Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study.
Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study.
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DOI：
10.1016/s2666-5247(20)30053-7
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发表时间：
2020-07
期刊：
影响因子：
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通讯作者：
Yuen KY
中科院分区：
文献类型：
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作者：
To KK;Cheng VC;Cai JP;Chan KH;Chen LL;Wong LH;Choi CY;Fong CH;Ng AC;Lu L;Luo CT;Situ J;Chung TW;Wong SC;Kwan GS;Sridhar S;Chan JF;Fan CY;Chuang VWM;Kok KH;Hung IF;Yuen KY
由于缺乏人群血清阳性率数据，亚临床严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染在延续COVID-19大流行中的作用尚不清楚。我们的目的是建立我们的酶免疫分析和微量中和试验的灵敏度和特异性，以及SARS-CoV-2在香港大流行前后的血清阳性率，以及从中国湖北省撤离的香港居民。我们在香港的一所医院和大学进行了一项多队列研究。我们使用来自SARS-CoV-2阳性患者的RT-PCR数据评估了我们的酶免疫测定和微量中和试验的灵敏度，并使用2019年之前收集的存档血清样本评估了我们的酶免疫测定和微量中和试验的特异性。我们比较了疫情开始前后香港一般人群的血清阳性率，并确定了2020年3月从中国湖北省撤离的香港居民的血清阳性率。在2020年2月26日至3月18日期间，我们评估了45名从COVID-19中康复的患者的RT-PCR样本，以确定我们的酶免疫分析和微量中和试验的灵敏度。为了确定这些试验的特异性，我们检索了存档血清。灵敏度为91·1%（41/45 [95% CI 78·8-97·5]），对于微量中和试验，57·8%（26/45 [42·2-72·3]）抗核蛋白IgG，66·7%（30/45 [51·1-80·0]）抗刺突蛋白受体结合域（RBD）IgG，73·3%（33/45 [58·1-85·4]）酶免疫测定（抗核蛋白或抗RBD IgG阳性）。酶免疫分析和微量中和试验的特异性均为100%（152/152 [95% CI 97·6-100·0]）。在香港一般人口中，1938人中有53人（2.7%）为酶免疫测定阳性，但在阳性的人中，所有53人均为微量中和阴性，2018年4月12日至2020年2月13日期间血清阳性率没有显著增加。在无症状的湖北返回者中，452人中有17人（4%）血清学阳性与酶免疫测定或微量中和试验，15人（88%）血清学阳性与微量中和试验，并确定了两个家庭集群。我们的血清学数据表明SARS-CoV-2是一种新出现的病毒。湖北返回者的血清阳性率表明，RT-PCR确认的患者仅占病例总数的一小部分。低血清阳性率显示大部分香港及湖北人口仍对COVID-19易感。如果没有疫苗或抗病毒预防措施，未来爆发的浪潮是不可避免的。年龄相关交叉反应性非中和抗体在COVID-19发病机制中的作用值得进一步研究。Richard and Carol Yu，May Tam Mak Mei Yin，Shaw Foundation（Hong Kong），Michael Tong，Marina Lee，and the Government Consultancy Service（详见附件）。
The role of subclinical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in perpetuating the COVID-19 pandemic is unknown because population seroprevalence data are absent. We aimed to establish the sensitivity and specificity of our enzyme immunoassay and microneutralisation assay, and the seroprevalence of SARS-CoV-2 in Hong Kong before and after the pandemic, as well as in Hong Kong residents evacuated from Hubei province, China. We did a multicohort study in a hospital and university in Hong Kong. We evaluated the sensitivity of our enzyme immunoassay and microneutralisation assay with RT-PCR data from patients positive for SARS-CoV-2 and the specificity of our enzyme immunoassay and microneutralisation assay with archived serum samples collected before 2019. We compared the seropositivity of the general population of Hong Kong before and after the pandemic had begun, and determined the seropositivity of Hong Kong residents evacuated from Hubei province, China, in March, 2020. Between Feb 26 and March 18, 2020, we assessed RT-PCR samples from 45 patients who had recovered from COVID-19 to establish the sensitivity of our enzyme immunoassay and microneutralisation assay. To establish the specificity of these assays, we retrieved archived serum. The sensitivity was 91·1% (41 of 45 [95% CI 78·8–97·5]) for the microneutralisation assay, 57·8% (26 of 45 [42·2–72·3]) for anti-nucleoprotein IgG, 66·7% (30 of 45 [51·1–80·0]) for anti-spike protein receptor binding domain (RBD) IgG, and 73·3% (33 of 45 [58·1–85·4]) for enzyme immunoassay (either positive for anti-nucleoprotein or anti-RBD IgG). The specificity was 100% (152 of 152 [95% CI 97·6–100·0]) for both the enzyme immunoassay and microneutralisation assay. Among the Hong Kong general population, 53 (2·7%) of 1938 were enzyme immunoassay positive, but of those who were positive, all 53 were microneutralisation negative, and no significant increase was seen in the seroprevalence between April 12, 2018, and Feb 13, 2020. Among asymptomatic Hubei returnees, 17 (4%) of 452 were seropositive with the enzyme immunoassay or the microneutralisation assay, with 15 (88%) of 17 seropositive with the microneutralisation assay, and two familial clusters were identified. Our serological data suggest that SARS-CoV-2 is a new emerging virus. The seropositivity rate in Hubei returnees indicates that RT-PCR-confirmed patients only represent a small proportion of the total number of cases. The low seroprevalence suggests that most of the Hong Kong and Hubei population remain susceptible to COVID-19. Future waves of the outbreak are inevitable without a vaccine or antiviral prophylaxis. The role of age-related cross reactive non-neutralising antibodies in the pathogenesis of COVID-19 warrants further investigation. Richard and Carol Yu, May Tam Mak Mei Yin, Shaw Foundation (Hong Kong), Michael Tong, Marina Lee, and the Government Consultancy Service (see acknowledgments for full list).