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1. SARS-CoV-2 infection in Africa: a systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021

Author

Anthony Nardone, Jesse Papenburg, Marta Valenciano, Hude Quan, Maria D Van Kerkhove, Didier K Ekouevi, Tyler Williamson, Shobna Sawry, Xiaomeng Ma, Ambrose Talisuna, Thierno Balde, Ines Vigan-Womas, David Buckeridge, Halidou Tinto, Michael Liu, Tingting Yan, Matthew P Cheng, Joseph Okeibunor, Samiratou Ouedraogo, Francine Ntoumi, Cheikh Talla, David Clifton, Tiffany G Harris, Ayôla A Adegnika, Lorenzo Subissi, Laura Steinhardt, Niklas Bobrovitz, Isidore T Traore, Timothy G Evans, Judy Chen, Cedric P Yansouni, Cheryl Cohen, Jason M Mwenda, Nsenga Ngoy, Hannah C Lewis, Harriet Ware, Mairead Whelan, Zihan Li, Brianna Cheng, Kim Noel, Christian Cao, Mercedes Yanes-Lane, Belinda L Herring, Rahul K Arora, Isabel Bergeri, Rafiou Adamou, Samira Z Assoumou, Rosemary A Audu, Jacob S Barnor, Enyew Birru, Henry K Bosa, Emily L Boucher, Annie Chauma-Mwale, Tienhan S Dabakuyo-Yonli, Gabriel Deveaux, Boly Diop, Titus H Divala, Emily K Dokubo, Irene O Donkor, Claire Donnici, Nathan Duarte, Natalie A Duarte, Paulin N Essone, Lee Fairlie, Ousmane Faye, Anne von Gottberg, Natasha Ilincic, Elsie A Ilori, Jackie Kleynhans, Dayoung Kim, Olatunji M Kolawole, Jambo C Kondwani, Emma Loeschnik, Sheila Makiala-Mandanda, Alexandre Manirakiza, Pinyi N Mawien, Portia C Mutevedzi, Edgard B Ngoungou, Eric M Osoro, Sandrine L Oyegue, Sara Perlman-Arrow, Hannah P Rahim, Karampreet Sachathep, Mitchell Segal, Anabel Selemon, Judith Shang, Joel F Djoba Siawaya, Kristen A Stafford, Joe A Theu, and Caseng Zhang

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction Estimating COVID-19 cumulative incidence in Africa remains problematic due to challenges in contact tracing, routine surveillance systems and laboratory testing capacities and strategies. We undertook a meta-analysis of population-based seroprevalence studies to estimate SARS-CoV-2 seroprevalence in Africa to inform evidence-based decision making on public health and social measures (PHSM) and vaccine strategy.Methods We searched for seroprevalence studies conducted in Africa published 1 January 2020–30 December 2021 in Medline, Embase, Web of Science and Europe PMC (preprints), grey literature, media releases and early results from WHO Unity studies. All studies were screened, extracted, assessed for risk of bias and evaluated for alignment with the WHO Unity seroprevalence protocol. We conducted descriptive analyses of seroprevalence and meta-analysed seroprevalence differences by demographic groups, place and time. We estimated the extent of undetected infections by comparing seroprevalence and cumulative incidence of confirmed cases reported to WHO.PROSPERO: CRD42020183634.Results We identified 56 full texts or early results, reporting 153 distinct seroprevalence studies in Africa. Of these, 97 (63%) were low/moderate risk of bias studies. SARS-CoV-2 seroprevalence rose from 3.0% (95% CI 1.0% to 9.2%) in April–June 2020 to 65.1% (95% CI 56.3% to 73.0%) in July–September 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 100:1, ranging from 18:1 to 954:1) and steady over time. Seroprevalence was highly heterogeneous both within countries—urban versus rural (lower seroprevalence for rural geographic areas), children versus adults (children aged 0–9 years had the lowest seroprevalence)—and between countries and African subregions.Conclusion We report high seroprevalence in Africa suggesting greater population exposure to SARS-CoV-2 and potential protection against COVID-19 severe disease than indicated by surveillance data. As seroprevalence was heterogeneous, targeted PHSM and vaccination strategies need to be tailored to local epidemiological situations.

Published
2022
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2. Global seroprevalence of SARS-CoV-2 antibodies: A systematic review and meta-analysis.

Author

Niklas Bobrovitz, Rahul Krishan Arora, Christian Cao, Emily Boucher, Michael Liu, Claire Donnici, Mercedes Yanes-Lane, Mairead Whelan, Sara Perlman-Arrow, Judy Chen, Hannah Rahim, Natasha Ilincic, Mitchell Segal, Nathan Duarte, Jordan Van Wyk, Tingting Yan, Austin Atmaja, Simona Rocco, Abel Joseph, Lucas Penny, David A Clifton, Tyler Williamson, Cedric P Yansouni, Timothy Grant Evans, Jonathan Chevrier, Jesse Papenburg, and Matthew P Cheng

Subjects
Medicine, Science
Abstract

BackgroundMany studies report the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. We aimed to synthesize seroprevalence data to better estimate the level and distribution of SARS-CoV-2 infection, identify high-risk groups, and inform public health decision making.MethodsIn this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to December 31, 2020. We included studies that reported a sample size, study date, location, and seroprevalence estimate. We corrected estimates for imperfect test accuracy with Bayesian measurement error models, conducted meta-analysis to identify demographic differences in the prevalence of SARS-CoV-2 antibodies, and meta-regression to identify study-level factors associated with seroprevalence. We compared region-specific seroprevalence data to confirmed cumulative incidence. PROSPERO: CRD42020183634.ResultsWe identified 968 seroprevalence studies including 9.3 million participants in 74 countries. There were 472 studies (49%) at low or moderate risk of bias. Seroprevalence was low in the general population (median 4.5%, IQR 2.4-8.4%); however, it varied widely in specific populations from low (0.6% perinatal) to high (59% persons in assisted living and long-term care facilities). Median seroprevalence also varied by Global Burden of Disease region, from 0.6% in Southeast Asia, East Asia and Oceania to 19.5% in Sub-Saharan Africa (pDiscussionMost of the population remains susceptible to SARS-CoV-2 infection. Public health measures must be improved to protect disproportionately affected groups, including racial and ethnic minorities, until vaccine-derived herd immunity is achieved. Improvements in serosurvey design and reporting are needed for ongoing monitoring of infection prevalence and the pandemic response.

Published
2021
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3. Global seroprevalence of SARS-CoV-2 antibodies: A systematic review and meta-analysis

Author

Lucas Penny, Michael Liu, Matthew P. Cheng, Austin Atmaja, Jonathan Chevrier, Natasha Ilincic, Mitchell Segal, Jordan Van Wyk, Mercedes Yanes-Lane, Abel Joseph, Jesse Papenburg, Christian Cao, Emily Boucher, Tyler Williamson, Claire Donnici, Cedric P. Yansouni, Judy Chen, Timothy Grant Evans, Niklas Bobrovitz, Simona Rocco, Nathan Duarte, Mairead Whelan, Sara Perlman-Arrow, Rahul Krishan Arora, Hannah Rahim, David A. Clifton, and Tingting Yan

Subjects
RNA viruses, Viral Diseases, Coronaviruses, Epidemiology, Antibodies, Viral, Global Health, Geographical Locations, Medical Conditions, Seroepidemiologic Studies, Medicine and Health Sciences, Medicine, Public and Occupational Health, Cumulative incidence, Medical Personnel, Child, Pathology and laboratory medicine, Virus Testing, education.field_of_study, Multidisciplinary, Incidence, Incidence (epidemiology), Middle Aged, Medical microbiology, Professions, Infectious Diseases, Meta-analysis, Viruses, SARS CoV 2, Pathogens, Research Article, Adult, medicine.medical_specialty, Asia, Adolescent, SARS coronavirus, Health Personnel, Science, Population, Sensitivity and Specificity, Microbiology, COVID-19 Serological Testing, Herd immunity, Young Adult, Diagnostic Medicine, Humans, Seroprevalence, education, Aged, Biology and life sciences, business.industry, Public health, Organisms, Viral pathogens, COVID-19, Covid 19, Microbial pathogens, Sample size determination, Medical Risk Factors, People and Places, Population Groupings, business, Demography
Abstract

BackgroundMany studies report the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. We aimed to synthesize seroprevalence data to better estimate the level and distribution of SARS-CoV-2 infection, identify high-risk groups, and inform public health decision making.MethodsIn this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to December 31, 2020. We included studies that reported a sample size, study date, location, and seroprevalence estimate. We corrected estimates for imperfect test accuracy with Bayesian measurement error models, conducted meta-analysis to identify demographic differences in the prevalence of SARS-CoV-2 antibodies, and meta-regression to identify study-level factors associated with seroprevalence. We compared region-specific seroprevalence data to confirmed cumulative incidence. PROSPERO: CRD42020183634.ResultsWe identified 968 seroprevalence studies including 9.3 million participants in 74 countries. There were 472 studies (49%) at low or moderate risk of bias. Seroprevalence was low in the general population (median 4.5%, IQR 2.4–8.4%); however, it varied widely in specific populations from low (0.6% perinatal) to high (59% persons in assisted living and long-term care facilities). Median seroprevalence also varied by Global Burden of Disease region, from 0.6% in Southeast Asia, East Asia and Oceania to 19.5% in Sub-Saharan Africa (pDiscussionMost of the population remains susceptible to SARS-CoV-2 infection. Public health measures must be improved to protect disproportionately affected groups, including racial and ethnic minorities, until vaccine-derived herd immunity is achieved. Improvements in serosurvey design and reporting are needed for ongoing monitoring of infection prevalence and the pandemic response.

Published
2021

4. Global seroprevalence of SARS-CoV-2 antibodies: a systematic review and meta-analysis

Author

Timothy Grant Evans, Abel Joseph, Matthew P. Cheng, Niklas Bobrovitz, Austin Atmaja, Jordan Van Wyk, Jonathan Chevrier, Tingting Yan, Rahul Krishan Arora, Natasha Ilincic, David A. Clifton, Mitchell Segal, Tyler Williamson, Christian Cao, Lucas Penny, Michael Liu, Jesse Papenburg, Simona Rocco, Nathan Duarte, Emily Boucher, Hannah Rahim, Cedric P. Yansouni, Judy Chen, Mairead Whelan, and Claire Donnici

Subjects
education.field_of_study, medicine.medical_specialty, Latin Americans, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Public health, Population, Sample size determination, Meta-analysis, Medicine, Seroprevalence, Cumulative incidence, business, education, Demography
Abstract

BackgroundMany studies report the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. We aimed to synthesize seroprevalence data to better estimate the level and distribution of SARS-CoV-2 infection, identify high-risk groups, and inform public health decision making.MethodsIn this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to December 31, 2020. We included studies that reported a sample size, study date, location, and seroprevalence estimate. We corrected estimates for imperfect test accuracy with Bayesian measurement error models, conducted meta-analysis to identify demographic differences in the prevalence of SARS-CoV-2 antibodies, and meta-regression to identify study-level factors associated with seroprevalence. We compared region-specific seroprevalence data to confirmed cumulative incidence. PROSPERO: CRD42020183634.ResultsWe identified 968 seroprevalence studies including 9.3 million participants in 74 countries. There were 472 studies (49%) at low or moderate risk of bias. Seroprevalence was low in the general population (median 4.5%, IQR 2.4-8.4%); however, it varied widely in specific populations from low (0.6% perinatal) to high (59% persons in assisted living and long-term care facilities). Median seroprevalence also varied by Global Burden of Disease region, from 0.6 % in Southeast Asia, East Asia and Oceania to 19.5% in Sub-Saharan Africa (pDiscussionMost of the population remains susceptible to SARS-CoV-2 infection. Public health measures must be improved to protect disproportionately affected groups, including racial and ethnic minorities, until vaccine-derived herd immunity is achieved. Improvements in serosurvey design and reporting are needed for ongoing monitoring of infection prevalence and the pandemic response.FundingPublic Health Agency of Canada through the COVID-19 Immunity Task Force.

Published
2020
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