was used to determine the factors associated with IgG positivity. Results: Total of 30,283 households were visited and 28,000 individuals were enrolled. Population-weighted seroprevalence after adjusting for test performance was 0.73 per cent [95% confidence interval (CI): 0.34-1.13]. Males, living in urban slums and occupation with high risk of exposure to potentially infected persons were associated with seropositivity. A cumulative 6,468,388 adult infections (95% CI: 3,829,029-11,199,423) were estimated in India by the early May. The overall ICR was between 81.6 (95% CI: 48.3-141.4) and 130.1 (95% CI: 77.0-225.2) with May 11 and May 3, 2020 as plausible reference points for reported cases. The IFR in the surveyed districts from high stratum, where death reporting was more robust, was 11.72 (95% CI: 7.21-19.19) to 15.04 (9.26-24.62) per 10,000 adults, using May 24 and June 1, 2020 as plausible reference points for reported deaths. Interpretation & conclusions: Seroprevalence of SARS-CoV-2 was low among the adult population in India around the beginning of May 2020. Further national and local serosurveys are recommended to better inform the public health strategy for containment and mitigation of the epidemic in various parts of the country.


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