loading page

Transmissibility and severity of COVID-19 in a humanitarian setting: First Few X investigation of cases and contacts in Juba, South Sudan, 2020.
  • +8
  • Richard Lako,
  • Niamh Meagher,
  • Joseph Wamala,
  • John Ndyahikayo,
  • Ayesheshem Ademe Tegegne,
  • Olushayo Olu,
  • David Price,
  • Soatiana Rajatonirina,
  • Elise Farley,
  • Joseph Okeibunor,
  • Valerie Mize
Richard Lako
Government of the Republic of South Sudan Ministry of Health
Author Profile
Niamh Meagher
The University of Melbourne

Corresponding Author:n.meagher@unimelb.edu.au

Author Profile
Joseph Wamala
World Health Organization, South Sudan
Author Profile
John Ndyahikayo
World Health Organization, South Sudan
Author Profile
Ayesheshem Ademe Tegegne
World Health Organization, South Sudan
Author Profile
Olushayo Olu
World Health Organization, South Sudan
Author Profile
David Price
The University of Melbourne
Author Profile
Soatiana Rajatonirina
World Health Organization Regional Office for Africa
Author Profile
Elise Farley
World Health Organization Regional Office for Africa
Author Profile
Joseph Okeibunor
World Health Organization Regional Office for Africa
Author Profile
Valerie Mize
World Health Organization, South Sudan
Author Profile

Abstract

Background First Few “X” (FFX) studies provide evidence to guide public health decision making and resource allocation. The adapted WHO Unity FFX protocol for COVID-19 was implemented to gain an understanding of the clinical, epidemiological, virological, and household transmission dynamics of the first cases of COVID-19 infection detected in Juba, South Sudan. Methods Laboratory-confirmed COVID-19 cases were identified through the national surveillance system, and an initial visit was conducted with eligible cases to identify all close contacts. Consenting cases and close contacts were enrolled between June 2020 and December 2020. Demographic, clinical information and biological samples were taken at enrolment and 14–21 days post-enrolment for all participants. Results Twenty-nine primary cases and 82 contacts were included in analyses. Most primary cases (n=23/29, 79.3%) and contacts (n=61/82, 74.4%) were male. Many primary cases (n=18/29, 62.1%) and contacts (n=51/82, 62.2%) were seropositive for SARS-CoV-2 at baseline. The secondary attack rate among susceptible contacts was 12.9% (4/31; 95% CI: 4.9%–29.7%). All secondary cases and most (72%) primary cases were asymptomatic. Reported symptoms included coughing (n=6/29, 20.7%), fever or history of fever (n=4/29, 13.8%), headache (n=3/29, 10.3%) and shortness of breath (n=3/29, 10.3%). Of 38 cases, two were hospitalised (5.3%) and one died (2.6%). Conclusions These findings were used to develop the South Sudanese Ministry of Health surveillance and contract tracing protocols, informing local COVID-19 case definitions, follow-up protocols and data management systems. This investigation demonstrates that rapid FFX implementation is critical in understanding the emerging disease and informing response priorities.
02 Apr 2023Submitted to Influenza and other respiratory viruses
03 Apr 2023Submission Checks Completed
03 Apr 2023Assigned to Editor
04 Apr 2023Reviewer(s) Assigned
26 Jun 2023Review(s) Completed, Editorial Evaluation Pending
28 Jun 2023Editorial Decision: Revise Major
07 Aug 20231st Revision Received
08 Aug 2023Submission Checks Completed
08 Aug 2023Assigned to Editor
11 Aug 2023Reviewer(s) Assigned
28 Aug 2023Review(s) Completed, Editorial Evaluation Pending
29 Aug 2023Editorial Decision: Accept