Population-based seroprevalence of SARS-CoV-2 antibodies in a high-altitude setting in Peru

Huamaní, Charles; Velásquez, Lucio; Montes, Sonia; Mayanga-Herrera, Ana; Bernabé‐Ortiz, Antonio

doi:10.1101/2021.01.17.21249990

Cited by 3 publications

References 29 publications

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SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru

et al. 2021

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Background: Worldwide, Peru has one of the highest infection fatality rates of COVID-19, and its capital city, Lima, accumulates roughly 50% of diagnosed cases. Despite surveillance efforts to assess the extent of the pandemic, reported cases and deaths only capture a fraction of its impact due to COVID-19 0 s broad clinical spectrum. This study aimed to estimate the seroprevalence of SARS-CoV-2 in Lima, stratified by age, sex, region, socioeconomic status (SES), overcrowding, and symptoms. Methods: We conducted a multi-stage, population-based serosurvey in Lima, between June 28th and July 9th, 2020, after 115 days of the index case and after the first peak cases. We collected whole blood samples by finger-prick and applied a structured questionnaire. A point-of-care rapid serological test assessed IgM and IgG antibodies against SARS-CoV-2. Seroprevalence estimates were adjusted by sampling weights and test performance. Additionally, we performed RT-PCR molecular assays to seronegatives and estimated the infection prevalence. Findings: We enrolled 3212 participants from 797 households and 241 sample clusters from Lima in the analysis. The SARS-CoV-2 seroprevalence was 20¢8% (95%CI 17¢2À23¢5), and the prevalence was 25¢2% (95%CI 22¢5À28¢2). Seroprevalence was equally distributed by sex (aPR=0¢96 [95%CI 0¢85À1¢09, p = 0¢547]) and across all age groups, including 60 versus 11 years old (aPR=0¢96 [95%CI 0¢73À1¢27, p = 0¢783]). A gradual decrease in SES was associated with higher seroprevalence (aPR=3¢41 [95%CI 1¢90À6¢12, p<0¢001] in low SES). Also, a gradual increase in the overcrowding index was associated with higher seroprevalence (aPR=1¢99 [95%CI 1¢41À2¢81, p<0¢001] in the fourth quartile). Seroprevalence was also associated with contact with a suspected or confirmed COVID-19 case, whether a household member (48¢9%, aPR=2¢67 [95%CI 2¢06À3¢47, p<0¢001]), other family members (27¢3%, aPR=1¢66 [95%CI 1¢15À2¢40, p = 0¢008]) or a workmate (34¢1%, aPR=2¢26 [95%CI 1¢53À3¢35, p<0¢001]). More than half of seropositive participants reported never having had symptoms (56¢1%, 95% CI 49¢7À62¢3). Interpretation: This first estimate of SARS-CoV-2 seroprevalence in Lima shows an intense transmission scenario, despite the government's numerous interventions early established. Susceptibles across age groups show that physical distancing interventions must not be relaxed. SES and overcrowding households are associated with seroprevalence. This study highlights the importance of considering the existing social inequalities for implementing the response to control transmission in low-and middle-income countries.

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SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru

et al. 2021

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Assessing the Burden of COVID-19 in Developing Countries: Systematic Review, Meta-Analysis, and Public Policy Implications

Owusu‐Boaitey

Pugh

Fosdick

et al. 2021

Preprint

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Introduction The infection fatality rate (IFR) of COVID-19 has been carefully measured and analyzed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries. Indeed, it has been suggested that the death rate in developing countries may be far lower than in high-income countries - an outcome that would be starkly different from the typical pattern for many other infectious diseases. Methods We systematically reviewed the literature to identify all serology studies in developing countries that were conducted using representative samples of specimens collected by early 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analyzed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible. Results Seroprevalence in many developing country locations was markedly higher than in high-income countries but still far short of herd immunity. In most locations, seroprevalence among older adults was similar to that of younger age-groups. Age-specific IFRs were 1.3-2.5x higher than in high-income countries. The median value of population IFR was 0.5% among developing countries with satisfactory death reporting as of 2016, compared to a median of 0.05% for other developing countries. Conclusion The burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to accelerate the provision of vaccine doses to vulnerable populations in developing countries.

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Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications

et al. 2022

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IntroductionThe infection fatality rate (IFR) of COVID-19 has been carefully measured and analysed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries.MethodsWe systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using representative samples collected by February 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analysed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible.ResultsIn most locations in developing countries, seroprevalence among older adults was similar to that of younger age cohorts, underscoring the limited capacity that these nations have to protect older age groups.Age-specific IFRs were roughly 2 times higher than in high-income countries. The median value of the population IFR was about 0.5%, similar to that of high-income countries, because disparities in healthcare access were roughly offset by differences in population age structure.ConclusionThe burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to ensure medical equity to populations in developing countries through provision of vaccine doses and effective medications.

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Population-based seroprevalence of SARS-CoV-2 antibodies in a high-altitude setting in Peru

Cited by 3 publications

References 29 publications

SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru

SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru

Assessing the Burden of COVID-19 in Developing Countries: Systematic Review, Meta-Analysis, and Public Policy Implications

Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications

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