Trend in Sensitivity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serology One Year After Mild and Asymptomatic Coronavirus Disease 2019 (COVID-19): Unpacking Potential Bias in Seroprevalence Studies

Bailie, Christopher R.; Tseng, Yeu-Yang; Carolan, Louise; Kirk, Martyn; Nicholson, Suellen; Fox, Annette; Sullivan, Sheena G.

doi:10.1093/cid/ciac020

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…Additionally, the probability of seroconversion after infection and the rapidity of seroreversion may vary depending on age [ 60 , 61 ]. Elderly people may have initially stronger immune responses linked to more severe disease or weaker responses due to immune system senescence.…”

Section: Discussionmentioning

confidence: 99%

Differential COVID-19 infection rates in children, adults, and elderly: Systematic review and meta-analysis of 38 pre-vaccination national seroprevalence studies

Axfors

Pezzullo

Contopoulos‐Ioannidis

et al. 2023

J Glob Health

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Background Debate exists about whether extra protection of elderly and other vulnerable individuals is feasible in COVID-19. We aimed to assess the relative infection rates in the elderly vs the non-elderly and, secondarily, in children vs adults. Methods We performed a systematic review and meta-analysis of seroprevalence studies conducted in the pre-vaccination era. We identified representative national studies without high risk of bias through SeroTracker and PubMed searches (last updated May 17, 2022). We noted seroprevalence estimates for children, non-elderly adults, and elderly adults, using cut-offs of 20 and 60 years (or as close to these ages, if they were unavailable) and compared them between different age groups. Results We included 38 national seroprevalence studies from 36 different countries comprising 826 963 participants. Twenty-six of these studies also included pediatric populations and twenty-five were from high-income countries. The median ratio of seroprevalence in elderly vs non-elderly adults (or non-elderly in general, if pediatric and adult population data were not offered separately) was 0.90-0.95 in different analyses, with large variability across studies. In five studies (all in high-income countries), we observed significant protection of the elderly with a ratio of <0.40, with a median of 0.83 in high-income countries and 1.02 elsewhere. The median ratio of seroprevalence in children vs adults was 0.89 and only one study showed a significant ratio of <0.40. The main limitation of our study is the inaccuracies and biases in seroprevalence studies. Conclusions Precision shielding of elderly community-dwelling populations before the availability of vaccines was indicated in some high-income countries, but most countries failed to achieve any substantial focused protection. Registration Open Science Framework (available at: https://osf.io/xvupr )

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Section: Discussionmentioning

confidence: 99%

Differential COVID-19 infection rates in children, adults, and elderly: Systematic review and meta-analysis of 38 pre-vaccination national seroprevalence studies

Axfors

Pezzullo

Contopoulos‐Ioannidis

et al. 2023

J Glob Health

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“…High assay sensitivities and specificities have been reported for each chemiluminescent immunoassay, 15,16,22,26 but typically without addressing potential variation by vaccination status, time since exposure, severity or age. [27][28][29] Like others, 30,31 we did not adjust for sensitivity or specificity in the primary analyses but explored their effects as outlined in Appendix 1, Supplementary Material 2, based on assumptions detailed in Appendix 1, Supplementary Material 3.…”

Section: Seroprevalence Estimationmentioning

confidence: 99%

Serial cross-sectional estimation of vaccine-and infection-induced SARS-CoV-2 seroprevalence in British Columbia, Canada

Skowronski

Kaweski

Irvine

et al. 2022

CMAJ

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The British Columbia Centre for Disease Control (BCCDC) has a longestablished serosurvey protocol to monitor population susceptibility to emerging or re-emerging respiratory viruses. The approach was first deployed during the influenza A (H1N1) pandemic in 2009 to monitor changes in seroprevalence across successive pandemic waves and the mass vaccination campaign. [1][2][3][4][5][6][7] The methodology is predicated upon serial cross-sectional convenience sampling of anonymized residual sera from children and adults of all ages in the most populated Lower Mainland region of BC. 8,9 Adapting this protocol, the BCCDC launched its first SARS-CoV-2 serosurvey in March 2020, just before the World Health Organization's declaration of the COVID-19 pandemic. 10 Baseline assessment was followed by additional serosurveys that spanned the time from mRNA vaccine availability in mid-December 2020, through 7 pandemic waves associated with multiple variants of concern to August 2022 (Figure 1). [11][12][13] Using these serosurveys, we sought to track the evolving proportion of the population that remained

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“…Prevalence log-odds were modeled for each snapshot independently, incorporating a hierarchical distribution for each age group, sex, and HA cell. High sensitivity and specificity have been reported for each of the CLIAs [15,16,22,25], but evaluations have not typically addressed potential variation by vaccination status, time since exposure, severity, age and/or target group [26][27][28]. Similar to other public health agencies [29,30], we do not adjust for sensitivity or specificity in primary analyses, but explore their effects as detailed in Supplementary_Material_2.…”

Section: Sero-prevalencementioning

confidence: 99%

Serial cross-sectional estimation of vaccine and infection-induced SARS-CoV-2 sero-prevalence in children and adults, British Columbia, Canada: March 2020 to August 2022

Skowronski

Kaweski

Irvine

et al. 2022

Preprint

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Background: We chronicle SARS-CoV-2 sero-prevalence through eight cross-sectional sero-surveys (snapshots) in the Lower Mainland (Greater Vancouver and Fraser Valley), British Columbia, Canada from March 2020 to August 2022. Methods: Anonymized-residual sera were obtained from children and adults attending an outpatient laboratory network. Sera were tested with at least three immuno-assays per snapshot to detect spike (S1) and/or nucleocapsid protein (NP) antibodies. Sero-prevalence was defined by dual-assay positivity, including any or infection-induced, the latter requiring S1+NP antibody detection from January 2021 owing to vaccine availability. Infection-induced estimates were used to assess the extent to which surveillance case reports under-estimated infections. Results: Sero-prevalence was ≤1% by the 3rd snapshot in September 2020 and <5% by January 2021 (4th). Following vaccine roll-out, sero-prevalence increased to >55% by May/June 2021 (5th), ~80% by September/October 2021 (6th), and >95% by March 2022 (7th). In all age groups, infection-induced sero-prevalence remained <15% through September/October 2021, increasing through subsequent Omicron waves to ~40% by March 2022 (7th) and ~60% by July/August 2022 (8th). By August 2022, at least 70-80% of children ≤19 years, 60-70% of adults 20-59 years, but ~40% of adults ≥60 years had been infected. Surveillance case reports under-estimated infections by 12-fold between the 6th-7th and 92-fold between the 7th-8th snapshots. Interpretation: By August 2022, most children and adults had acquired SARS-CoV-2 vaccine and infection exposures, resulting in more robust hybrid immunity. Conversely the elderly, still at greatest risk of severe outcomes, remain largely-dependent on vaccine-induced protection alone, and should be prioritized for additional doses.

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Trend in Sensitivity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serology One Year After Mild and Asymptomatic Coronavirus Disease 2019 (COVID-19): Unpacking Potential Bias in Seroprevalence Studies

Cited by 11 publications

References 15 publications

Differential COVID-19 infection rates in children, adults, and elderly: Systematic review and meta-analysis of 38 pre-vaccination national seroprevalence studies

Differential COVID-19 infection rates in children, adults, and elderly: Systematic review and meta-analysis of 38 pre-vaccination national seroprevalence studies

Serial cross-sectional estimation of vaccine-and infection-induced SARS-CoV-2 seroprevalence in British Columbia, Canada

Serial cross-sectional estimation of vaccine and infection-induced SARS-CoV-2 sero-prevalence in children and adults, British Columbia, Canada: March 2020 to August 2022

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