SARS-CoV-2 seroepidemiology in Cape Town, South Africa, and implications for future outbreaks in low-income communities

SARS-CoV-2 seroepidemiology in Cape Town, South Africa, and implications for future outbreaks in low-income communities. Hussey, H., Vreede, H., Davies, M. A., Heekes, A., Kalk, E., Hardie, D., van Zyl, G., Naidoo, M., Morden, E., Bam, J. L., Zinyakatira, N., Centner, C. M, Maritz, J., Opie, J., Chapanduka, Z., Mahomed, H., Smith, M., Cois, A., Pienaar, D., Redd, A. D, Preiser, W., Wilkinson, R. J, Boulle, A., & Hsiao, N. Y. PLOS Global Public Health, 4(8):e0003554, Public Library of Science, aug, 2024.

Paper doi abstract bibtex

In low- and middle-income countries where SARS-CoV-2 testing is limited, seroprevalence studies can help describe and characterise the extent of the pandemic, as well as elucidate protection conferred by prior exposure. We conducted repeated cross-sectional serosurveys (July 2020 –November 2021) using residual samples from patients from Cape Town, South Africa, sent for routine laboratory studies for non-COVID-19 conditions. SARS-CoV-2 anti-nucleocapsid antibodies and linked clinical information were used to investigate: (1) seroprevalence over time and risk factors associated with seropositivity, (2) ecological comparison of seroprevalence between subdistricts, (3) case ascertainment rates, and (4) the relative protection against COVID-19 associated with seropositivity and vaccination statuses. Among the subset sampled, seroprevalence of SARS-CoV-2 in Cape Town increased from 39.19% (95% confidence interval [CI] 37.23–41.19) in July 2020 to 67.8% (95%CI 66.31–69.25) in November 2021. Poorer communities had both higher seroprevalence and COVID-19 mortality. Only 10% of seropositive individuals had a recorded positive SARS-CoV-2 test. Using COVID-19 hospital admission and death data at the Provincial Health Data Centre, antibody positivity before the start of the Omicron BA.1 wave (28 November 2021) was strongly protective for severe disease (adjusted odds ratio [aOR] 0.15; 95%CI 0.05–0.46), with additional benefit in those who were also vaccinated (aOR 0.07, 95%CI 0.01–0.35). The high population seroprevalence in Cape Town was attained at the cost of substantial COVID-19 mortality. At the individual level, seropositivity was highly protective against subsequent infections and severe COVID-19 disease. In low-income communities, where diagnostic testing capacity is often limited, surveillance systems dependent on them will underestimate the true extent of an outbreak. Rapidly conducted seroprevalence studies can play an important role in addressing this.

@article{Hussey2024,
abstract = {In low- and middle-income countries where SARS-CoV-2 testing is limited, seroprevalence studies can help describe and characterise the extent of the pandemic, as well as elucidate protection conferred by prior exposure. We conducted repeated cross-sectional serosurveys (July 2020 –November 2021) using residual samples from patients from Cape Town, South Africa, sent for routine laboratory studies for non-COVID-19 conditions. SARS-CoV-2 anti-nucleocapsid antibodies and linked clinical information were used to investigate: (1) seroprevalence over time and risk factors associated with seropositivity, (2) ecological comparison of seroprevalence between subdistricts, (3) case ascertainment rates, and (4) the relative protection against COVID-19 associated with seropositivity and vaccination statuses. Among the subset sampled, seroprevalence of SARS-CoV-2 in Cape Town increased from 39.19{\%} (95{\%} confidence interval [CI] 37.23–41.19) in July 2020 to 67.8{\%} (95{\%}CI 66.31–69.25) in November 2021. Poorer communities had both higher seroprevalence and COVID-19 mortality. Only 10{\%} of seropositive individuals had a recorded positive SARS-CoV-2 test. Using COVID-19 hospital admission and death data at the Provincial Health Data Centre, antibody positivity before the start of the Omicron BA.1 wave (28 November 2021) was strongly protective for severe disease (adjusted odds ratio [aOR] 0.15; 95{\%}CI 0.05–0.46), with additional benefit in those who were also vaccinated (aOR 0.07, 95{\%}CI 0.01–0.35). The high population seroprevalence in Cape Town was attained at the cost of substantial COVID-19 mortality. At the individual level, seropositivity was highly protective against subsequent infections and severe COVID-19 disease. In low-income communities, where diagnostic testing capacity is often limited, surveillance systems dependent on them will underestimate the true extent of an outbreak. Rapidly conducted seroprevalence studies can play an important role in addressing this.},
author = {Hussey, Hannah and Vreede, Helena and Davies, Mary Ann and Heekes, Alexa and Kalk, Emma and Hardie, Diana and van Zyl, Gert and Naidoo, Michelle and Morden, Erna and Bam, Jamy Lee and Zinyakatira, Nesbert and Centner, Chad M and Maritz, Jean and Opie, Jessica and Chapanduka, Zivanai and Mahomed, Hassan and Smith, Mariette and Cois, Annibale and Pienaar, David and Redd, Andrew D and Preiser, Wolfgang and Wilkinson, Robert J and Boulle, Andrew and Hsiao, Nei Yuan},
doi = {10.1371/JOURNAL.PGPH.0003554},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hussey et al. - 2024 - SARS-CoV-2 seroepidemiology in Cape Town, South Africa, and implications for future outbreaks in low-income commu.pdf:pdf},
isbn = {1111111111},
issn = {2767-3375},
journal = {PLOS Global Public Health},
keywords = {Antibodies,COVID 19,HIV vaccines,OA,SARS CoV 2,Serodiagnosis,Serology,Vaccination and immunization,Virus testing,fund{\_}ack,genomics{\_}fund{\_}ack,original},
mendeley-tags = {OA,fund{\_}ack,genomics{\_}fund{\_}ack,original},
month = {aug},
number = {8},
pages = {e0003554},
publisher = {Public Library of Science},
title = {{SARS-CoV-2 seroepidemiology in Cape Town, South Africa, and implications for future outbreaks in low-income communities}},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003554},
volume = {4},
year = {2024}
}

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