COVID-Kavach-Based Seropositivity in the General Population of Ahmedabad: Just Before the Start of the Vaccination for the Elderly in India.

Background The present study was carried out in succession of three serosurvey studies carried out during 2020 in Ahmedabad with an objective to estimate the seroprevalence of immunoglobulin G (IgG) antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in Ahmedabad city so as to scientifically understand the pandemic progression. Methods Polio booth-based stratification was followed for the population-based stratified sampling among the general population of Ahmedabad. The seroprevalence was compared with various factors for valid and precise predictions regarding the immunity status of the population. Results As on February 2021, the seroprevalence for IgG antibodies against SARS-CoV2 in the general population of Ahmedabad was 27.92% (95% confidence interval 27.06-28.80), much below the minimum desired for herd immunity. Comparison of seropositivity with age groups showed higher seroprevalence with increasing age groups. Seroprevalence was higher among males (29.08%) than females (27.01%) and the difference was statistically significant (Z=2.30, P=0.02). Calculating the seropositivity among the subcategories, cases had a seropositivity of 64.90% and family contacts had a seropositivity of 28.00%. Seronegative cases indicate the possibility of absent, undetectable, or disappearing IgG antibodies. Seropositivity of 37% among the vaccinated individuals may be related to dose and duration of vaccination, as the COVID vaccination had started just before the present study and none had completed 14 days after the second dose. Conclusions The low level of IgG antibodies against SARS-CoV2 using the COVID-Kavach test kit in the general population of Ahmedabad city of India, as on February 2021, before the start of COVID vaccination for the general population suggests that the preventive measures be strongly followed for continued control of the pandemic situation at least till majority of the population is effectively covered with vaccination.

Seroprevalence of Immunoglobulin-G Antibody Among Confirm Cases of COVID-19.

Background Sero-surveillance to find the presence of IgG antibodies among COVID-19 cases helps in the better understanding of the immune response after COVID-19 infection. Objectives To estimate seropositivity among confirmed COVID-19 cases and to correlate the seropositivity with various factors affecting seropositivity. Methods Population-based sero-surveillance among COVID-19 cases was carried out during the second half of August 2020 in Ahmedabad using the COVID KAVACH, Immunoglobulin-G (IgG) Antibody Detection Enzyme-Linked Immunosorbent Assay (ELISA) kits. Seropositivity among cases was measured and compared with various other factors to understand the immunity status among COVID-19 cases. Results With 1073 positive for IgG antibodies from 1720 samples, the seropositivity among COVID-19 cases is 62.38% [95%CI 60.07-64.64%]. The difference in seropositivity based on gender was statistically not significant (Z=0.26, P=0.79). Children have the highest seropositivity (94.44%) and from young adults, to the elderly, the proportion of positivity among cases shows an increasing trend. Time gap analysis from the date of diagnosis shows that the proportion of cases with IgG antibodies increases gradually reaching its peak at around 10 weeks (third month) and then declines gradually. Conclusion Seropositivity among COVID-19 cases is 62.38%. The proportion of cases with IgG antibodies reaches its peak at around 10 weeks (third month) after diagnosis and then declines gradually. This fall indicates that the detected antibodies may not be long-lasting and may become undetectable/absent over a period of time. The reason for seronegative results in COVID-19 cases needs further in-depth scientific research.

Assessing seropositivity for IgG antibodies against SARS-CoV-2 in Ahmedabad city of India: a cross-sectional study.

OBJECTIVES: To study the percentage seropositivity for SARS-CoV-2 to understand the pandemic status and predict the future situations in Ahmedabad. STUDY DESIGN: Cross-sectional study. SETTINGS: Field area of Ahmedabad Municipal Corporation. PARTICIPANTS: More than 30 000 individuals irrespective of their age, sex, acute/past COVID-19 infection participated in the serosurvey which covered all the 75 Urban Primary Health Centres (UPHCs) across 48 wards and 7 zones of the city. Study also involved healthcare workers (HCWs) from COVID-19/non-COVID-19 hospitals. INTERVENTIONS: Seropositivity of IgG antibodies against SARS-CoV-2 was measured as a mark of COVID-19 infection. PRIMARY AND SECONDARY OUTCOMES: Seropositivity was used to calculate cumulative incidence. Correlation of seropositivity with available demographic detail was used for valid and precise assessment of the pandemic situation. RESULTS: From 30 054 samples, the results were available for 29 891 samples and the crude seropositivity is 17.61%. For all the various age groups, the seropositivity calculated between 15% and 20%. The difference in seropositivity for both the sex group is statistically not significant. The seropositivity is significantly lower (13.64%) for HCWs as compared with non-HCWs (18.71%). Seropositivity shows increasing trend with time. Zone with maximum initial cases has high positivity as compared with other zones. UPHCs with recent rise in cases are leading in seropositivity as compared with earlier and widely affected UPHCs. CONCLUSIONS: The results of serosurveillance suggest that the population of Ahmedabad is still largely susceptible. People still need to follow preventive measures to protect themselves till an effective vaccine is available to the people at large. The data indicate the possibility of vanishing immunity over time and need further research to cross verify with scientific evidences.

Deaths from acute abdominal conditions and geographic access to surgical care in India: a nationally representative population-based spatial analysis.

BACKGROUND: Acute abdominal conditions have high case-fatality rates in the absence of timely surgical care. In India, and many other low-income and middle-income countries, few population-based studies have quantified mortality from surgical conditions and related mortality to access to surgical care. We aimed to describe the spatial and socioeconomic distributions of deaths from acute abdomen (DAA) in India and to quantify potential access to surgical facilities in relation to such deaths. METHODS: We examined deaths from acute abdominal conditions within a nationally representative, population-based mortality survey of 1·1 million Indian households and linked these to nationally representative facility data. Spatial clustering of deaths from acute abdominal conditions was calculated with the Getis-Ord Gi* statistic from about 4000 postal codes. We compared high or low acute abdominal mortality clusters for their geographic access to well-resourced surgical care (24 h surgical and anaesthesia services, blood bank, critical care beds, basic laboratory, and radiology). FINDINGS: 923 (1·1%) of 86 806 study deaths in those aged 0-69 years were identified as deaths from acute abdominal conditions, corresponding to an estimated 72 000 deaths nationally in India in 2010. Most deaths occurred at home (71%), in rural areas (87%), and were caused by peptic ulcer disease (79%). There was wide variation in rates of deaths from acute abdominal conditions. We identified 393 high-mortality geographic clusters and 567 low-mortality clusters. High-mortality clusters of acute abdominal conditions were located significantly further from well-resourced hospitals than were low-mortality clusters. The odds ratio of a postal code area being a high-mortality cluster was 4·4 (99% CI 3·2-6·0) for living 50 km or more from well-resourced district hospitals (rising to an OR of 16·1 for >100 km), after adjustment for socioeconomic status and caste. INTERPRETATION: Improvements in human and physical resources at existing public hospitals are required to reduce deaths from acute abdominal conditions in India. Had all of the Indian population had access to well-resourced hospitals within 50 km, more than 50 000 deaths from acute abdominal conditions could have been averted in 2010, and likely more from other emergency surgical conditions. Our geocoded facility data were limited to public district hospitals. However, noting the high rate of catastrophic health expenditures in India, we chose to focus on publicly provided services which are the only option usually available to the poor. FUNDING: The Bill & Melinda Gates Foundation, Dalla Lana School of Public Health, and Canadian Institute of Health Research.

Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes.

OBJECTIVES: To quantify and describe the mechanism of road traffic injury (RTI) deaths in India. DESIGN: We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports. SETTING: 1.1 million homes in India. PARTICIPANTS: Over 122 000 deaths at all ages from 2001 to 2003. PRIMARY AND SECONDARY OUTCOME MEASURES: Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained. RESULTS: The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods. CONCLUSIONS: In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

Prevalence of chikungunya in the city of Ahmedabad, India, during the 2006 outbreak: a community-based study.

Prevalence of chikungunya in the city of Ahmedabad, India during the 2006 outbreak was investigated to estimate the prevalence of suspected chikungunya cases to find out demographic parameters and proportion of various symptoms among suspected chikungunya cases, and to evaluate the effectiveness of control measures implemented by the public health sector. A total of 6667 people from 1301 households were surveyed. The prevalence of suspected chikungunya cases was 32.9% (31.8% – 34.2%). Prevalence was higher in females (p

Systemic involvements and fatalities during Chikungunya epidemic in India, 2006.

BACKGROUND: In addition to classical manifestations of Chikungunya infection, severe infections requiring hospitalization were reported during outbreaks in India in 2006. OBJECTIVES: To describe the systemic syndromes and risk groups of severe Chikungunya infections. STUDY DESIGN: We prospectively investigated suspected Chikungunya cases hospitalized in Ahmedabad, Gujarat during September-October 2006, and retrospectively investigated laboratory-confirmed Chikungunya cases hospitalized with neurologic syndromes in Pune, Maharashtra. Hospital records were reviewed for demographic, comorbidity, clinical and laboratory information. Sera and/or cerebrospinal fluid were screened by one or more methods, including virus-specific IgM antibodies, viral RNA and virus isolation. RESULTS: Among 90 laboratory-confirmed Chikungunya cases hospitalized in Ahmedabad, classical Chikungunya was noted in 25 cases and severe Chikungunya was noted in 65 cases, including non-neurologic (25) and neurologic (40) manifestations. Non-neurologic systemic syndromes in the 65 severe Chikungunya cases included renal (45), hepatic (23), respiratory (21), cardiac (10), and hematologic manifestations (8). Males (50) and those aged >or=60 years (50) were commonly affected with severe Chikungunya, and age >or=60 years represented a significant risk. Comorbidities were seen in 21 cases with multiple comorbidities in 7 cases. Among 18 deaths, 14 were males, 15 were aged >or=60 years and 5 had comorbidities. In Pune, 59 laboratory-confirmed Chikungunya cases with neurologic syndromes were investigated. Neurologic syndromes in 99 cases from Ahmedabad and Pune included encephalitis (57), encephalopathy (42), and myelopathy (14) or myeloneuropathy (12). CONCLUSIONS: Chikungunya infection can cause systemic complications and probably deaths, especially in elderly adults.