COVID-19 Cluster in School: A Study on Epidemiology and Clinical Manifestations among Cases from Rengas Cluster in Perak, Malaysia

Abstract

   Background: A COVID-19 cluster named as Rengas Cluster was declared on 6th November 2020 after nine students from a boarding school in Padang Rengas, Perak diagnosed as positive COVID-19. Risk assessment was conducted and Targeted Enhanced Movement Control Order (TEMCO) was enforced at the school to contain the viral transmission. An investigation was carried out to analyze epidemiological data, clinical manifestations among cases and effect of TEMCO on this cluster.  Methods: A retrospective cross-sectional study was conducted from 2nd August 2021 until 3rd September 2021 using data that obtained from Kuala Kangsar District Health Office Crisis Preparedness and Response Centre (CPRC) Surveillance System through e-COVID notification system. The variables used in this current study include socio-demographic and clinical characteristics that include age group, gender, occupation, co-morbidities, symptoms and signs.  Results: There were 132 cases out of 324 exposed populations whereby most cases were students (87.9%) and aged between 11 and 20 years old (84.8%). More than half of cases were female (57.6%) with only one case had existing co-morbidity. Majority of cases were asymptomatic (64.4%). Those symptomatic mainly presented with cough (66%) and the strongest significant positive correlation were observed between anosmia and ageusia (r = 0.807, n = 47, p < 0.001). There was no significant association between age group and development of symptoms [χ2 (6, N = 132) = 6.014, p > 0.05]. An abrupt decline in number of cases was observed following TEMCO enforcement.  Conclusion: COVID-19 cases in Rengas Cluster were mostly among young students, asymptomatic and mildly symptomatic. This cluster was timely and effectively controlled by TEMCO enforcement which contributed towards early diagnosis, isolation and treatment for more effective control and preventive measures.