TY - JOUR T1 - The secondary transmission pattern of COVID-19 based on contact tracing in Rwanda JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-004885 VL - 6 IS - 6 SP - e004885 AU - Muhammed Semakula AU - FranÇois Niragire AU - Angela Umutoni AU - Sabin Nsanzimana AU - Vedaste Ndahindwa AU - Edison Rwagasore AU - Thierry Nyatanyi AU - Eric Remera AU - Christel Faes Y1 - 2021/06/01 UR - http://gh.bmj.com/content/6/6/e004885.abstract N2 - Introduction COVID-19 has shown an exceptionally high spread rate across and within countries worldwide. Understanding the dynamics of such an infectious disease transmission is critical for devising strategies to control its spread. In particular, Rwanda was one of the African countries that started COVID-19 preparedness early in January 2020, and a total lockdown was imposed when the country had only 18 COVID-19 confirmed cases known. Using intensive contact tracing, several infections were identified, with the majority of them being returning travellers and their close contacts. We used the contact tracing data in Rwanda for understanding the geographic patterns of COVID-19 to inform targeted interventions.Methods We estimated the attack rates and identified risk factors associated to COVID-19 spread. We used Bayesian disease mapping models to assess the spatial pattern of COVID-19 and to identify areas characterised by unusually high or low relative risk. In addition, we used multiple variable conditional logistic regression to assess the impact of the risk factors.Results The results showed that COVID-19 cases in Rwanda are localised mainly in the central regions and in the southwest of Rwanda and that some clusters occurred in the northeast of Rwanda. Relationship to the index case, being male and coworkers are the important risk factors for COVID-19 transmission in Rwanda.Conclusion The analysis of contact tracing data using spatial modelling allowed us to identify high-risk areas at subnational level in Rwanda. Estimating risk factors for infection with SARS-CoV-2 is vital in identifying the clusters in low spread of SARS-CoV-2 subnational level. It is imperative to understand the interactions between the index case and contacts to identify superspreaders, risk factors and high-risk places. The findings recommend that self-isolation at home in Rwanda should be reviewed to limit secondary cases from the same households and spatiotemporal analysis should be introduced in routine monitoring of COVID-19 in Rwanda for policy making decision on real time.Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Data sets used are available for public after manuscript is being accepted for publication. ER -