Global seroprevalence of SARS-CoV-2 antibodies : a systematic review and meta-analysis
Global seroprevalence of SARS-CoV-2 antibodies : a systematic review and meta-analysis
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- dc.contributor.author
- Bobrovitz, Niklas
- Arora, Rahul Krishan
- Cao, Christian
- Boucher, Emily
- Liu, Michael
- Donnici, Claire
- Yanes-Lane, Mercedes
- Whelan, Mairead
- Perlman-Arrow, Sara
- Chen, Judy
- Rahim, Hannah
- Ilincic, Natasha
- Segal, Mitchell
- Duarte, Nathan
- Van Wyk, Jordan
- Yan, Tingting
- Atmaja, Austin
- Rocco, Simona
- Joseph, Abel
- Penny, Lucas
- Clifton, David A.
- Williamson, Tyler
- Yansouni, Cedric P.
- Evans, Timothy Grant
- Chevrier, Jonathan
- Papenburg, Jesse
- Cheng, Matthew P.
- dc.date.accessioned
- 2025-01-30T15:33:19Z
- dc.date.available
- 2025-01-30T15:33:19Z
- dc.date.issued
- 2021-06-23
- dc.description.abstract - en
- <p>Background<br> Many 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.</p> <p>Methods<br> In 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.</p> <p>Results<br> We 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 (p<0.001). National studies had lower seroprevalence estimates than regional and local studies (p<0.001). Compared to Caucasian persons, Black persons (prevalence ratio [RR] 3.37, 95% CI 2.64–4.29), Asian persons (RR 2.47, 95% CI 1.96–3.11), Indigenous persons (RR 5.47, 95% CI 1.01–32.6), and multi-racial persons (RR 1.89, 95% CI 1.60–2.24) were more likely to be seropositive. Seroprevalence was higher among people ages 18–64 compared to 65 and over (RR 1.27, 95% CI 1.11–1.45). Health care workers in contact with infected persons had a 2.10 times (95% CI 1.28–3.44) higher risk compared to health care workers without known contact. There was no difference in seroprevalence between sex groups. Seroprevalence estimates from national studies were a median 18.1 times (IQR 5.9–38.7) higher than the corresponding SARS-CoV-2 cumulative incidence, but there was large variation between Global Burden of Disease regions from 6.7 in South Asia to 602.5 in Sub-Saharan Africa. Notable methodological limitations of serosurveys included absent reporting of test information, no statistical correction for demographics or test sensitivity and specificity, use of non-probability sampling and use of non-representative sample frames.</p> <p>Discussion<br> Most 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.</p>
- dc.description.sponsorship
- This research was funded by the Public Health Agency of Canada through Canada’s COVID-19 Immunity Task Force (https://www.covid19immunitytaskforce.ca/). DAC reports personal fees from Oxford University Innovation, Biobeats (https://www.bio-beat.com/), and Sensyne Health. MPC reports grants from McGill Interdisciplinary Initiative in Infection and Immunity and grants from Canadian Institutes of Health Research during the conduct of the study.
- dc.identifier.doi
- https://doi.org/10.1371/journal.pone.0252617
- dc.identifier.issn
- 1932-6203
- dc.identifier.pubmedID
- 34161316
- dc.identifier.uri
- https://open-science.canada.ca/handle/123456789/3383
- dc.language.iso
- en
- dc.publisher - en
- PLOS
- dc.rights - en
- Creative Commons Attribution 4.0 International (CC BY 4.0)
- dc.rights - fr
- Creative Commons Attribution 4.0 International (CC BY 4.0)
- dc.rights.uri - en
- https://creativecommons.org/licenses/by/4.0/
- dc.rights.uri - fr
- https://creativecommons.org/licenses/by/4.0/deed.fr
- dc.subject - en
- Health
- Coronavirus diseases
- Epidemiology
- dc.subject - fr
- Santé
- Maladie à coronavirus
- Épidémiologie
- dc.subject.en - en
- Health
- Coronavirus diseases
- Epidemiology
- dc.subject.fr - fr
- Santé
- Maladie à coronavirus
- Épidémiologie
- dc.title - en
- Global seroprevalence of SARS-CoV-2 antibodies : a systematic review and meta-analysis
- dc.type - en
- Article
- dc.type - fr
- Article
- local.acceptedmanuscript.articlenum
- e0252617
- local.article.journalissue
- 6
- local.article.journaltitle - en
- PLoS ONE
- local.article.journalvolume
- 16
- local.pagination
- 1-21
- local.peerreview - en
- Yes
- local.peerreview - fr
- Oui
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