TY - JOUR
T1 - SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection – A multistage national household survey and modelling study, Dominican Republic, June–October 2021
AU - Nilles, Eric J.
AU - Paulino, Cecilia Then
AU - de St. Aubin, Michael
AU - Restrepo, Angela Cadavid
AU - Mayfield, Helen
AU - Dumas, Devan
AU - Finch, Emilie
AU - Garnier, Salome
AU - Etienne, Marie Caroline
AU - Iselin, Louisa
AU - Duke, William
AU - Jarolim, Petr
AU - Oasan, Timothy
AU - Yu, Jingyou
AU - Wan, Huahua
AU - Peña, Farah
AU - Iihoshi, Naomi
AU - Abdalla, Gabriela
AU - Lopez, Beatriz
AU - Cruz, Lucia de la
AU - Henríquez, Bernarda
AU - Espinosa-Bode, Andres
AU - Puello, Yosanly Cornelio
AU - Durski, Kara
AU - Baldwin, Margaret
AU - Baez, Amado Alejandro
AU - Merchant, Roland C.
AU - Barouch, Dan H.
AU - Skewes-Ramm, Ronald
AU - Gutiérrez, Emily Zielinski
AU - Kucharski, Adam
AU - Lau, Colleen L.
N1 - Publisher Copyright:
© 2022 The Author(s)
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
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U2 - 10.1016/j.lana.2022.100390
DO - 10.1016/j.lana.2022.100390
M3 - Article
AN - SCOPUS:85141546849
SN - 2667-193X
VL - 16
JO - Lancet Regional Health - Americas
JF - Lancet Regional Health - Americas
M1 - 100390
ER -
