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Genomic epidemiology reveals multiple introductions and spread of SARS-CoV-2 in the Indian state of Karnataka.

ABSTRACT: Karnataka, a state in south India, reported its first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on March 8, 2020, more than a month after the first case was reported in India. We used a combination of contact tracing and genomic epidemiology to trace the spread of SARS-CoV-2 in the state up until May 21, 2020 (1578 cases). We obtained 91 genomes of SARS-CoV-2 which clustered into seven lineages (Pangolin lineages-A, B, B.1, B.1.80, B.1.1, B.4, and B.6). The lineages in Karnataka were known to be circulating in China, Southeast Asia, Iran, Europe and other parts of India and are likely to have been imported into the state both by international and domestic travel. Our sequences grouped into 17 contact clusters and 24 cases with no known contacts. We found 14 of the 17 contact clusters had a single lineage of the virus, consistent with multiple introductions and most (12/17) were contained within a single district, reflecting local spread. In most of the 17 clusters, the index case (12/17) and spreaders (11/17) were symptomatic. Of the 91 sequences, 47 belonged to the B.6 lineage, including eleven of 24 cases with no known contact, indicating ongoing transmission of this lineage in the state. Genomic epidemiology of SARS-CoV-2 in Karnataka suggests multiple introductions of the virus followed by local transmission in parallel with ongoing viral evolution. This is the first study from India combining genomic data with epidemiological information emphasizing the need for an integrated approach to outbreak response.

SUBMITTER: Pattabiraman C

PROVIDER: S-EPMC7746284 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Genomic epidemiology reveals multiple introductions and spread of SARS-CoV-2 in the Indian state of Karnataka.

Pattabiraman Chitra C Habib Farhat F P K Harsha H Rasheed Risha R Prasad Pramada P Reddy Vijayalakshmi V Dinesh Prameela P Damodar Tina T Hosallimath Kiran K George Anson K AK Kiran Reddy Nakka Vijay NV John Banerjee B Pattanaik Amrita A Kumar Narendra N Mani Reeta S RS Venkataswamy Manjunatha M MM Shahul Hameed Shafeeq K SK Kumar B G Prakash P Desai Anita A Vasanthapuram Ravi R

PloS one 20201217 12

Karnataka, a state in south India, reported its first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on March 8, 2020, more than a month after the first case was reported in India. We used a combination of contact tracing and genomic epidemiology to trace the spread of SARS-CoV-2 in the state up until May 21, 2020 (1578 cases). We obtained 91 genomes of SARS-CoV-2 which clustered into seven lineages (Pangolin lineages-A, B, B.1, B.1.80, B.1.1, B.4, and B.6). The l ...[more]

PMID: 33332472

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Project description:BackgroundThe huge surge in COVID-19 cases in Karnataka state, India, during early phase of the pandemic especially following return of residents from other states and countries required investigation with respect to transmission dynamics, clinical status, demographics, comorbidities and mortality. Knowledge on the role of symptomatic and asymptomatic cases in transmission of SARS-CoV-2 was not available.MethodsThe study included all the cases reported from March 8 - May 31, 2020. Individuals with a history of international or domestic travel from high burden states, Influenza-like Illness or Severe Acute Respiratory Illness and high-risk contacts of COVID-19 cases were included. Detailed analysis based on contact tracing data available from the line-list of state surveillance unit was performed using cluster network analysis software.FindingsAmongst the 3404 COVID-19 positive cases, 3096 (91%) were asymptomatic while 308 (9%) were symptomatic. Majority of asymptomatic cases were in the age range of 16 and 45 years while symptomatic cases were between 31 and 65 years. Mortality rate was especially higher among middle-aged and elderly cases with co-morbidities, 34/38 (89·4%). Cluster network analysis of 822 cases indicated that the secondary attack rate, size of the cluster and superspreading events were higher when the source case was symptomatic as compared to an asymptomatic.InterpretationOur findings indicate that both asymptomatic and symptomatic SARS-CoV-2 cases transmit the infection, although symptomatic cases were the main driving force within the state during the beginning of the pandemic. Considering the large proportion of asymptomatic cases, their ability to spread infection cannot be overlooked. Notwithstanding the limitations and bias in identifying asymptomatic cases, the findings have major implications for testing policies. Active search, early testing and treatment of symptomatic elderly patients with comorbidities should be prioritized for containing the spread of COVID-19 and reducing mortality.FundingIntermediate Fellowship, Wellcome Trust-DBT India Alliance to Giridhara R Babu, Grant number: IA/CPHI/14/1/501499.

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Genomic epidemiology reveals multiple introductions and spread of SARS-CoV-2 in the Indian state of Karnataka.

Publications

Genomic epidemiology reveals multiple introductions and spread of SARS-CoV-2 in the Indian state of Karnataka.

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