Estimation of US SARS-CoV-2 Infections, Symptomatic Infections, Hospitalizations, and Deaths Using Seroprevalence Surveys.
Estimation of US SARS-CoV-2 Infections, Symptomatic Infections, Hospitalizations, and Deaths Using Seroprevalence Surveys.
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DOI：
10.1001/jamanetworkopen.2020.33706
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发表时间：
2021-01-04
影响因子：
13.8
通讯作者：
Swerdlow DL
中科院分区：
文献类型：
--
作者：
Angulo FJ;Finelli L;Swerdlow DL
考虑到漏报，美国的严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）疾病负担是什么？在这项利用2019年冠状病毒病报告病例的公共卫生监测数据和血清患病率调查的横断面研究中，截至2020年11月15日，美国估计有46 910 006例SARS-CoV-2感染，28 122 752例有症状感染，956 174例住院治疗，304 915例死亡。这项研究的结果表明，尽管到11月中旬，超过14%的美国人口感染了SARS-CoV-2，但在达到群体免疫之前还有很大的差距。需要估计严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）疾病负担，以帮助指导干预措施。估计截至2020年11月15日，美国SARS-CoV-2感染、症状感染、住院和死亡人数。在这项针对所有年龄段受访者的横断面研究中，使用了来自4个地区和1个全国疾病控制和预防中心（CDC）血清患病率调查（4月[n = 16 596]， 5月，6月和7月[n = 40 817]和8月[n = 38 355]）的数据来估计感染漏报乘数和症状漏报乘数。从普通人群中随机抽取的社区服务调查数据也被用于验证低报乘数。SARS-CoV-2感染、有症状感染、住院治疗和死亡。将参与两次或两次以上调查的10个州的5次CDC血清患病率调查得出的少报乘数的中位数应用于报告的2019冠状病毒病（COVID-19）病例的监测数据，分别获得5个时间段的SARS-CoV-2感染和症状感染的估计值，并将这些估计值求和，以估计美国的SARS-CoV-2感染和症状感染。将感染和症状感染的估计值与住院率和病死率的估计值结合起来，得出SARS-CoV-2住院和死亡的估计值。通过将4月CDC调查结果与随机抽取的5项血清调查（n = 22 118）进行比较，评估调查的外部有效性。疾控中心在8月份的调查中，通过将这10个州的乘数与所有州的乘数进行比较，评估了来自10个特定州的乘数的内部有效性。利用乘数的四分位数范围进行敏感性分析，得出SARS-CoV-2感染和有症状感染的高、低估计值。然后使用漏报乘数来调整报告的COVID-19感染，以估计SARS-COV-2的全部疾病负担。调整报道COVID-19感染使用漏报乘数来自CDC seroprevalence研究(n = 16 596年)4月,可能14 (n = 291), 6月14 (n = 159), (n = 367), 7月和8月38 (n = 355),有估计910年46中位数006(四分位范围(差),38 192 705 - 60 814 748)SARS-CoV-2感染,28 122 752 (IQR, 23 014 957 - 36 438 592)有症状感染,956 174 (IQR, 782 509 - 1 238 912)住院治疗,915年和304年(差,截至2020年11月15日，美国死亡人数为248,253 - 395,296)。截至2020年11月中旬，估计有14.3% （IQR, 11.6%-18.5%）的美国人口感染了SARS-CoV-2。由于漏报，SARS-CoV-2疾病负担可能比报告的COVID-19病例大得多。即使在对漏报进行调整之后，估计的受感染人口比例与达到群体免疫所需的受感染比例之间仍然存在很大差距。需要进行更多的血清流行率调查，以监测大流行，包括在采用安全有效的疫苗之后。本横断面研究评估了美国的严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）疾病负担，使用监测数据和血清患病率调查来估计截至2020年11月15日的SARS-CoV-2感染、症状感染、住院和死亡人数。
Accounting for underreporting, what is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease burden in the US? In this cross-sectional study using data from public health surveillance of reported coronavirus disease 2019 cases and seroprevalence surveys, an estimated 46 910 006 SARS-CoV-2 infections, 28 122 752 symptomatic infections, 956 174 hospitalizations, and 304 915 deaths occurred in the US through November 15, 2020. Findings of this study suggest that although more than 14% of the US population was infected with SARS-CoV-2 by mid-November, a substantial gap remains before herd immunity can be reached. Estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease burden are needed to help guide interventions. To estimate the number of SARS-CoV-2 infections, symptomatic infections, hospitalizations, and deaths in the US as of November 15, 2020. In this cross-sectional study of respondents of all ages, data from 4 regional and 1 nationwide Centers for Disease Control and Prevention (CDC) seroprevalence surveys (April [n = 16 596], May, June, and July [n = 40 817], and August [n = 38 355]) were used to estimate infection underreporting multipliers and symptomatic underreporting multipliers. Community serosurvey data from randomly selected members of the general population were also used to validate the underreporting multipliers. SARS-CoV-2 infections, symptomatic infections, hospitalizations, and deaths. The median of underreporting multipliers derived from the 5 CDC seroprevalence surveys in the 10 states that participated in 2 or more surveys were applied to surveillance data of reported coronavirus disease 2019 (COVID-19) cases for 5 respective time periods to derive estimates of SARS-CoV-2 infections and symptomatic infections, which were summed to estimate SARS-CoV-2 infections and symptomatic infections in the US. Estimates of infections and symptomatic infections were combined with estimates of the hospitalization ratio and fatality ratio to derive estimates of SARS-CoV-2 hospitalizations and deaths. External validity of the surveys was evaluated with the April CDC survey by comparing results to 5 serosurveys (n = 22 118) that used random sampling of the general population. Internal validity of the multipliers from the 10 specific states was assessed in the August CDC survey by comparing multipliers from the 10 states to all states. A sensitivity analysis was conducted using the interquartile range of the multipliers to derive a high and low estimate of SARS-CoV-2 infections and symptomatic infections. The underreporting multipliers were then used to adjust the reported COVID-19 infections to estimate the full SARS-COV-2 disease burden. Adjusting reported COVID-19 infections using underreporting multipliers derived from CDC seroprevalence studies in April (n = 16 596), May (n = 14 291), June (n = 14 159), July (n = 12 367), and August (n = 38 355), there were estimated medians of 46 910 006 (interquartile range [IQR], 38 192 705-60 814 748) SARS-CoV-2 infections, 28 122 752 (IQR, 23 014 957–36 438 592) symptomatic infections, 956 174 (IQR, 782 509–1 238 912) hospitalizations, and 304 915 (IQR, 248 253–395 296) deaths in the US through November 15, 2020. An estimated 14.3% (IQR, 11.6%-18.5%) of the US population were infected by SARS-CoV-2 as of mid-November 2020. The SARS-CoV-2 disease burden may be much larger than reported COVID-19 cases owing to underreporting. Even after adjusting for underreporting, a substantial gap remains between the estimated proportion of the population infected and the proportion infected required to reach herd immunity. Additional seroprevalence surveys are needed to monitor the pandemic, including after the introduction of safe and efficacious vaccines. This cross-sectional study assesses the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease burden in the US, using surveillance data and seroprevalence surveys to estimate the number of SARS-CoV-2 infections, symptomatic infections, hospitalizations, and deaths through November 15, 2020.
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