Secondary attack rate among high-risk contacts of COVID-19 paediatric index cases: a study at the beginning of the pandemic in Pune city of Western Maharashtra, India

Ganesh R. Jagadale, Muralidhar P. Tambe, Yallapa Jadhav, Pradip S. Borle, Malangori A. Parande, Minal Hatnapure, Priyanka Salunke, Pradnya Shinde, Apeksha Paunikar, Arundhati Galande


Background: The COVID-19 was the emerging disease caused by SARS-COV2. Efficient transmission of this disease occurs through droplets and fomites. The susceptibility of children to coronavirus disease-19 (COVID-19) and transmission of COVID-19 from children to others is a relatively unexplored area. The aim of this study was to understand the transmission dynamics of severe acute respiratory syndrome coronavirus 2 in children. Study objectives were to estimate secondary attack rate of COVID-19 from paediatric index case during the early phase of pandemic in Pune city and to identify factors associated with transmission and development of the COVID-19 disease.

Methods: This was a retrospective cohort study conducted in the month of June 2020. The sample includes 58 contacts of 11 laboratory confirmed pediatric index cases of COVID-19 from Pune municipal corporation after written informed consent. A confidential telephonic interview of parents was taken by using a prestructured questionnaire which includes socio-demographic data, family background, type of house, development of symptoms, outcome etc.

Results: The mean age of primary pediatric case was 12.7±5.1 years. All of them were symptomatic. The SAR estimated was 55.2%. The factors significantly affecting SAR were comorbidity, no. of family members, type of family, overcrowding, no. of rooms, bedroom attached with toilet.

Conclusions: The household SAR from paediatric patients is high and is closely associated with family size and other household characteristics. Hence, home quarantine should be advocated in smaller families with appropriate isolation facilities; more emphasis is given to co-morbid individuals.


COVID -19, Maharashtra, Pediatrics, Secondary attack rate

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Maharashtra COVID-19 Dashboard. Available at: Accessed on 4 June 2020.

Tambe MP, Parande MA, Tapare VS, Borle PS, Lakde RN, Shelke SC, BJMC COVID Epidemiology group. An epidemiological study of laboratory confirmed COVID-19 cases admitted in a tertiary care hospital of Pune, Maharashtra. Indian J Public Health. 2020;64:S183-7.

Time of India news article. Available at: medium=text and utm_campaign=cppst. Accessed on 10 October 2020

Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109:1088-95.

Gandhi M, Yokoe DS, Havlir DV. Asymptomatic transmission, the Achilles’ heel of current strategies to control COVID-19. N Engl J Med. 2020;382:2158-60.

He D, Zhao S, Lin Q. The relative transmissibility of asymptomatic COVID-19 infections among close contacts. Int J Infect Dis. 2020;94:145-7.

Ministry of health and family welfare, Government of India, COVID-19 guidelines for home quarantine. Available at: Accessed on 01 June 2020.

Ministry of health and family welfare, Government of India, COVID-19 SOP for Contact Tracing for COVID-19 Cases. Available at: Accessed on 04 June 2020.

Park K. Park’s Textbook of P and SM, 25th edition. Dynamics of disease transmission Banarsidas Bhanot Publisher, Jabalpur. 2019;102-8.

Gupta N, Saravu K, Varma M. Transmission of SARS-CoV-2 infection by children: a study of contacts of index paediatric cases in India. J Trop Pediatr. 2020;67(1):fmaa081.

Shah K, Saxena D, Mavalankar D. Secondary attack rate of COVID-19 in household contacts: a systematic review. QJM. 2020;113(12):841-50.

Shah K, Kandre Y, Mavalankar D. Secondary attack rate in household contacts of COVID-19 Paediatric index cases: a study from Western India. J public health. 2021;43(2):243-5.

Paul LA, Daneman N, Schwartz KL. Association of Age and Pediatric Household Transmission of SARS-CoV-2 Infection. JAMA Pediatr. 2021;175(11):1151-8.

Jagdale GR, Parande MA, Borle PS, Tapare VS, Tambe MP, Wavare S et al. Secondary Attack Rate among the Contacts of COVID-19 Patients at the Beginning of the Pandemic in Pune City of Western Maharashtra, India. J Commun Dis. 2021;53(3):51-9.

Telle K, Jorgensen SB, Hart R, Greve-Isdahl M, Kacelnik O. Secondary attack rates of COVID-19 in Norwegian families: a nation-wide register-based study. Eur J Epidemiol. 2021;36(7):741-8.