Estimated SARS-CoV-2 infection rate and fatality risk in Gauteng Province, South Africa : a population-based seroepidemiological survey

dc.contributor.authorMutevedzi, Portia Chipo
dc.contributor.authorKawonga, Mary
dc.contributor.authorKwatra, Gaurav
dc.contributor.authorMoultrie, Andrew
dc.contributor.authorBaillie, Vicky
dc.contributor.authorMabena, Nicoletta
dc.contributor.authorMathibe, Masego Nicole
dc.contributor.authorRafuma, Martin Mosotho
dc.contributor.authorMaposa, Innocent
dc.contributor.authorAbbott, Geoff
dc.contributor.authorHugo, J.F.M. (Jannie)
dc.contributor.authorIkalafeng, Bridget
dc.contributor.authorAdelekan, Tsholofelo
dc.contributor.authorLukhele, Mkhululi
dc.contributor.authorMadhi, Shabir A.
dc.date.accessioned2023-11-10T07:26:19Z
dc.date.available2023-11-10T07:26:19Z
dc.date.issued2022-04
dc.descriptionDATA AVAILABILITY : De-identified individual-level data and data sets generated during the current study are available for researchers who provide a methodologically sound proposal. If approved, the requestor must sign a data-use agreement. Additionally, the study protocol is available on request. All requests must be addressed to the corresponding author. Data will be available 3 months after publication of this manuscript.en_US
dc.description.abstractBACKGROUND : Limitations in laboratory testing capacity undermine the ability to quantify the overall burden of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. METHODS : We undertook a population-based serosurvey for SARS-CoV-2 infection in 26 subdistricts, Gauteng Province (population 15.9 million), South Africa, to estimate SARS-CoV-2 infection, infection fatality rate (IFR) triangulating seroprevalence, recorded COVID-19 deaths and excess-mortality data. We employed three-stage random household sampling with a selection probability proportional to the subdistrict size, stratifying the subdistrict census-sampling frame by housing type and then selecting households from selected clusters. The survey started on 4 November 2020, 8 weeks after the end of the first wave (SARS-CoV-2 nucleic acid amplification test positivity had declined to <10% for the first wave) and coincided with the peak of the second wave. The last sampling was performed on 22 January 2021, which was 9 weeks after the SARS-CoV-2 resurgence. Serum SARS-CoV-2 receptor-binding domain (RBD) immunoglobulin-G (IgG) was measured using a quantitative assay on the Luminex platform. RESULTS : From 6332 individuals in 3453 households, the overall RBD IgG seroprevalence was 19.1% [95% confidence interval (CI): 18.1–20.1%] and similar in children and adults. The seroprevalence varied from 5.5% to 43.2% across subdistricts. Conservatively, there were 2 897 120 (95% CI: 2 743 907–3 056 866) SARS-CoV-2 infections, yielding an infection rate of 19 090 per 100 000 until 9 January 2021, when 330 336 COVID-19 cases were recorded. The estimated IFR using recorded COVID-19 deaths (n = 8198) was 0.28% (95% CI: 0.27–0.30) and 0.67% (95% CI: 0.64–0.71) assuming 90% of modelled natural excess deaths were due to COVID-19 (n = 21 582). Notably, 53.8% (65/122) of individuals with previous self-reported confirmed SARS-CoV-2 infection were RBD IgG seronegative. CONCLUSIONS : The calculated number of SARS-CoV-2 infections was 7.8-fold greater than the recorded COVID-19 cases. The calculated SARS-CoV-2 IFR varied 2.39-fold when calculated using reported COVID-19 deaths (0.28%) compared with excess-mortality-derived COVID-19-attributable deaths (0.67%). Waning RBD IgG may have inadvertently underestimated the number of SARS-CoV-2 infections and conversely overestimated the mortality risk. Epidemic preparedness and response planning for future COVID-19 waves will need to consider the true magnitude of infections, paying close attention to excess-mortality trends rather than absolute reported COVID-19 deaths.en_US
dc.description.departmentFamily Medicineen_US
dc.description.librarianhj2023en_US
dc.description.sponsorshipThe Bill and Melinda Gates Foundation.en_US
dc.description.urihttps://academic.oup.com/ijeen_US
dc.identifier.citationMutevedzi, P.C., Kawonga, M., Kwatra, G. et al. 2022, 'Estimated SARS-CoV-2 infection rate and fatality risk in Gauteng Province, South Africa : a population-based seroepidemiological survey', International Journal of Epidemiology, vol. 51, no. 2, pp. 404–417, https://doi.org/10.1093/ije/dyab217.en_US
dc.identifier.issn0300-5771 (print)
dc.identifier.issn1464-3685 (online)
dc.identifier.other10.1093/ije/dyab217
dc.identifier.urihttp://hdl.handle.net/2263/93230
dc.language.isoenen_US
dc.publisherOxford University Pressen_US
dc.rightsThe Author(s) 2021. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).en_US
dc.subjectCOVID-19 pandemicen_US
dc.subjectCoronavirus disease 2019 (COVID-19)en_US
dc.subjectSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)en_US
dc.subjectInfection-mortality risken_US
dc.subjectSerosurveyen_US
dc.subjectSeroprevalenceen_US
dc.subject.otherHealth sciences articles SDG-03
dc.subject.otherSDG-03: Good health and well-being
dc.subject.otherHealth sciences articles SDG-04
dc.subject.otherSDG-04: Quality education
dc.titleEstimated SARS-CoV-2 infection rate and fatality risk in Gauteng Province, South Africa : a population-based seroepidemiological surveyen_US
dc.typeArticleen_US

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