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Insights from a Pan India Sero-Epidemiological survey (Phenome-India Cohort) for SARS-CoV2

  1. Salwa Naushin
  2. Viren Sardana
  3. Rajat Ujjainiya
  4. Nitin Bhatheja
  5. Rintu Kutum
  6. Akash Kumar Bhaskar
  7. Shalini Pradhan
  8. Satyartha Prakash
  9. Raju Khan
  10. Birendra Singh Rawat
  11. Karthik Bharadwaj Tallapaka
  12. Mahesh Anumalla
  13. Giriraj Ratan Chandak
  14. Amit Lahiri
  15. Susanta Kar
  16. Shrikant Ramesh Mulay
  17. Madhav Nilakanth Mugale
  18. Mrigank Srivastava
  19. Shaziya Khan
  20. Anjali Srivastava
  21. Bhawana Tomar
  22. Murugan Veerapandian
  23. Ganesh Venkatachalam
  24. Selvamani Raja Vijayakumar
  25. Ajay Agarwal
  26. Dinesh Gupta
  27. Prakash M Halami
  28. Muthukumar Serva Peddha
  29. Gopinath M Sundaram
  30. Ravindra P Veeranna
  31. Anirban Pal
  32. Vinay Kumar Agarwal
  33. Anil Ku Maurya
  34. Ranvijay Kumar Singh
  35. Ashok Kumar Raman
  36. Suresh Kumar Anandasadagopan
  37. Parimala Karuppanan
  38. Subramanian Venkatesan
  39. Harish Kumar Sardana
  40. Anamika Kothari
  41. Rishabh Jain
  42. Anupama Thakur
  43. Devendra Singh Parihar
  44. Anas Saifi
  45. Jasleen Kaur
  46. Virendra Kumar
  47. Avinash Mishra
  48. Iranna Gogeri
  49. Geethavani Rayasam
  50. Praveen Singh
  51. Rahul Chakraborty
  52. Gaura Chaturvedi
  53. Pinreddy Karunakar
  54. Rohit Yadav
  55. Sunanda Singhmar
  56. Dayanidhi Singh
  57. Sharmistha Sarkar
  58. Purbasha Bhattacharya
  59. Sundaram Acharya
  60. Vandana Singh
  61. Shweta Verma
  62. Drishti Soni
  63. Surabhi Seth
  64. Sakshi Vashisht
  65. Sarita Thakran
  66. Firdaus Fatima
  67. Akash Pratap Singh
  68. Akanksha Sharma
  69. Babita Sharma
  70. Manikandan Subramanian
  71. Yogendra S Padwad
  72. Vipin Hallan
  73. Vikram Patial
  74. Damanpreet Singh
  75. Narendra Vijay Tripude
  76. Partha Chakrabarti
  77. Sujay Krishna Maity
  78. Dipyaman Ganguly
  79. Jit Sarkar
  80. Sistla Ramakrishna
  81. Balthu Narender Kumar
  82. Kiran A Kumar
  83. Sumit G Gandhi
  84. Piyush Singh Jamwal
  85. Rekha Chouhan
  86. Vijay Lakshmi Jamwal
  87. Nitika Kapoor
  88. Debashish Ghosh
  89. Ghanshyam Thakkar
  90. Umakanta Subudhi
  91. Pradip Sen
  92. Saumya Ray Chaudhury
  93. Rashmi Kumar
  94. Pawan Gupta
  95. Amit Tuli
  96. Deepak Sharma
  97. Rajesh P Ringe
  98. Amarnarayan D
  99. Mahesh Kulkarni
  100. Dhansekaran Shanmugam
  101. Mahesh S Dharne
  102. Sayed G Dastager
  103. Rakesh Joshi
  104. Amita P Patil
  105. Sachin N Mahajan
  106. Abujunaid Habib Khan
  107. Vasudev Wagh
  108. Rakesh Kumar Yadav
  109. Ajinkya Khilari
  110. Mayuri Bhadange
  111. Arvindkumar H Chaurasiya
  112. Shabda E Kulsange
  113. Krishna Khairnar
  114. Shilpa Paranjape
  115. Jatin Kalita
  116. Narahari G Sastry
  117. Tridip Phukan
  118. Prasenjit Manna
  119. Wahengbam Romi
  120. Pankaj Bharali
  121. Dibyajyoti Ozah
  122. Ravi Kumar Sahu
  123. Elapavalooru VSSK Babu
  124. Rajeev Sukumaran
  125. Aiswarya R Nair
  126. Prajeesh Kooloth Valappil
  127. Anoop Puthiyamadam
  128. Adarsh Velayudhanpillai
  129. Kalpana Chodankar
  130. Samir Damare
  131. Yennapu Madhavi
  132. Ved Varun Aggarwal
  133. Sumit Dahiya
  134. Anurag Agrawal
  135. Debasis Dash  Is a corresponding author
  136. Shantanu Sengupta  Is a corresponding author
  1. CSIR-Institute of Genomics and Integrative Biology, India
  2. Academy of Scientific and Innovative Research (AcSIR), India
  3. CSIR-Advanced Materials and Processes Research Institute, India
  4. CSIR-Central Building Research Institute, India
  5. CSIR-Centre for Cellular Molecular Biology, India
  6. CSIR-Central Drug Research Institute, India
  7. CSIR-Central Electrochemical Research Institute, India
  8. CSIR-Central Electronics Engineering Research Institute, India
  9. CSIR-Central Food Technological Research Institute, India
  10. CSIR-Central Institute of Medicinal Aromatic Plants, India
  11. CSIR-Central Institute of Mining and Fuel Research, India
  12. CSIR-Central Leather Research Institute, India
  13. CSIR-Central Scientific Instruments Organization, India
  14. CSIR-Central Salt Marine Chemicals Research Institute, India
  15. CSIR Fourth Paradigm Institute, India
  16. CSIR- Headquarters, Rafi Marg, India
  17. CSIR-Institute of Himalayan Bioresource Technology, India
  18. CSIR-Indian Institute of Chemical Biology, India
  19. CSIR-Indian Institute of Chemical Technology, India
  20. CSIR-Indian Institute of Integrative Medicine, India
  21. CSIR-Indian Institute of Petroleum, India
  22. CSIR-Institute of Minerals and Materials Technology, India
  23. CSIR-Institute of Microbial Technology, India
  24. CSIR- National Aerospace Laboratories, India
  25. CSIR-National Chemical Laboratory, India
  26. CSIR-National Environmental Engineering Research Institute, India
  27. CSIR-North - East Institute of Science and Technology, India
  28. CSIR-National Geophysical Research Institute, India
  29. CSIR-National Institute for Interdisciplinary Science and Technology, India
  30. CSIR-National Institute of Oceanography, India
  31. CSIR-National Institute of Science, Technology and Development Studies, India
  32. CSIR-National Physical Laboratory, India
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Cite this article as: eLife 2021;10:e66537 doi: 10.7554/eLife.66537

Abstract

To understand the spread of SARS-CoV2, in August and September 2020, the Council of Scientific and Industrial Research (India) conducted a serosurvey across its constituent laboratories and centers across India. Of 10,427 volunteers, 1058 (10.14%) tested positive for SARS-CoV2 anti-nucleocapsid (anti-NC) antibodies, 95% of which had surrogate neutralization activity. Three-fourth of these recalled no symptoms. Repeat serology tests at 3 (n = 607) and 6 (n = 175) months showed stable anti-NC antibodies but declining neutralization activity. Local seropositivity was higher in densely populated cities and was inversely correlated with a 30-day change in regional test positivity rates (TPRs). Regional seropositivity above 10% was associated with declining TPR. Personal factors associated with higher odds of seropositivity were high-exposure work (odds ratio, 95% confidence interval, p value: 2.23, 1.92–2.59, <0.0001), use of public transport (1.79, 1.43–2.24, <0.0001), not smoking (1.52, 1.16–1.99, 0.0257), non-vegetarian diet (1.67, 1.41–1.99, <0.0001), and B blood group (1.36, 1.15–1.61, 0.001).

Introduction

The World Health Organization declared SARS-CoV-2 infection as a pandemic on March 11, 2020 (WHO, 2020). Within 2 weeks, India announced a lockdown strategy that severely influenced the growth of the pandemic, which was initially very focal in the large cities, gathering pace and spreading to smaller cities and towns as the nation unlocked for societal and economic considerations.

Early literature pointed towards asymptomatic transmission of SARS-CoV-2 and raised the need for extended testing (Nishiura et al., 2020; Bai et al., 2020). While RT-PCR was an undisputed choice for establishing a positive infection, serosurveillance revealed that many more were probably getting infected without manifesting symptoms (Brown and Walensky, 2020; Oran and Topol, 2020). Initial estimates of asymptomatic infection rate from the West were around 40–45% (Oran and Topol, 2020).

In India, the first case of Covid was reported on January 30, 2020 (Andrews et al., 2020). Serological surveys have confirmed that spread beyond the Indian megacities was minimal in early May–June, with less than 1% seropositivity outside the designated containment zones, suggesting that the lockdown had been effective in limiting the spread (Murhekar et al., 2020a). This was not without human and economic costs. By the end of June, migrant workforces caught in the cities during the lockdown were sent to their rural homes, which may have led to subsequent rapid, multifocal rise in cases in July 2020. By October 2020, total new cases began to decline with further outbreaks limited to a few geographies. Thus, the period of August–September 2020 is an important transition point. The present study is one of two studies at a national scale that was designed to assess the spread of infection. A national serosurvey in 70 districts of India, conducted by the Indian Council of Medical Research (ICMR), had a reported crude positivity rate of about 10% (Murhekar et al., 2020b). Since only a few districts of India account for the majority of urban areas, the ICMR survey is not representative of Indian cities (Murhekar et al., 2020a), where a combination of higher population density and indoor lives has led to greater spread of disease than rural areas. Existing city-wise serosurveys are variable in target population as well as methodology and cannot be easily compared to determine the relative course of the pandemic (Ray et al., 2020; Satpati et al., 2020; Babu et al., 2020; Sharma et al., 2020). The current study was launched by the Council of Scientific and Industrial Research (CSIR) in its more than 40 constituent laboratories and centers spread all over the country, representing a wide range of ethnicities, geosocial habitats, and occupational exposures in the form of a longitudinal cohort (Phenome-India Cohort). Though limited by not being a population-denominated study, the cohort includes permanent staff, families of staff members, students, and temporary employees proving support services such as security, sanitation, housekeeping, etc. This is a diverse microcosm of India encompassing multiple socioeconomic groups and has the advantage of permitting deeper assessments such as questionnaire surveys and periodic reassessment of humoral antibody response in those found to be seropositive. Our data is thus the first that permits valid comparisons between many important urban regions of India. Here, we report results from phase 1 of this study covering the critical period of August–September 2020.

Results

Seropositivity varied widely across India

In 10,427 subjects from over 17 states and 2 union territories, the average seropositivity was 10.14% (95% confidence interval [CI] 9.6–10.7), but varied widely across locations (Figure 1). We found that 95% of the seropositive subjects also had significant neutralizing activity, suggesting at least partial immunity (Figure 1—source data 1).

Demographics of serosurvey (India map may not be to scale and is for representation purposes only and seropositivity is rounded off).
Figure 1—source data 1

Data for all labs/centers utilized for Figure 2A,B.

Lab, district, and date of collection (DOC) (columns A–C), total samples collected, number of seropositive samples, seropositivity in percentage (rounded off), and number of samples tested and found positive for neutralizing antibody (NAB). Columns (E–I) Number of confirmed cases and tests done for respective states 15 days and prior and after the DOC. Columns (L–N) Data obtained from http://www.covid19India.org. State data has been utilized as a surrogate to city/district data for city/district data was not available for number of cases/tests done for many.

https://cdn.elifesciences.org/articles/66537/elife-66537-fig1-data1-v2.docx

Seropositivity, population density, and trajectory of new infections

As expected from the known outward spread of infection from large Indian cities, seropositivity was greater in regions with higher population density (Figure 2A). Changes in test positivity rate (TPR) are a relatively robust marker of the local level of transmission and are preferred when absolute number of tests or test rates are variable, as was the case here. Lab-wise seropositivity was correlated with the regional change in TPR. By this measure, regional transmission of SARS-CoV2 was inversely correlated to local seropositivity (Figure 2B). Seropositivity of 10% or more was associated with reductions in TPR, which may mean declining transmission (Figure 2—source data 1).

Seropositivity and test positivity rate.

(A) Population density-based seropositivity, an overall p value of <0.0001 was obtained on one-way ANOVA. (B) Change in COVID19 test positivity rate (%) for states (y-axis) against observed seropositivity of labs/centers in the state (x-axis). A negative slope reflects declining test positivity rate with increase in seropositivity.

Figure 2—source data 1

Data for all labs/centers utilized for Figure 2A, B.

Lab, district, and date of collection (DOC) (columns A–C), total samples collected, number of seropositive samples, seropositivity in percentage (rounded off), number of samples tested and found positive for neutralizing antibody (NAB). Columns (E–I) Number of confirmed cases and tests done for respective states 15 days and prior and after the DOC. Columns (L–N) Data obtained from http://www.covid19India.org. State data has been utilized as a surrogate to city/district data for city/district data was not available for number of cases/tests done for many.

https://cdn.elifesciences.org/articles/66537/elife-66537-fig2-data1-v2.docx

Survey-based correlates of seropositivity

Out of 861 seropositive subjects who also provided data on symptomatology, 647 subjects (75.3%) did not recall any of the nine symptoms asked for (two of these did not provide gender data) (Supplementary file 1). Among the minority of subjects with symptoms, the most reported symptom constellation was those of a mild flu-like disease with fever (~50%) as the most frequent symptom. Loss of smell or taste was uncommonly reported (~25% of symptomatic subjects) (Supplementary file 2).

We further examined associations of other available variables with seropositivity to explore potential factors that modulate risk of infection in India. Apart from gender and age, distribution of the other variables recorded in CSIR-cohort (prevalence of smoking, diet, physiological parameters like ABO blood group type) was similar to the national averages and the sample can be considered representative (Patidar and Dhiman, 2021; Mohan et al., 2018; Government of India, 2014). The univariate associations are shown in Figure 3, separately for each gender. Due to gender imbalance and possible confounding between various parameters, significance of associations was further tested in a balanced iterative logistic regression (Figure 3—figure supplement 1). The strongest gender-independent associations were with occupation and mode of transport. Outsourced staff performing support services such as security, housekeeping, etc., and subjects using public transport were more likely to be seropositive. In males, smoking and vegetarian diet was associated with lower seropositivity.

Figure 3 with 1 supplement see all
Demographics of data available for different variables.

Blood group type was reported for 7496 subjects. Blood group distribution of subjects in our study was similar to national reference based on a recent systematic review (Patidar and Dhiman, 2021). Seropositivity was significantly different between different groups, being highest for blood group type AB (10.19%) followed by B (9.94%), O (7.09%), and A (6.97%). Blood group O was found to be associated with a lower seropositivity rate, with an odds ratio (OR) of 0.76 (95% CI 0.64–0.91, p=0.018) vs. non-O blood group types, while B appeared to be at high risk with an OR of 1.36 (95% CI 1.15–1.61, p=0∙001). While blood group A had an OR of 0.78, the association was not found to be significant (p=0.10) and a similar observation was made with blood group AB (p=0.35), it had an OR of 1.27 (Supplementary file 3). Rh factor was not found to have a significant association with seropositivity (p=0.35).

Stability of humoral response to SARS-CoV-2

Of 607 subjects whose samples were collected again at 3 months, anti-nucleocapsid (anti-NC) antibody levels were similar or higher for most, with 17 (2.8%) becoming seronegative (Figure 4A). In contrast, 34 subjects (5.6%) did not have neutralizing activity based on a surrogate measure (>20% inhibition of receptor-spike protein binding; Figure 4B). Of 175 subjects whose samples were collected again at 5–6 months, 8 (4.6%) became seronegative (Figure 4C). In contrast, neutralizing activity was not present in 31 (17.7%) subjects (Figure 4DFigure 4—source data 1).

Antibody levels (A) and neutralizing activity (B) level at baseline (x-axis) and after 3 months (y-axis).

Antibody levels (C) and neutralizing activity (D) level at baseline (x-axis) and after 5–6 months (y-axis).

Figure 4—source data 1

Raw data for antibody and neutralizing antibody levels at baseline, 3 months and 5-6 months.

https://cdn.elifesciences.org/articles/66537/elife-66537-fig4-data1-v2.xlsx

Discussion

This study, which recruited subjects from 24 cities in India, provides an important and timely snapshot of the spread of SARS-CoV2 pandemic across India shortly before the peak of new cases. It confirms that by September 2020 a large pool of recovered Indians with at least partial immunity existed. Between our study and the other national serosurvey at the same time, more than a hundred million Indians were likely to belong to this category. The subsequent nationwide decline of new cases starting in October 2020 can be well understood through these observations. There is some evidence of declining transmission in high-seropositivity regions within September, based on falling TPRs, but due to changes in tests and expansion of testing, this can only be indirectly inferred. As shown in our study, the fraction of such recovered subjects with resistance to reinfection was more than double among people performing high-contact jobs and using public transport. Thus, it is not surprising that in combination with a strong emphasis on masking and distancing, new cases started declining soon after this serosurvey. As of January 2021, despite the onset of winter and new year festivities, India has not seen major outbreaks. It is important to note that the crude seropositivity rate reported by us needs adjustments for demographics, fraction of infected subjects who may not develop antibodies, test characteristics, among others, to be a true population seropositivity rate. Here, we intentionally avoid such adjustments since it provides a false sense of precision with too many unknowns and unmeasurables. We focus on the more meaningful variation of the crude rate, its clinical correlates, and public health implications. We are confident from the data that a very large pool of recovered and immune subjects existed by September 2020, as stated, and expect that downward adjustments for national demographics will be counterbalanced by upward adjustments for almost 20% of RT-PCR-proven asymptomatic infections who develop transient antibody responses (Koopmans and Haagmans, 2020).

Apart from the seropositivity rate, our data also reveals important associations between demographic, physiological, lifestyle-related, and occupational attributes with susceptibility to infection. The workforce in our cohort comprised adult population, and no major difference was observed in seropositivity among different age groups or those with comorbidities. Males were found to be more susceptible, in agreement with other published reports (Ortolan et al., 2020). However, there were fewer females in our study and many of the occupational responsibilities with higher chances of exposure, like that of security personnel, were skewed towards males. On iteratively ran regression models, we did not find gender to be a predictor for seropositivity.

ABO blood group type has been shown to be associated with SARS-CoV-2 infection, but the results are variable in different studies. Most studies found that the O group is associated with a lower risk of infection or severity and blood group A was reported to be high risk in some studies (Zhao et al., 2020; Wu et al., 2020; Göker et al., 2020; Ellinghaus et al., 2020). In a meta-analysis authored by Golinelli et al., 2020, they observed positive association with A blood group, while blood group O was to be associated with lesser positivity using a random effects model. Another study from India observed blood group O to be associated with less mortality while blood group B with higher mortality when they analyzed the national data available (Padhi et al., 2020). A complex molecular interaction is said to play a significant role, and the molecular pathways for the same need to be elucidated for the effects observed especially with blood group O, which was also confirmed by our study.

The associations with diet and smoking are intriguing but preliminary. It has been proposed that a fiber-rich diet may play an important role in COVID-19 through anti-inflammatory properties by modification of gut microbiota (Conte and Toraldo, 2020). A recent review has highlighted the role of trace elements, nutraceuticals, and probiotics in COVID-19 (Jayawardena et al., 2020). The negative association with smoking has been reported elsewhere, but not shown to be causal (Fontanet et al., 2020; Makoto Miyara et al., 2020; Rossato et al., 2020; Petrilli et al., 2020; Farsalinos et al., 2020). Further exploration is necessary before reaching any conclusions, especially since seropositivity is an imperfect marker of infection risk and may equally well be explained by altered antibody response and dynamics.

The stability of antibody response is poorly understood, especially in India (Figueiredo-Campos et al., 2020; Seow et al., 2020; Deshpande et al., 2020). Our data shows that while anti-NC antibodies provide long-lasting evidence of viral exposure or infection, about 20% of seropositive individuals lack meaningful neutralization activity after 5–6 months. Using more stringent measures (more than 30% inhibition of surrogate receptor-spike protein binding), the loss of neutralization may be even higher. We speculate that this may be related to recurrence of outbreaks in March 2021, after the peak in September 2020.

The aggregate seropositivity of 10.14% in our multicentric study suggests that India had a large pool of recovered immune subjects by September 2020, especially among its high-contact workers and people using public transport, leading to a decline in new infections. However, the duration of such immunity may not be sufficient to prevent future outbreaks, even in highly affected regions.

Materials and methods

Study design, sampling, and data collection

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The longitudinal cohort study was approved by the Institutional Human Ethics Committee of CSIR-IGIB vide approval CSIR-IGIB/IHEC/2019–20. The participation was voluntary, and participants had to fill an online informed consent with a consent to publish and share findings and deidentified data. Online statistical tool was utilized to calculate the minimum sample size for estimating seropositivity of about 5% with 10% precision (0.005) with 95% confidence to be 7300 (Dhand and Khatkar, 2014). In this study, we enrolled >10,000 subjects. 10,427 adult subjects working in the CSIR laboratories and their family members enrolled for the study based on voluntary participation. Informed consent was obtained from all the participants, and the samples were collected maintaining all recommended precautions. Blood samples (6 ml) were collected in EDTA vials from each participant, and antibodies to SARS-CoV-2 NC antigen were measured using an Electro-chemiluminescence Immunoassay (ECLIA)-Elecsys Anti-SARS-CoV-2 kit (Roche Diagnostics) as per the manufacturer’s protocol. This approved assay is considered a method of choice when a single test is to be deployed (Krüttgen et al., 2021). A Cut-off index COI >1 was considered seropositive. Positive samples were further tested for neutralizing antibody (NAB) response directed against the spike protein using GENScript cPass SARS-CoV-2 Neutralization Antibody Detection Kit (GenScript, USA), according to the manufacturer’s protocol. This is a blocking ELISA used for qualitative detection of total neutralizing antibodies against SARS-CoV-2 virus in plasma. A value of 20% or above was considered to have neutralizing ability.

All the participants were requested to fill an online questionnaire, which included information on date of birth, gender, blood group, type of occupation, history of diabetes, hypertension, cardiovascular disease, liver and kidney disease, diet preferences, mode of travel, contact history, and hospital visits. These forms were then downloaded in MS Excel data format and merged with registration forms filled at the time of sample collection based on unique IDs.

Data and statistical analysis

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Region-wise and total seropositivity was calculated from the fraction of samples positive for antibodies to SARS-CoV-2 NC antigen. Data regarding RT-PCR/rapid antigen testing and positive cases was gathered from http://www.covid19India.org. Change in TPR, a robust parameter for estimating the level of infection transmission when the level of testing is variable, was calculated as per the following equation:

ChangeinTPR=(TPR15DaysafterDOCTPR15DaysbeforeDOC)MeanofTPR15DaysPriorand15DaysAfter100

*DOC = date of collection.

IGIB, New Delhi, and NAL, Bengaluru, were removed from this change in TPR analysis for the sample collection was spread over 2–3 weeks in these labs. Questionnaire-based variables were assessed for response types and blank fields, that is, responses that were not provided by the participants of the survey. Based on multiple response types for each variable, categories were made to assign the response to either of the categories. For visualization, ggpubr (v0.4.0), ggrepel (v0.8.2), and ggplot2 (v3.3.2) packages were used in R. No data imputation was carried out. Chi-square test was performed to evaluate variables that had a significant association with outcome of being tested positive (p<0.05) along with OR with 95% CI. An adjusted p value was obtained through Bonferroni correction method for multiple comparison testing. Following the chi-square test, an iterative logistic regression was carried out on a balanced dataset. Variance inflation factor (VIF) was separately evaluated to assess multicollinearity. Statistical analysis and model development were carried out with visualization in R programming environment version 3.6.1, MS Excel 2016, and OriginPro V2021; faraway (v1.0.7) package was utilized for estimation of VIF.

Role of the funding source

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The sponsor of this study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Data availability

Source data files have been provided for Figures 1, 2,3 and 4. For Figure 2B, data is available in source data file and the district wise data listed in the source file on the number of confirmed cases and tests was taken from https://www.covid19india.org/. From this site, the data has to be manually extracted for desired time points by manually hovering over the number of cases and tests done graph when a district is selected after selection of the state. Code of Data Analysis and Model Definition Files- is available on Github at https://github.com/rintukutum/pan-india-csir-sero-epi (copy archived at https://archive.softwareheritage.org/swh:1:rev:7b789acbdb09c6842ab208c0ea84b52e88be43d7).

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    115. Castro P
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    The New England Journal of Medicine 383:1522–1534.
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  2. Report
    1. Makoto Miyara FT
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    Low Rate of Daily Active Tobacco Smoking in Patients with Symptomatic COVID-19
    Qeios.

Decision letter

  1. Jameel Iqbal
    Reviewing Editor; James J Peters Veterans Affairs Medical Center, United States
  2. Mone Zaidi
    Senior Editor; Icahn School of Medicine at Mount Sinai, United States
  3. Madhuri Kanitkar
    Reviewer; Armed Force Medical College, India
  4. Manindra Agrawal
    Reviewer; Indian Institute of Technology Kanpur, India

Our editorial process produces two outputs: (i) public reviews designed to be posted alongside the preprint for the benefit of readers; (ii) feedback on the manuscript for the authors, including requests for revisions, shown below. We also include an acceptance summary that explains what the editors found interesting or important about the work.

Acceptance summary:

This publication is the first large scale COVID-19 seroprevalence study from India, and demonstrates that more than a hundred million individuals were infected. While this rate is notably higher than officially reported statistics, interestingly 3 month and 5-6 month follow-up analyses demonstrated that neutralization antibody activity significantly declines in about a quarter of individuals, most of whom remain seropositive. Overall this study’s findings have implications for reinfection as well as shed light on the severity of the initial COVID-19 infection wave in India.

Decision letter after peer review:

Thank you for submitting your article "Insights from a Pan India Sero-Epidemiological survey (Phenome-India Cohort) for SARS-CoV2" for consideration by eLife. Your article has been reviewed by 3 peer reviewers, and the evaluation has been overseen by a Reviewing Editor and Mone Zaidi as the Senior Editor. The following individuals involved in review of your submission have agreed to reveal their identity: Madhuri Kanitkar (Reviewer #2); Manindra Agrawal (Reviewer #3).

The reviewers have discussed their reviews with one another, and the Reviewing Editor has drafted this to help you prepare a revised submission.

Essential revisions:

There was a marked debate amongst the reviewers regarding the validity of the findings and their usefulness. Overall, the reviewers felt that further expansion of the observational cohort make strengthen novel findings. There a numerous suggestions for improvement and narrowing focus on what can be concluded from the investigation.

1. Include three month follow-up data if available for the cohorts.

2. Narrow focus to limit conclusions on diet, smoking etc. as the reviewers felt that the study was not designed or powered to look at those differences.

Reviewer #1 (Recommendations for the authors):

My recommendation would be that the manuscript, while interesting, largely consists of a series of observations on a cohort that can hardly be said to be representative of the larger Indian population. It is this that I see to be the main defect of the manuscript. I tried hard to see if this study might at all be relevant to a broader understanding of COVID-19 in India but concluded that there were too many confounding variables – the selection of employees and contract workers in CSIR laboratories already speakers to a higher-than-average awareness of COVID-19. In addition, the bias towards metropolitan areas is a defect. The fact that the seroprevalence for the city of Pune provides results that are quite different from others for the same city is a cause for worry. As a last point, I thought that the writing could have been tighter and more targeted, especially in the introduction.

Reviewer #2 (Recommendations for the authors):

The authors of this well-designed cohort study for sero-positivity need to be complimented. A few suggestions for the study are as follows:

1. Table 1 – Title may specify Demographics of the Seropositive individuals.

2. The symptoms sought for in the history have not been clarified in the questionnaire and being recall minor symptoms are likely to be under reported. A table/figure may be added

3. It is not clear how some individuals have completed six months for repeat antibody titers when the study implies it was conducted in Aug Sept.

4. In case children of this close-knit cohort can be included the study can give an additional insight into the role children will play as schools open up.

Reviewer #3 (Recommendations for the authors):

No specific comments.

https://doi.org/10.7554/eLife.66537.sa1

Author response

Essential revisions:

There was a marked debate amongst the reviewers regarding the validity of the findings and their usefulness. Overall, the reviewers felt that further expansion of the observational cohort make strengthen novel findings. There a numerous suggestions for improvement and narrowing focus on what can be concluded from the investigation.

1. Include three month follow-up data if available for the cohorts.

Thank you for the suggestion, which has led to important insights. While full cohort follow-up is not yet available, we have now obtained 3 month follow-up of 607 people who were seropositive at baseline (see revised Figure 4A and 4B), and 5-6 month follow-up for 175 individuals (now added as Figure 4C and 4D) a. We note that amongst those who passed a neutralization antibody surrogate threshold at baseline, 20-30% fail to pass that mark by 6 months. (Figure 4 Source Data) Yet, only 5% lose seropositivity, suggesting declining immunity despite persisting seropositivity. This may be relevant to the current course of increasing outbreaks after the previous peak in October 2020, and the manuscript discussion has been modified accordingly.

2. Narrow focus to limit conclusions on diet, smoking etc. as the reviewers felt that the study was not designed or powered to look at those differences.

We agree that the observations in regard to diet and smoking are only hypothesis generating and need specifically designed studies to confirm the findings. We have also mentioned in the manuscript that associations found between sero-positivity and some of the parameters should be confirmed with studies specifically designed for this purpose. As suggested, we state that “The associations with diet and smoking are intriguing, but preliminary. It has been proposed that a fiber-rich diet may play an important role in COVID-19 through anti-inflammatory properties by modification of gut microbiota.25 A recent review has highlighted the role of trace elements, nutraceuticals and probiotics in COVID-19.26 The negative association with smoking has been reported elsewhere, but not shown to be causal.27-31 Further exploration is necessary before reaching any conclusions, especially since seropositivity is an imperfect marker of infection-risk and may equally well be explained by altered antibody response and dynamics”

Reviewer #1 (Recommendations for the authors):

My recommendation would be that the manuscript, while interesting, largely consists of a series of observations on a cohort that can hardly be said to be representative of the larger Indian population. It is this that I see to be the main defect of the manuscript. I tried hard to see if this study might at all be relevant to a broader understanding of COVID-19 in India but concluded that there were too many confounding variables – the selection of employees and contract workers in CSIR laboratories already speakers to a higher-than-average awareness of COVID-19. In addition, the bias towards metropolitan areas is a defect. The fact that the seroprevalence for the city of Pune provides results that are quite different from others for the same city is a cause for worry. As a last point, I thought that the writing could have been tighter and more targeted, especially in the introduction.

We agree with the reviewer that this is a very specific cohort, largely urban, and with higher levels of education than average. We further agree that the utility of this cohort is not in making general statements about the population, but rather in deriving specific insights for which the cohort is best suited. We enumerate some of them that are present in this manuscript.

a. It is as important to understand the relative degree of spread between Indian cities, where a combination of denser population and indoor lives has led to the greatest spread of disease. Since pandemics are typically self-limiting, regions with greater spread are further along the course and can expect declines faster. This provides useful insight for public health strategy. While our cohort does not necessarily represent the average population, it is similar between cities, something that is not true for any other survey. The ICMR national sero-survey is a random selection of districts and is heavily rural biased.1 While that is important, that is not where fast growing outbreaks are likely based on a very outdoor life and lower density. Other city-wise serosurveys are variable in target population as well as methodology and cannot be easily compared.2-5 Thus our data is the first that permits comparison between many important urban regions of India, showing which regions were more advanced along the course and where future outbreaks were still likely. We note here that some of the regions identified by this survey as high risk such as Kerala, interior Maharashtra, amongst others, are where the outbreaks continued until much later.

b. The CSIR cohort has the added advantage of greater baseline data and repeated access, we are able to determine antibody stability, as shown, and possible correlates

c. The cohort is well suited to understanding clinical associations of SARS CoV2 infections such as symptom rate and severity amongst its participants as well as associations of infection risks (using seropositivity as an imperfect surrogate).

d. The Pune city sero-surveillance which has been pointed out by the reviewer was a survey of Pune’s five most affected sub-wards and not the Pune population in general. 6 Despite all the limitations, which we accept in the prior comment, our overall crude positivity rate of 10% is very similar to that of the ICMR national serosurvey, and in general the patterns we see are along the lines of what is known about severity of outbreaks. Thus, there is no real evidence to the contrary that would establish inaccuracy of the trends seen by us, and we respectfully note that surprising findings may be the most valuable ones. In fact, seeing current trends of rising cases in Maharashtra, including in Pune, when compared to other cities, our survey values may have been more correct.

Reviewer #2 (Recommendations for the authors):

The authors of this well-designed cohort study for sero-positivity need to be complimented. A few suggestions for the study are as follows:

1. Table 1 – Title may specify Demographics of the Seropositive individuals.

Thank you for the correction. It has been addressed and the title now changed.

2. The symptoms sought for in the history have not been clarified in the questionnaire and being recall minor symptoms are likely to be under reported. A table/figure may be added

We regret the lack of clarity. Supplementary File 2 contains the frequency of symptoms reported as per the questionnaire. We agree that minor symptoms are usually underreported, but during these times of SARS-CoV-2 pandemic, people have become highly aware of their symptoms.

3. It is not clear how some individuals have completed six months for repeat antibody titers when the study implies it was conducted in Aug Sept.

For CSIR-IGIB, the study started in May-June and hence we were able to obtain minimal samples at 6 months completion. This is also the reason, CSIR-IGIB had been removed from figure 2B analysis as stated in the manuscript.

4. In case children of this close-knit cohort can be included the study can give an additional insight into the role children will play as schools open up.

We agree that children could provide specific insights into transmission dynamics specifically when schools open up but the current ethical approval didn’t permit us to have reporting for children and hence would be taken care of in future.

References:

1. Murhekar M, Bhatnagar T, Selvaraju S, et al. Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May-June 2020. Indian Journal of Medical Research 2020;152(1):48-60. doi: 10.4103/ijmr.IJMR_3290_20

2. Ray A, Singh K, Chattopadhyay S, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India. medRxiv 2020:2020.08.22.20179937. doi: 10.1101/2020.08.22.20179937

3. Satpati P, Sarangi SS, Gantait K, et al. Sero-surveillance (IgG) of SARS-CoV-2 among Asymptomatic General population of Paschim Medinipur District, West Bengal, India(Conducted during last week of July and 1st week of August 2020) – A Joint Venture of VRDL Lab (ICMR), Midnapore Medical College and amp; Hospital and amp; Department of Health and Family Welfare,Govt. of West Bengal, Paschim Medinipur. medRxiv 2020:2020.09.12.20193219. doi: 10.1101/2020.09.12.20193219

4. Babu GR, Sundaresan R, Athreya S, et al. The burden of active infection and anti-SARS-CoV-2 IgG antibodies in the general population: Results from a statewide survey in Karnataka, India. medRxiv 2020:2020.12.04.20243949. doi: 10.1101/2020.12.04.20243949

5. Sharma N, Sharma P, Basu S, et al. The seroprevalence and trends of SARS-CoV-2 in Delhi, India: A repeated population-based seroepidemiological study. medRxiv 2020:2020.12.13.20248123. doi: 10.1101/2020.12.13.20248123

6. Kulkarni P. “Pune’s first sero-survey shows 51.5% citizens have Covidantibodies”: The Times of India, 18 August 2020.; 2020 [Available from: https://timesofindia.indiatimes.com/city/pune/citys-first-sero-survey-shows-51-5-citizens-have-covid-antibodies/articleshow/77602008.cms].

7. Stadlbauer D, Tan J, Jiang K, et al. Repeated cross-sectional sero-monitoring of SARS-CoV-2 in New York City. Nature 2021;590(7844):146-50. doi: 10.1038/s41586-020-2912-6

8. Bauch CT. Estimating the COVID-19 R number: a bargain with the devil? The Lancet Infectious Diseases 2021;21(2):151-53. doi: 10.1016/S1473-3099(20)30840-9

9. Mandal M, Mandal S. COVID-19 pandemic scenario in India compared to China and rest of the world: a data driven and model analysis. medRxiv 2020:2020.04.20.20072744. doi: 10.1101/2020.04.20.20072744

10. 2014 [cited 2020]. [Available from: https://censusindia.gov.in/2011-Common/Sample_Registration_System.html].

11. Conte L, Toraldo DM. Targeting the gut–lung microbiota axis by means of a high-fibre diet and probiotics may have anti-inflammatory effects in COVID-19 infection. Therapeutic Advances in Respiratory Disease 2020;14:1753466620937170. doi: 10.1177/1753466620937170

12. Jayawardena R, Sooriyaarachchi P, Chourdakis M, et al. Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes and metabolic syndrome 2020;14(4):367-82. doi: 10.1016/j.dsx.2020.04.015 [published Online First: 2020/04/26]

13. Patidar GK, Dhiman Y. Distribution of ABO and Rh (D) Blood groups in India: A systematic review. ISBT Science Series;n/a(n/a) doi: https://doi.org/10.1111/voxs.12576

14. Golinelli D, Boetto E, Maietti E, et al. The association between ABO blood group and SARS-CoV-2 infection: A meta-analysis. PLOS ONE 2020;15(9):e0239508. doi: 10.1371/journal.pone.0239508

15. Zhao J, Yang Y, Huang H, et al. Relationship between the ABO Blood Group and the COVID-19 Susceptibility. medRxiv 2020:2020.03.11.20031096. doi: 10.1101/2020.03.11.20031096

16. Wu Y, Feng Z, Li P, et al. Relationship between ABO blood group distribution and clinical characteristics in patients with COVID-19. Clinica Chimica Acta 2020;509:220-23. doi: https://doi.org/10.1016/j.cca.2020.06.026

17. Latz CA, DeCarlo C, Boitano L, et al. Blood type and outcomes in patients with COVID-19. Ann Hematol 2020;99(9):2113-18. doi: 10.1007/s00277-020-04169-1 [published Online First: 07/12]

18. Göker H, Aladağ Karakulak E, Demiroğlu H, et al. The effects of blood group types on the risk of COVID-19 infection and its clinical outcome. Turk J Med Sci 2020;50(4):679-83. doi: 10.3906/sag-2005-395

19. Barnkob MB, Pottegård A, Støvring H, et al. Reduced prevalence of SARS-CoV-2 infection in ABO blood group O. Blood Adv 2020;4(20):4990-93. doi: 10.1182/bloodadvances.2020002657

https://doi.org/10.7554/eLife.66537.sa2

Article and author information

Author details

  1. Salwa Naushin

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Data curation, Formal analysis, Supervision, Investigation, Writing - review and editing
    Contributed equally with
    Viren Sardana
    Competing interests
    No competing interests declared
  2. Viren Sardana

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Data curation, Software, Formal analysis, Supervision, Validation, Investigation, Visualization, Methodology, Writing - original draft, Writing - review and editing
    Contributed equally with
    Salwa Naushin
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-6735-2946
  3. Rajat Ujjainiya

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Data curation, Formal analysis, Supervision, Validation, Investigation, Methodology, Writing - review and editing
    Competing interests
    No competing interests declared
  4. Nitin Bhatheja

    CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    Contribution
    Data curation, Software, Formal analysis, Validation, Investigation, Visualization, Methodology, Writing - review and editing
    Competing interests
    No competing interests declared
  5. Rintu Kutum

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Data curation, Software, Formal analysis, Validation, Visualization, Writing - review and editing
    Competing interests
    No competing interests declared
  6. Akash Kumar Bhaskar

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Methodology, Writing - review and editing
    Competing interests
    No competing interests declared
  7. Shalini Pradhan

    CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    Contribution
    Formal analysis, Investigation, Methodology, Writing - review and editing
    Competing interests
    No competing interests declared
  8. Satyartha Prakash

    CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    Contribution
    Data curation, Software, Formal analysis, Visualization, Writing - review and editing
    Competing interests
    No competing interests declared
  9. Raju Khan

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Advanced Materials and Processes Research Institute, Bhopal, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  10. Birendra Singh Rawat

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Building Research Institute, Roorkee, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  11. Karthik Bharadwaj Tallapaka

    CSIR-Centre for Cellular Molecular Biology, Hyderabad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  12. Mahesh Anumalla

    CSIR-Centre for Cellular Molecular Biology, Hyderabad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  13. Giriraj Ratan Chandak

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Centre for Cellular Molecular Biology, Hyderabad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  14. Amit Lahiri

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  15. Susanta Kar

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  16. Shrikant Ramesh Mulay

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  17. Madhav Nilakanth Mugale

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  18. Mrigank Srivastava

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  19. Shaziya Khan

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  20. Anjali Srivastava

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  21. Bhawana Tomar

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Drug Research Institute, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  22. Murugan Veerapandian

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Electrochemical Research Institute, Karaikudi, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  23. Ganesh Venkatachalam

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Electrochemical Research Institute, Karaikudi, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  24. Selvamani Raja Vijayakumar

    CSIR-Central Electrochemical Research Institute, Karaikudi, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  25. Ajay Agarwal

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Electronics Engineering Research Institute, Pilani, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  26. Dinesh Gupta

    CSIR-Central Electronics Engineering Research Institute, Pilani, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  27. Prakash M Halami

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Food Technological Research Institute, Mysore, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  28. Muthukumar Serva Peddha

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Food Technological Research Institute, Mysore, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  29. Gopinath M Sundaram

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Food Technological Research Institute, Mysore, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
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  30. Ravindra P Veeranna

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Food Technological Research Institute, Mysore, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
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  31. Anirban Pal

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Institute of Medicinal Aromatic Plants, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
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  32. Vinay Kumar Agarwal

    CSIR-Central Institute of Medicinal Aromatic Plants, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
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  33. Anil Ku Maurya

    CSIR-Central Institute of Medicinal Aromatic Plants, Lucknow, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
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  34. Ranvijay Kumar Singh

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Institute of Mining and Fuel Research, Dhanbad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
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  35. Ashok Kumar Raman

    CSIR-Central Institute of Mining and Fuel Research, Dhanbad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
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  36. Suresh Kumar Anandasadagopan

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Leather Research Institute, Chennai, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
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  37. Parimala Karuppanan

    CSIR-Central Leather Research Institute, Chennai, India
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  38. Subramanian Venkatesan

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Leather Research Institute, Chennai, India
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    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
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  39. Harish Kumar Sardana

    CSIR-Central Scientific Instruments Organization, Chandigarh, India
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    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
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  40. Anamika Kothari

    CSIR-Central Scientific Instruments Organization, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  41. Rishabh Jain

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Scientific Instruments Organization, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  42. Anupama Thakur

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Scientific Instruments Organization, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  43. Devendra Singh Parihar

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Scientific Instruments Organization, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  44. Anas Saifi

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Scientific Instruments Organization, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  45. Jasleen Kaur

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Scientific Instruments Organization, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  46. Virendra Kumar

    CSIR-Central Scientific Instruments Organization, Chandigarh, India
    Contribution
    Visualization, Writing - review and editing
    Competing interests
    No competing interests declared
  47. Avinash Mishra

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Central Salt Marine Chemicals Research Institute, Bhavnagar, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  48. Iranna Gogeri

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR Fourth Paradigm Institute, Bengaluru, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  49. Geethavani Rayasam

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR- Headquarters, Rafi Marg, New Delhi, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  50. Praveen Singh

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  51. Rahul Chakraborty

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  52. Gaura Chaturvedi

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  53. Pinreddy Karunakar

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  54. Rohit Yadav

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  55. Sunanda Singhmar

    CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  56. Dayanidhi Singh

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  57. Sharmistha Sarkar

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  58. Purbasha Bhattacharya

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  59. Sundaram Acharya

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  60. Vandana Singh

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  61. Shweta Verma

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  62. Drishti Soni

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  63. Surabhi Seth

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  64. Sakshi Vashisht

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  65. Sarita Thakran

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  66. Firdaus Fatima

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  67. Akash Pratap Singh

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  68. Akanksha Sharma

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  69. Babita Sharma

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Resources, Formal analysis, Investigation, Writing - review and editing
    Competing interests
    No competing interests declared
  70. Manikandan Subramanian

    CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    Contribution
    Formal analysis, Writing - review and editing
    Competing interests
    No competing interests declared
  71. Yogendra S Padwad

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Himalayan Bioresource Technology, Palampur, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-1793-9340
  72. Vipin Hallan

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Himalayan Bioresource Technology, Palampur, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  73. Vikram Patial

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Himalayan Bioresource Technology, Palampur, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  74. Damanpreet Singh

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Himalayan Bioresource Technology, Palampur, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  75. Narendra Vijay Tripude

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Himalayan Bioresource Technology, Palampur, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  76. Partha Chakrabarti

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Chemical Biology, Kolkata, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-9502-8695
  77. Sujay Krishna Maity

    CSIR-Indian Institute of Chemical Biology, Kolkata, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  78. Dipyaman Ganguly

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Chemical Biology, Kolkata, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-7786-1795
  79. Jit Sarkar

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Chemical Biology, Kolkata, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  80. Sistla Ramakrishna

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Chemical Technology, Hyderabad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  81. Balthu Narender Kumar

    CSIR-Indian Institute of Chemical Technology, Hyderabad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  82. Kiran A Kumar

    CSIR-Indian Institute of Chemical Technology, Hyderabad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  83. Sumit G Gandhi

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Integrative Medicine, Jammu, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  84. Piyush Singh Jamwal

    CSIR-Indian Institute of Integrative Medicine, Jammu, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-6640-7079
  85. Rekha Chouhan

    CSIR-Indian Institute of Integrative Medicine, Jammu, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  86. Vijay Lakshmi Jamwal

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Integrative Medicine, Jammu, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  87. Nitika Kapoor

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Integrative Medicine, Jammu, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  88. Debashish Ghosh

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Indian Institute of Petroleum, Dehradun, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  89. Ghanshyam Thakkar

    CSIR-Indian Institute of Petroleum, Dehradun, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  90. Umakanta Subudhi

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Minerals and Materials Technology, Bhubaneswar, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  91. Pradip Sen

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Microbial Technology, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  92. Saumya Ray Chaudhury

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Microbial Technology, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  93. Rashmi Kumar

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Microbial Technology, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  94. Pawan Gupta

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Microbial Technology, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  95. Amit Tuli

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Microbial Technology, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  96. Deepak Sharma

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-Institute of Microbial Technology, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-1104-575X
  97. Rajesh P Ringe

    CSIR-Institute of Microbial Technology, Chandigarh, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  98. Amarnarayan D

    CSIR- National Aerospace Laboratories, Bengaluru, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  99. Mahesh Kulkarni

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-3932-9092
  100. Dhansekaran Shanmugam

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-3341-4846
  101. Mahesh S Dharne

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-3965-7320
  102. Sayed G Dastager

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  103. Rakesh Joshi

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  104. Amita P Patil

    CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  105. Sachin N Mahajan

    CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  106. Abujunaid Habib Khan

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  107. Vasudev Wagh

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  108. Rakesh Kumar Yadav

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  109. Ajinkya Khilari

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-5884-8747
  110. Mayuri Bhadange

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  111. Arvindkumar H Chaurasiya

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  112. Shabda E Kulsange

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Chemical Laboratory, Pune, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  113. Krishna Khairnar

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Environmental Engineering Research Institute, Nagpur, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  114. Shilpa Paranjape

    CSIR-National Environmental Engineering Research Institute, Nagpur, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  115. Jatin Kalita

    CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  116. Narahari G Sastry

    CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  117. Tridip Phukan

    CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  118. Prasenjit Manna

    CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  119. Wahengbam Romi

    CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  120. Pankaj Bharali

    CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  121. Dibyajyoti Ozah

    CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  122. Ravi Kumar Sahu

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-North - East Institute of Science and Technology, Jorhat, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  123. Elapavalooru VSSK Babu

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Geophysical Research Institute, Hyderabad, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  124. Rajeev Sukumaran

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  125. Aiswarya R Nair

    CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  126. Prajeesh Kooloth Valappil

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  127. Anoop Puthiyamadam

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  128. Adarsh Velayudhanpillai

    CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  129. Kalpana Chodankar

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Institute of Oceanography, Goa, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  130. Samir Damare

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Institute of Oceanography, Goa, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  131. Yennapu Madhavi

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Institute of Science, Technology and Development Studies, New Delhi, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  132. Ved Varun Aggarwal

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Physical Laboratory, New Delhi, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  133. Sumit Dahiya

    1. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    2. CSIR-National Physical Laboratory, New Delhi, India
    Contribution
    Resources, Writing - review and editing, Contributed in lab/ centre co-ordination, enrolment of volunteers, sample collection and logistics
    Competing interests
    No competing interests declared
  134. Anurag Agrawal

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Conceptualization, Resources, Data curation, Formal analysis, Supervision, Funding acquisition, Validation, Investigation, Visualization, Writing - original draft, Project administration, Writing - review and editing
    Competing interests
    No competing interests declared
  135. Debasis Dash

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Conceptualization, Resources, Data curation, Software, Formal analysis, Supervision, Funding acquisition, Validation, Investigation, Visualization, Writing - original draft, Project administration, Writing - review and editing
    For correspondence
    ddash@igib.res.in
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-5647-3785
  136. Shantanu Sengupta

    1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
    2. Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
    Contribution
    Conceptualization, Resources, Data curation, Formal analysis, Supervision, Funding acquisition, Validation, Investigation, Visualization, Methodology, Writing - original draft, Project administration, Writing - review and editing
    For correspondence
    shantanus@igib.res.in
    Competing interests
    No competing interests declared
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-8461-0735

Funding

CSIR (MLP-2007)

  • Shantanu Sengupta

CSIR (MLP-2002)

  • Satyartha Prakash

Department of Science and Technology, India (GAP-0192)

  • Nitin Bhatheja

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Acknowledgements

SSG would like to acknowledge CSIR grant MLP 2007 for this work. SN, AKB, and RajatU would like to thank CSIR for their fellowships. SPrakash would like to acknowledge CSIR grant MLP-2002 (CSIR-IGIB) for the fellowship. NB would like to address CSIR grant GAP-0192 (CSIR-IGIB) for this work. We would also like to thank the directors of all the CSIR Institutes for facilitating the study. We also thank Pushpesh Ranjan, Jitendra, Neeraj Kumar, Abhijeet, and Rajkumar from AMPRI. V Santosh Kumar from CCMB. Dr. Chandra Prakash Pandey from CDRI. Vipul Sharma, Akansh Agarwal, Hansraj Choudhary, Vijay Chatterjee, Narendra Meena, Ved Prakash, Alok Mishra, Navin Singhal, Ankit Shukla, and Sudeep Rathore from CEERI. Avilash S, Rani C, and Naveen Shashidhar Kumbar from CFTRI. Swachchha Majumdar from CGCRI. Dr. Dyaneshwar Umrao Bawankule, Dr. Debabrata Chanda, Pankaj Shukla, Sanjay Singh, Dr. Dayanandan Mani, Ravi Kumar, Pankaj Yadav, and Parmanand Kumar from CIMAP. D C Sharma, Dr. Neelam J Gupta, A K Jain, and Sudhansu Bhagat from CRRI. Pankaj Pandey, Rajesh, Dr. Mohammed Faruq, and Ajay Pratap Singh from IGIB. Yogita Singh and Karvan Kaushal from CSIO. Jaykumar Patel, Shrikant Khandare, and Dr. Kannan Srinivasan from CSMCRI. Dr. Prakash L Ganapathi, G Bhatt, Shashikala U, and Shashidhar KN from NAL. Dr. Vidyadhar Mudkavi, Ravichandran C, and Sunil Babu MG from 4PI. Dr. Robin Singh, Mahesh S, Mohit Kumar Swarnakar, and Dr. Pankaj Kulurkar from IHBT. Saikat Chakrabarti and Sandip Paul from IICB. Siva Ranjith and B Vijay Kumar from IICT. Sajad Ahmed from IIIM. Rene Christina, Neha Bansal, and Ayan Banerjee from IIP. SK Goyal from NEERI-Delhi. Dr. PR Meganathan and Dr. Shaik Basha from NEERI-Hyderabad. Antara Sharma from NEIST. Dr. Shuchismita Benzwal and Chaitanya Dinesh from NGRI. Shana S Nair from NIIST. N Anandavalli and P Vasudevan from SERC. Vibha Malhotra Swaney from TKDL. Rashmi Arya and Prafulla Malwadkar from URDIP. Ajeet Singh and Dr. RK Sinha from HRDC.

Ethics

Human subjects: The longitudinal cohort study was approved by Institutional Human Ethics Committee of CSIR-IGIB vide approval CSIR-IGIB/IHEC/2019-20. The participation was voluntary, and participants had to fill an online informed consent with a consent to publish and share findings and deidentified data.

Senior Editor

  1. Mone Zaidi, Icahn School of Medicine at Mount Sinai, United States

Reviewing Editor

  1. Jameel Iqbal, James J Peters Veterans Affairs Medical Center, United States

Reviewers

  1. Madhuri Kanitkar, Armed Force Medical College, India
  2. Manindra Agrawal, Indian Institute of Technology Kanpur, India

Publication history

  1. Received: January 14, 2021
  2. Accepted: April 9, 2021
  3. Accepted Manuscript published: April 20, 2021 (version 1)
  4. Version of Record published: May 13, 2021 (version 2)

Copyright

© 2021, Naushin et al.

This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited.

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