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\begin{document}

\title{Transmissibility and severity of COVID-19 in a humanitarian setting:
First Few X investigation of cases and contacts in Juba, South Sudan,
2020.}



\author[1]{Richard Lako}%
\author[2]{Niamh Meagher}%
\author[3]{Joseph Wamala}%
\author[3]{John Ndyahikayo}%
\author[3]{Ayesheshem Ademe Tegegne}%
\author[3]{Olushayo Olu}%
\author[2]{David Price}%
\author[4]{Soatiana Rajatonirina}%
\author[4]{Elise Farley}%
\author[4]{Joseph  Okeibunor}%
\author[3]{Valerie Mize}%
\affil[1]{Government of the Republic of South Sudan Ministry of Health}%
\affil[2]{The University of Melbourne}%
\affil[3]{World Health Organization, South Sudan}%
\affil[4]{World Health Organization Regional Office for Africa}%


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  \date{May 19, 2024}


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\begin{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.%
\end{abstract}%



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