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Global SARS-CoV-2 seroprevalence from January 2020 to April 2022: A systematic review and meta-analysis of standardized population-based studies

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dc.contributor.authorIsabel Bergeri
dc.contributor.authorMairead G. Whelan
dc.contributor.authorHarriet Ware
dc.contributor.authorLorenzo Subissi
dc.contributor.authorAnthony Nardone
dc.contributor.authorHannah C. Lewis
dc.contributor.authorZihan Li
dc.contributor.authorXiaomeng Ma
dc.contributor.authorMarta Valenciano
dc.contributor.authorBrianna Cheng
dc.contributor.authorLubna Al Ariqi
dc.contributor.authorArash Rashidian
dc.contributor.authorJoseph Okeibunor
dc.contributor.authorTasnim Azim
dc.contributor.authorPushpa Wijesinghe
dc.contributor.authorLinh-Vi Le
dc.contributor.authorAisling Vaughan
dc.contributor.authorRichard Pebody
dc.contributor.authorAndrea Vicari
dc.contributor.authorTingting Yan
dc.contributor.authorMercedes Yanes-Lane
dc.contributor.authorChristian Cao
dc.contributor.authorDavid A. Clifton
dc.contributor.authorMatthew P. Cheng
dc.contributor.authorJesse Papenburg
dc.contributor.authorDavid Buckeridge
dc.contributor.authorNiklas Bobrovitz
dc.contributor.authorRahul K. Arora
dc.contributor.authorMaria D. Van Kerkhove
dc.date.accessioned2024-07-16T15:30:21Z
dc.date.available2024-07-16T15:30:21Z
dc.date.issued2022
dc.description.abstractBackground: Our understanding of the global scale of Severe Acute Respiratory Syndrome Coronavi rus 2 (SARS-CoV-2) infection remains incomplete: Routine surveillance data underesti mate infection and cannot infer on population immunity; there is a predominance of asymptomatic infections, and uneven access to diagnostics. We meta-analyzed SARS CoV-2 seroprevalence studies, standardized to those described in the World Health Organization’s Unity protocol (WHO Unity) for general population seroepidemiological studies, to estimate the extent of population infection and seropositivity to the virus 2 years into the pandemic. Methods and findings: We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence published between January 1, 2020 and May 20, 2022. The review protocol is registered with PROS PERO (CRD42020183634). We included general population cross-sectional and cohort studies meeting an assay quality threshold (90% sensitivity, 97% specificity; exceptions for humanitarian settings). We excluded studies with an unclear or closed population sample frame. Eligible studies—those aligned with the WHO Unity protocol—were extracted and critically appraised in duplicate, with risk of bias evaluated using a modified Joanna Briggs Institute checklist. We meta-analyzed seroprevalence by country and month, pooling to esti mate regional and global seroprevalence over time; compared seroprevalence from infec tion to confirmed cases to estimate underascertainment; meta-analyzed differences in seroprevalence between demographic subgroups such as age and sex; and identified national factors associated with seroprevalence using meta-regression. We identified 513 full texts reporting 965 distinct seroprevalence studies (41% low- and middle-income coun tries [LMICs]) sampling 5,346,069 participants between January 2020 and April 2022, including 459 low/moderate risk of bias studies with national/subnational scope in further analysis. By September 2021, global SARS-CoV-2 seroprevalence from infection or vacci nation was 59.2%, 95% CI [56.1% to 62.2%]. Overall seroprevalence rose steeply in 2021 due to infection in some regions (e.g., 26.6% [24.6 to 28.8] to 86.7% [84.6% to 88.5%] in Africa in December 2021) and vaccination and infection in others (e.g., 9.6% [8.3% to 11.0%] in June 2020 to 95.9% [92.6% to 97.8%] in December 2021, in European high income countries [HICs]). After the emergence of Omicron in March 2022, infection-induced seroprevalence rose to 47.9% [41.0% to 54.9%] in Europe HIC and 33.7% [31.6% to 36.0%] in Americas HIC. In 2021 Quarter Three (July to September), median seroprevalence to cumulative incidence ratios ranged from around 2:1 in the Americas and Europe HICs to over 100:1 in Africa (LMICs). Children 0 to 9 years and adults 60+ were at lower risk of sero positivity than adults 20 to 29 (p < 0.001 and p = 0.005, respectively). In a multivariable model using prevaccination data, stringent public health and social measures were associated with lower seroprevalence (p = 0.02). The main limitations of our methodology include that some estimates were driven by certain countries or populations being overrepresented. Conclusions: In this study, we observed that global seroprevalence has risen considerably over time and with regional variation; however, over one-third of the global population are seronegative to the SARS-CoV-2 virus. Our estimates of infections based on seroprevalence far exceed reported Coronavirus Disease 2019 (COVID-19) cases. Quality and standardized seroprev alence studies are essential to inform COVID-19 response, particularly in resource-limited regions
dc.identifier.doihttps://doi.org/10.1371/journal. pmed.1004107
dc.identifier.urihttps://repository.nih.gov.my/handle/123456789/570
dc.language.isoen
dc.titleGlobal SARS-CoV-2 seroprevalence from January 2020 to April 2022: A systematic review and meta-analysis of standardized population-based studies
dc.typetext::journal
dspace.entity.typePublication
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