@article{Hussey2022c,
abstract = {Abstract Background In low- and middle-income countries where SARS-CoV-2 testing is limited, seroprevalence studies can characterise the scale and determinants of the pandemic, as well as elucidate protection conferred by prior exposure. Methods We conducted repeated cross-sectional serosurveys (July 2020 - November 2021) using residual plasma from routine convenient blood samples from patients with non-COVID-19 conditions from Cape Town, South Africa. 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, to estimate variant disease severity. Findings Among the subset sampled, seroprevalence of SARS-CoV-2 in Cape Town increased from 39.2{\%} in July 2020 to 67.8{\%} 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. 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). Interpretation 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. {\#}{\#}{\#} Competing Interest Statement The authors have declared no competing interest. {\#}{\#}{\#} Funding Statement The study is funded by National Health Laboratory service, Western Cape Department of Health, Wellcome Trust, and in part by the Division of Intramural Research, NIAID, NIH. RJW is supported by the Francis Crick Institute which receives funding from Cancer Research UK (FC0010218), Medical Research Council (FC0010218), and Wellcome (FC0010218). He also received funding from Wellcome (203135,222754). {\#}{\#}{\#} Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the University of Cape Town Human Research Ethics Committee (HREC REF 449/2020) and Stellenbosch University Human Research Ethics Committee (N20/08/051). Institutional approval was obtained from the National Health Laboratory Service and the Western Cape Department of Health. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. The Western Cape Department of Health and Wellness evaluates research proposals for all research in the public health sector in the province, subject to standard research ethics, government approval and data governance prescripts. This includes those that draw on routine datasets like the current study.For more information email Health.Research@westerncape.gov.za},
author = {Hussey, Hannah and Vreede, Helena and Davies, Mary-Ann and Heekes, Alexa and Kalk, Emma and Hardie, Diana Ruth and Zyl, Gert Van and Naidoo, Michelle and Morden, Erna and Bam, Jamy-Lee and Zinyakatira, Nesbert and Centner, Chad and Maritz, Jean and Opie, Jessica and Chapanduka, Zivanai and Mahomed, Hassan and Smith, Mariette and Cois, Annibale and Pienaar, David and Redd, Andrew and Preiser, Wolfgang and Wilkinson, Robert J and Chetty, Kamy and Boulle, Andrew and Hsiao, Nei-yuan Marvin},
doi = {10.1101/2022.12.01.22282927},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hussey et al. - 2022 - Epidemiology and outcomes of SARS-CoV-2 infection associated with anti-nucleocapsid seropositivity in Cape Town,.pdf:pdf},
journal = {medRxiv},
keywords = {OA,fund{\_}ack,genomics{\_}fund{\_}ack,original},
mendeley-tags = {OA,fund{\_}ack,genomics{\_}fund{\_}ack,original},
month = {dec},
pages = {2022.12.01.22282927},
publisher = {Cold Spring Harbor Laboratory Press},
title = {{Epidemiology and outcomes of SARS-CoV-2 infection associated with anti-nucleocapsid seropositivity in Cape Town, South Africa}},
url = {https://www.medrxiv.org/content/10.1101/2022.12.01.22282927v1 https://www.medrxiv.org/content/10.1101/2022.12.01.22282927v1.abstract},
year = {2022}
}

{"_id":"HAikBwhJa6jz8QdYs","bibbaseid":"hussey-vreede-davies-heekes-kalk-hardie-zyl-naidoo-etal-epidemiologyandoutcomesofsarscov2infectionassociatedwithantinucleocapsidseropositivityincapetownsouthafrica-2022","author_short":["Hussey, H.","Vreede, H.","Davies, M.","Heekes, A.","Kalk, E.","Hardie, D. R.","Zyl, G. V.","Naidoo, M.","Morden, E.","Bam, J.","Zinyakatira, N.","Centner, C.","Maritz, J.","Opie, J.","Chapanduka, Z.","Mahomed, H.","Smith, M.","Cois, A.","Pienaar, D.","Redd, A.","Preiser, W.","Wilkinson, R. J","Chetty, K.","Boulle, A.","Hsiao, N. M."],"bibdata":{"bibtype":"article","type":"article","abstract":"Abstract Background In low- and middle-income countries where SARS-CoV-2 testing is limited, seroprevalence studies can characterise the scale and determinants of the pandemic, as well as elucidate protection conferred by prior exposure. Methods We conducted repeated cross-sectional serosurveys (July 2020 - November 2021) using residual plasma from routine convenient blood samples from patients with non-COVID-19 conditions from Cape Town, South Africa. 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, to estimate variant disease severity. Findings Among the subset sampled, seroprevalence of SARS-CoV-2 in Cape Town increased from 39.2% in July 2020 to 67.8% 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. 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). Interpretation 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study is funded by National Health Laboratory service, Western Cape Department of Health, Wellcome Trust, and in part by the Division of Intramural Research, NIAID, NIH. RJW is supported by the Francis Crick Institute which receives funding from Cancer Research UK (FC0010218), Medical Research Council (FC0010218), and Wellcome (FC0010218). He also received funding from Wellcome (203135,222754). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the University of Cape Town Human Research Ethics Committee (HREC REF 449/2020) and Stellenbosch University Human Research Ethics Committee (N20/08/051). Institutional approval was obtained from the National Health Laboratory Service and the Western Cape Department of Health. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. The Western Cape Department of Health and Wellness evaluates research proposals for all research in the public health sector in the province, subject to standard research ethics, government approval and data governance prescripts. This includes those that draw on routine datasets like the current study.For more information email Health.Research@westerncape.gov.za","author":[{"propositions":[],"lastnames":["Hussey"],"firstnames":["Hannah"],"suffixes":[]},{"propositions":[],"lastnames":["Vreede"],"firstnames":["Helena"],"suffixes":[]},{"propositions":[],"lastnames":["Davies"],"firstnames":["Mary-Ann"],"suffixes":[]},{"propositions":[],"lastnames":["Heekes"],"firstnames":["Alexa"],"suffixes":[]},{"propositions":[],"lastnames":["Kalk"],"firstnames":["Emma"],"suffixes":[]},{"propositions":[],"lastnames":["Hardie"],"firstnames":["Diana","Ruth"],"suffixes":[]},{"propositions":[],"lastnames":["Zyl"],"firstnames":["Gert","Van"],"suffixes":[]},{"propositions":[],"lastnames":["Naidoo"],"firstnames":["Michelle"],"suffixes":[]},{"propositions":[],"lastnames":["Morden"],"firstnames":["Erna"],"suffixes":[]},{"propositions":[],"lastnames":["Bam"],"firstnames":["Jamy-Lee"],"suffixes":[]},{"propositions":[],"lastnames":["Zinyakatira"],"firstnames":["Nesbert"],"suffixes":[]},{"propositions":[],"lastnames":["Centner"],"firstnames":["Chad"],"suffixes":[]},{"propositions":[],"lastnames":["Maritz"],"firstnames":["Jean"],"suffixes":[]},{"propositions":[],"lastnames":["Opie"],"firstnames":["Jessica"],"suffixes":[]},{"propositions":[],"lastnames":["Chapanduka"],"firstnames":["Zivanai"],"suffixes":[]},{"propositions":[],"lastnames":["Mahomed"],"firstnames":["Hassan"],"suffixes":[]},{"propositions":[],"lastnames":["Smith"],"firstnames":["Mariette"],"suffixes":[]},{"propositions":[],"lastnames":["Cois"],"firstnames":["Annibale"],"suffixes":[]},{"propositions":[],"lastnames":["Pienaar"],"firstnames":["David"],"suffixes":[]},{"propositions":[],"lastnames":["Redd"],"firstnames":["Andrew"],"suffixes":[]},{"propositions":[],"lastnames":["Preiser"],"firstnames":["Wolfgang"],"suffixes":[]},{"propositions":[],"lastnames":["Wilkinson"],"firstnames":["Robert","J"],"suffixes":[]},{"propositions":[],"lastnames":["Chetty"],"firstnames":["Kamy"],"suffixes":[]},{"propositions":[],"lastnames":["Boulle"],"firstnames":["Andrew"],"suffixes":[]},{"propositions":[],"lastnames":["Hsiao"],"firstnames":["Nei-yuan","Marvin"],"suffixes":[]}],"doi":"10.1101/2022.12.01.22282927","file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hussey et al. - 2022 - Epidemiology and outcomes of SARS-CoV-2 infection associated with anti-nucleocapsid seropositivity in Cape Town,.pdf:pdf","journal":"medRxiv","keywords":"OA,fund_ack,genomics_fund_ack,original","mendeley-tags":"OA,fund_ack,genomics_fund_ack,original","month":"dec","pages":"2022.12.01.22282927","publisher":"Cold Spring Harbor Laboratory Press","title":"Epidemiology and outcomes of SARS-CoV-2 infection associated with anti-nucleocapsid seropositivity in Cape Town, South Africa","url":"https://www.medrxiv.org/content/10.1101/2022.12.01.22282927v1 https://www.medrxiv.org/content/10.1101/2022.12.01.22282927v1.abstract","year":"2022","bibtex":"@article{Hussey2022c,\r\nabstract = {Abstract Background In low- and middle-income countries where SARS-CoV-2 testing is limited, seroprevalence studies can characterise the scale and determinants of the pandemic, as well as elucidate protection conferred by prior exposure. Methods We conducted repeated cross-sectional serosurveys (July 2020 - November 2021) using residual plasma from routine convenient blood samples from patients with non-COVID-19 conditions from Cape Town, South Africa. 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, to estimate variant disease severity. Findings Among the subset sampled, seroprevalence of SARS-CoV-2 in Cape Town increased from 39.2{\\%} in July 2020 to 67.8{\\%} 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. 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). Interpretation 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. {\\#}{\\#}{\\#} Competing Interest Statement The authors have declared no competing interest. {\\#}{\\#}{\\#} Funding Statement The study is funded by National Health Laboratory service, Western Cape Department of Health, Wellcome Trust, and in part by the Division of Intramural Research, NIAID, NIH. RJW is supported by the Francis Crick Institute which receives funding from Cancer Research UK (FC0010218), Medical Research Council (FC0010218), and Wellcome (FC0010218). He also received funding from Wellcome (203135,222754). {\\#}{\\#}{\\#} Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the University of Cape Town Human Research Ethics Committee (HREC REF 449/2020) and Stellenbosch University Human Research Ethics Committee (N20/08/051). Institutional approval was obtained from the National Health Laboratory Service and the Western Cape Department of Health. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. The Western Cape Department of Health and Wellness evaluates research proposals for all research in the public health sector in the province, subject to standard research ethics, government approval and data governance prescripts. 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