SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection – A multistage national household survey and modelling study, Dominican Republic, June–October 2021
Fecha
2022-11-08Autor
Nilles, Eric J.
Then Paulino, Cecilia
St. Aubin, Michael de
Cadavid Restrepo, Angela
Mayfield, Helen
Dumas, Devan
Finch, Emilie
Garnier, Salome
Etienne, Marie Caroline
Iselin, Louisa
Duke, William
Jarolim, Petr
Oasan, Timothy
Yu, Jingyou
Wan, Huahua
Peña, Farah
Iihoshi, Naomi
Abdalla, Gabriela
Lopez, Beatriz
Cruz, Lucia de la
Henríquez, Bernarda
Espinosa-Bode, Andres
Cornelio Puello, Yosanly
Durski, Kara
Baldwin, Margaret
Baez, Amado Alejandro
Merchant, Roland C
Barouch, Dan H.
Skewes-Ramm, Ronald
Zielinski Gutiérrez, Emily
Kucharski, Adam
Laue, Colleen L.
Metadatos
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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 SARSCoV-
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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