Household transmission of SARS-CoV-2 in a rural area in South Africa
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i2.1159Keywords:
COVID-19, South Africa, household transmission, incidence, ruralAbstract
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.
References
World Health Organization. 14.9 million excess deaths associated with the COVID‐19 pandemic in 2020 and 2021. Updated 5 May 2022. https://www.who.int/news/item/05‐05‐2022‐14.9‐million‐excess‐ deaths‐were‐associated‐with‐the‐covid‐19‐pandemic‐in‐2020‐and‐2021 (accessed31 May 2023).
WHO‐China Joint Mission. Report of the WHO‐China Joint Mission on coronavirus disease 2019 (COVID‐19 ). 28 February 2020. https://www.who.int/publications/i/item/report‐of‐the‐who‐china‐ joint‐mission‐on‐coronavirus‐disease‐2019‐(covid‐19) (accessed 15 August 2020).
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‐19 ) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239‐1242. https://doi.org/10.1001/jama.2020.2648
Curmei M, Ilyas A, Evans O, Steinhardt J. Constructing and adjusting estimates for household transmission of SARS‐CoV‐2 from prior studies, widespread‐testing and contact‐tracing data. Int J Epidemiol 2021;50(5):1444‐1457. https://doi.org/10.1093/ije/dyab108
Wang Z, Ma W, Zheng X, Wu G, Zhang R. Household transmission of SARS‐CoV‐2. J Infect 2020;81(1):179‐182. https://doi.org/10.1016/j.jinf.2020.03.040
Madewell ZJ, Yang Y, Longini IM Jr, Halloran ME, Dean NE. Household transmission of SARS‐ CoV‐2: A systematic review and meta‐analysis. JAMA Netw Open 2020;3(12):e2031756. https://doi. org/10.1001/jamanetworkopen.2020.31756
Cohen C, Kleynhans J, von Gottberg A, et al. SARS‐CoV‐2 incidence, transmission, and reinfection in a rural and an urban setting: Results of the PHIRST‐C cohort study, South Africa, 2020 ‐ 21. Lancet Infect Dis 2022;22(6):821‐834. https://doi.org/10.1016/s1473‐3099(22)00069‐x
Kleynhans J, Tempia S, Wolter N, et al. SARS‐CoV‐2 seroprevalence in a rural and urban household cohort during first and second waves of infections, South Africa, July 2020 ‐ March 2021. Emerg Infect Dis 2021;27(12):3020‐3029. https://doi.org/10.3201/eid2712.211465
Jiwani SS, Antiporta DA. Inequalities in access to water and soap matter for the COVID‐19 response in sub‐Saharan Africa. Int J Equity Health 2020;19(1):82. https://doi.org/10.1186/s12939‐020‐01199‐z
Geldsetzer P, Reinmuth M, Ouma PO, et al. Mapping physical access to health care for older adults in
sub‐Saharan Africa and implications for the COVID‐19 response: A cross‐sectional analysis. Lancet Healthy Longev 2020;1(1):e32‐e42. https://doi.org/10.1016/S2666‐7568(20)30010‐6
Jassat W, Mudara C, Ozougwu L, et al. Difference in mortality among individuals admitted to hospital with COVID‐19 during the first and second waves in South Africa: A cohort study. Lancet Glob Health 2021;9(9):e1216‐e1225. https://doi.org/10.1016/S2214‐109X(21)00289‐8
Ogunkola IO, Adebisi YA, Imo UF, Odey GO, Esu E, Lucero‐Prisno DE 3rd. Rural communities in Africa should not be forgotten in responses to COVID‐19 . Int J Health Plann Manage 2020;35(6):1302‐ 1305. https://doi.org/10.1002/hpm.3039
Statistics South Africa. Matjhabeng Local Municipality 2011. https://www.statssa.gov.za/?page_ id=993&id=matjhabeng‐municipality (accessed 15 August 2020).
Madewell ZJ, Yang Y, Longini IM Jr, Halloran ME, Dean NE. Factors associated with household transmission of SARS‐CoV‐2: An updated systematic review and meta‐analysis. JAMA Netw Open 2021;4(8):e2122240. https://doi.org/10.1001/jamanetworkopen.2021.22240
Sykes W, Mhlanga L, Swanevelder R, et al. Prevalence of anti‐SARS‐CoV‐2 antibodies among blood donors in Northern Cape, KwaZulu‐Natal, Eastern Cape, and Free State provinces of South Africa in January 2021. Res Sq 2021. https://doi.org/10.21203/rs.3.rs‐233375/v1
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