Global SARS-CoV-2 seroprevalence from January 2020 to April 2022 : a systematic review and meta-analysis of standardized population-based studies

Bergeri, Isabel; Whelan, Mairead G.; Ware, Harriet; Subissi, Lorenzo; Nardone, Anthony; Lewis, Hannah C.; Li, Zihan; Ma, Xiaomeng; Valenciano, Marta; Cheng, Brianna; Al Ariqi, Lubna; Rashidian, Arash; Okeibunor, Joseph; Azim, Tasnim; Wijesinghe, Pushpa; Le, Linh-Vi; Vaughan, Aisling; Pebody, Richard; Vicari, Andrea; Yan, Tingting; Yanes-Lane, Mercedes; Cao, Christian; Clifton, David A.; Cheng, Matthew P.; Papenburg, Jesse; Buckeridge, David; Bobrovitz, Niklas; Arora, Rahul K.; Van Kerkhove, Maria D.; Unity Studies Collaborator Group

doi:https://open-science.canada.ca/handle/123456789/3387

Global SARS-CoV-2 seroprevalence from January 2020 to April 2022 : a systematic review and meta-analysis of standardized population-based studies

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dc.contributor.author: Bergeri, Isabel; Whelan, Mairead G.; Ware, Harriet; Subissi, Lorenzo; Nardone, Anthony; Lewis, Hannah C.; Li, Zihan; Ma, Xiaomeng; Valenciano, Marta; Cheng, Brianna; Al Ariqi, Lubna; Rashidian, Arash; Okeibunor, Joseph; Azim, Tasnim; Wijesinghe, Pushpa; Le, Linh-Vi; Vaughan, Aisling; Pebody, Richard; Vicari, Andrea; Yan, Tingting; Yanes-Lane, Mercedes; Cao, Christian; Clifton, David A.; Cheng, Matthew P.; Papenburg, Jesse; Buckeridge, David; Bobrovitz, Niklas; Arora, Rahul K.; Van Kerkhove, Maria D.; Unity Studies Collaborator Group
dc.date.accessioned: 2025-01-31T21:16:15Z
dc.date.available: 2025-01-31T21:16:15Z
dc.date.issued: 2022-11-10
dc.description.abstract - en: Background Our understanding of the global scale of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains incomplete: Routine surveillance data underestimate infection and cannot infer on population immunity; there is a predominance of asymptomatic infections, and uneven access to diagnostics. We meta-analyzed SARS-CoV-2 seroprevalence studies, standardized to those described in the World Health Organization’s Unity protocol (WHO Unity) for general population seroepidemiological studies, to estimate the extent of population infection and seropositivity to the virus 2 years into the pandemic. Methods and findings We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence published between January 1, 2020 and May 20, 2022. The review protocol is registered with PROSPERO (CRD42020183634). We included general population cross-sectional and cohort studies meeting an assay quality threshold (90% sensitivity, 97% specificity; exceptions for humanitarian settings). We excluded studies with an unclear or closed population sample frame. Eligible studies—those aligned with the WHO Unity protocol—were extracted and critically appraised in duplicate, with risk of bias evaluated using a modified Joanna Briggs Institute checklist. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate underascertainment; meta-analyzed differences in seroprevalence between demographic subgroups such as age and sex; and identified national factors associated with seroprevalence using meta-regression. We identified 513 full texts reporting 965 distinct seroprevalence studies (41% low- and middle-income countries [LMICs]) sampling 5,346,069 participants between January 2020 and April 2022, including 459 low/moderate risk of bias studies with national/subnational scope in further analysis. By September 2021, global SARS-CoV-2 seroprevalence from infection or vaccination was 59.2%, 95% CI [56.1% to 62.2%]. Overall seroprevalence rose steeply in 2021 due to infection in some regions (e.g., 26.6% [24.6 to 28.8] to 86.7% [84.6% to 88.5%] in Africa in December 2021) and vaccination and infection in others (e.g., 9.6% [8.3% to 11.0%] in June 2020 to 95.9% [92.6% to 97.8%] in December 2021, in European high-income countries [HICs]). After the emergence of Omicron in March 2022, infection-induced seroprevalence rose to 47.9% [41.0% to 54.9%] in Europe HIC and 33.7% [31.6% to 36.0%] in Americas HIC. In 2021 Quarter Three (July to September), median seroprevalence to cumulative incidence ratios ranged from around 2:1 in the Americas and Europe HICs to over 100:1 in Africa (LMICs). Children 0 to 9 years and adults 60+ were at lower risk of seropositivity than adults 20 to 29 (p < 0.001 and p = 0.005, respectively). In a multivariable model using prevaccination data, stringent public health and social measures were associated with lower seroprevalence (p = 0.02). The main limitations of our methodology include that some estimates were driven by certain countries or populations being overrepresented. Conclusions In this study, we observed that global seroprevalence has risen considerably over time and with regional variation; however, over one-third of the global population are seronegative to the SARS-CoV-2 virus. Our estimates of infections based on seroprevalence far exceed reported Coronavirus Disease 2019 (COVID-19) cases. Quality and standardized seroprevalence studies are essential to inform COVID-19 response, particularly in resource-limited regions.
dc.description.sponsorship: This work was supported by WHO (WHO COVID-19 Solidarity Response Fund, to IB. https://covid19responsefund.org/en/; German Federal Ministry of Health COVID-19 Research and Development Fund, to IB; World Health Organisation funding, to RKA), the Public Health Agency of Canada (Canada’s COVID-19 Immunity Task Force through the Public Health Agency of Canada, to RKA, grant number 2021-HQ-000056 https://www.covid19immunitytaskforce.ca/), the Canadian Medical Association (Joule Innovation Fund, to RKA https://joulecma.ca/), and the Robert Koch Institute (funding to RKA https://www.rki.de). IB, LS, AnV, LA, AR, JO, TA, PW, LL, AiV, RP, MVK are employed and receive salaries from WHO (one of the funders of this study), and AN, MV, BC and HCL are WHO consultants. Authors who are members of the SeroTracker Group (led by RKA, including MW, HW, ZL, XM, TY, CC, MYL, JP, MPC, DB, ML, MS, GRD, NI, CZ, SP, HPR, TY, KCN, DK, SAA, ND, CD, NAD, EL, RKI, ASB, ELB, AS, JC) were supported through the aforementioned grants from WHO, Canada’s COVID-19 Immunity Task Force through the Public Health Agency of Canada, the Robert Koch Institute, and the Canadian Medical Association Joule Innovation Fund. WHO had a role in the study design, data collection, data analysis, data interpretation, and the writing of the report. No other funders had any such role.
dc.identifier.doi: https://doi.org/10.1371/journal.pmed.1004107
dc.identifier.issn: 1549-1676
dc.identifier.pubmedID: 36355774
dc.identifier.uri: https://open-science.canada.ca/handle/123456789/3387
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 SARS-CoV-2 seroprevalence from January 2020 to April 2022 : a systematic review and meta-analysis of standardized population-based studies
dc.type - en: Article
dc.type - fr: Article
local.acceptedmanuscript.articlenum: e1004107
local.article.journalissue: 11
local.article.journaltitle - en: PLoS Medicine
local.article.journalvolume: 19
local.pagination: 1-24
local.peerreview - en: Yes
local.peerreview - fr: Oui

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