Epidemiological Investigation of the First 135 COVID-19 Cases in Brunei: Implications for Surveillance, Control, and Travel Restrictions

Am J Trop Med Hyg. 2020 Oct;103(4):1608-1613. doi: 10.4269/ajtmh.20-0771.

Abstract

Studies on the early introduction of SARS-CoV-2 in a naive population have important epidemic control implications. We report findings from the epidemiological investigation of the initial 135 COVID-19 cases in Brunei and describe the impact of control measures and travel restrictions. Epidemiological and clinical information was obtained for all confirmed COVID-19 cases, whose symptom onset was from March 9 to April 5, 2020. The basic reproduction number (R0), incubation period, and serial interval (SI) were calculated. Time-varying R was estimated to assess the effectiveness of control measures. Of the 135 cases detected, 53 (39.3%) were imported. The median age was 36 (range = 0.5-72) years. Forty-one (30.4%) and 13 (9.6%) were presymptomatic and asymptomatic cases, respectively. The median incubation period was 5 days (interquartile range [IQR] = 5, range = 1-11), and the mean SI was 5.4 days (SD = 4.5; 95% CI: 4.3, 6.5). The reproduction number was between 3.9 and 6.0, and the doubling time was 1.3 days. The time-varying reproduction number (Rt) was below one (Rt = 0.91; 95% credible interval: 0.62, 1.32) by the 13th day of the epidemic. Epidemic control was achieved through a combination of public health measures, with emphasis on a test-isolate-trace approach supplemented by travel restrictions and moderate physical distancing measures but no actual lockdown. Regular and ongoing testing of high-risk groups to supplement the existing surveillance program and a phased easing of physical distancing measures has helped maintain suppression of the COVID-19 outbreak in Brunei, as evidenced by the identification of only six additional cases from April 5 to August 5, 2020.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Betacoronavirus / pathogenicity*
  • Brunei / epidemiology
  • COVID-19
  • Child
  • Child, Preschool
  • Communicable Disease Control / methods
  • Communicable Disease Control / organization & administration*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / transmission
  • Epidemiological Monitoring
  • Female
  • Humans
  • Incidence
  • Infant
  • Infectious Disease Incubation Period
  • Male
  • Middle Aged
  • Pandemics / prevention & control*
  • Patient Isolation / methods
  • Patient Isolation / organization & administration*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / transmission
  • Psychological Distance
  • Quarantine / methods
  • Quarantine / organization & administration
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index