Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020
Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020
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DOI：
10.1001/jamainternmed.2020.4130
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发表时间：
2020-12-01
影响因子：
39
通讯作者：
Thornburg, Natalie J.
中科院分区：
文献类型：
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作者：
Havers, Fiona P.;Reed, Carrie;Thornburg, Natalie J.
报告的严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）感染病例可能低估了受影响社区的感染流行率。大规模血清流行率研究可以更好地估计以前感染的人口比例。目的估计美国几个地理站点便利样本中SARS-CoV-2抗体的流行情况。设计、环境和参与者：本横断面研究对从所有年龄的人获得的方便的残余血清样本进行血清学检测。该血清于2020年3月23日至5月12日收集，由两家商业实验室公司进行常规临床检测。收集地点为加州旧金山湾区；康涅狄格;南佛罗里达;路易斯安那州;明尼阿波利斯-圣保罗-圣克劳德都会区，明尼苏达州；密苏里州;纽约市区，纽约；宾夕法尼亚州费城都会区；犹他州;以及华盛顿州西部。感染SARS-CoV-2。使用酶联免疫吸附试验估计SARS-CoV-2刺突蛋白抗体的存在，并根据年龄和性别对现场人群进行标准化估计。根据测试性能特征（96.0%敏感性和99.3%特异性）调整估计值。每个站点的感染人数是通过推断站点人群的血清患病率来估计的；将估计感染人数与截至最后一次标本采集日期的2019冠状病毒病（COVID-19）报告病例数进行比较。结果共检测血清16 025人，其中女性8853人（55.2%）；18岁及以下1205人（7.5%），65岁及以上5845人（36.2%）。每个站点的大多数标本均未发现SARS-CoV-2抗体的证据。对SARS-CoV-2刺状蛋白抗体血清反应的人群比例调整后的估计范围从旧金山湾区的1.0%（4月23日至27日收集）到纽约市的6.9%（3月23日至4月1日收集）。估计感染人数为报告病例数的6至24倍；在7个地点（康涅狄格州、佛罗里达州、路易斯安那州、密苏里州、纽约市都会区、犹他州和华盛顿州西部），估计发生的SARS-CoV-2感染人数是报告病例数的10倍以上。在2020年3月至5月初，美国10个不同地理地点的大多数人未感染SARS-CoV-2病毒。然而，估计的感染人数远远大于所有地点报告的病例数。调查结果可能反映出患有轻微疾病或无疾病或未寻求医疗护理或接受检测但仍可能导致病毒在人群中持续传播的人数。
IMPORTANCE Reported cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection likely underestimate the prevalence of infection in affected communities. Large-scale seroprevalence studies provide better estimates of the proportion of the population previously infected.OBJECTIVE To estimate prevalence of SARS-CoV-2 antibodies in convenience samples from several geographic sites in the US.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study performed serologic testing on a convenience sample of residual sera obtained from persons of all ages. The serum was collected from March 23 through May 12, 2020, for routine clinical testing by 2 commercial laboratory companies. Sites of collection were San Francisco Bay area, California; Connecticut; south Florida; Louisiana; Minneapolis-St Paul-St Cloud metro area, Minnesota; Missouri; New York City metro area, New York; Philadelphia metro area, Pennsylvania; Utah; and western Washington State.EXPOSURES Infection with SARS-CoV-2.MAIN OUTCOMES AND MEASURES The presence of antibodies to SARS-CoV-2 spike protein was estimated using an enzyme-linked immunosorbent assay, and estimates were standardized to the site populations by age and sex. Estimates were adjusted for test performance characteristics (96.0% sensitivity and 99.3% specificity). The number of infections in each site was estimated by extrapolating seroprevalence to site populations; estimated infections were compared with the number of reported coronavirus disease 2019 (COVID-19) cases as of last specimen collection date.RESULTS Serum samples were tested from 16 025 persons, 8853 (55.2%) of whom were women; 1205 (7.5%) were 18 years or younger and 5845 (36.2%) were 65 years or older. Most specimens from each site had no evidence of antibodies to SARS-CoV-2. Adjusted estimates of the proportion of persons seroreactive to the SARS-CoV-2 spike protein antibodies ranged from 1.0% in the San Francisco Bay area (collected April 23-27) to 6.9% of persons in New York City (collected March 23-April 1). The estimated number of infections ranged from 6 to 24 times the number of reported cases; for 7 sites (Connecticut, Florida, Louisiana, Missouri, New York Citymetro area, Utah, and western Washington State), an estimated greater than 10 times more SARS-CoV-2 infections occurred than the number of reported cases.CONCLUSIONS AND RELEVANCE During March to early May 2020, most persons in 10 diverse geographic sites in the US had not been infected with SARS-CoV-2 virus. The estimated number of infections, however, was much greater than the number of reported cases in all sites. The findings may reflect the number of persons who had mild or no illness or who did not seek medical care or undergo testing but who still may have contributed to ongoing virus transmission in the population.