SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection – A multistage national household survey and modelling study, Dominican Republic, June–October 2021

Eric J. Nilles, Cecilia Then Paulino, Michael de St. Aubin, Angela Cadavid Restrepo, Helen Mayfield, Devan Dumas, Emilie Finch, Salome Garnier, Marie Caroline Etienne, Louisa Iselin, William Duke, Petr Jarolim, Timothy Oasan, Jingyou Yu, Huahua Wan, Farah Peña, Naomi Iihoshi, Gabriela Abdalla, Beatriz Lopez, Lucia de la CruzBernarda Henríquez, Andres Espinosa-Bode, Yosanly Cornelio Puello, Kara Durski, Margaret Baldwin, Amado Alejandro Baez, Roland C. Merchant, Dan H. Barouch, Ronald Skewes-Ramm, Emily Zielinski Gutiérrez, Adam Kucharski, Colleen L. Lau

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Population-level SARS-CoV-2 immunological protection is poorly understood but can guide vaccination and non-pharmaceutical intervention priorities. Our objective was to characterise cumulative infections and immunological protection in the Dominican Republic. Methods: Household members ≥5 years were enrolled in a three-stage national household cluster serosurvey in the Dominican Republic. We measured pan-immunoglobulin antibodies against the SARS-CoV-2 spike (anti-S) and nucleocapsid glycoproteins, and pseudovirus neutralising activity against the ancestral and B.1.617.2 (Delta) strains. Seroprevalence and cumulative prior infections were weighted and adjusted for assay performance and seroreversion. Binary classification machine learning methods and pseudovirus neutralising correlates of protection were used to estimate 50% and 80% protection against symptomatic infection. Findings: Between 30 Jun and 12 Oct 2021 we enrolled 6683 individuals from 3832 households. We estimate that 85.0% (CI 82.1–88.0) of the ≥5 years population had been immunologically exposed and 77.5% (CI 71.3–83) had been previously infected. Protective immunity sufficient to provide at least 50% protection against symptomatic SARS-CoV-2 infection was estimated in 78.1% (CI 74.3–82) and 66.3% (CI 62.8–70) of the population for the ancestral and Delta strains respectively. Younger (5–14 years, OR 0.47 [CI 0.36–0.61]) and older (≥75-years, 0.40 [CI 0.28–0.56]) age, working outdoors (0.53 [0.39–0.73]), smoking (0.66 [0.52–0.84]), urban setting (1.30 [1.14–1.49]), and three vs no vaccine doses (18.41 [10.69–35.04]) were associated with 50% protection against the ancestral strain. Interpretation: Cumulative infections substantially exceeded prior estimates and overall immunological exposure was high. After controlling for confounders, markedly lower immunological protection was observed to the ancestral and Delta strains across certain subgroups, findings that can guide public health interventions and may be generalisable to other settings and viral strains. Funding: This study was funded by the US CDC.

Original languageEnglish (US)
Article number100390
JournalThe Lancet Regional Health - Americas
Volume16
DOIs
StatePublished - Dec 2022
Externally publishedYes

ASJC Scopus subject areas

  • Health Policy
  • Internal Medicine
  • Public Health, Environmental and Occupational Health

Fingerprint

Dive into the research topics of 'SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection – A multistage national household survey and modelling study, Dominican Republic, June–October 2021'. Together they form a unique fingerprint.

Cite this