Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland; Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; University Centre for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.
Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Lancet. 2020 Aug 1;396(10247):313-319. doi: 10.1016/S0140-6736(20)31304-0. Epub 2020 Jun 11.
BACKGROUND: Assessing the burden of COVID-19 on the basis of medically attended case numbers is suboptimal given its reliance on testing strategy, changing case definitions, and disease presentation. Population-based serosurveys measuring anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) antibodies provide one method for estimating infection rates and monitoring the progression of the epidemic. Here, we estimate weekly seroprevalence of anti-SARS-CoV-2 antibodies in the population of Geneva, Switzerland, during the epidemic. METHODS: The SEROCoV-POP study is a population-based study of former participants of the Bus Santé study and their household members. We planned a series of 12 consecutive weekly serosurveys among randomly selected participants from a previous population-representative survey, and their household members aged 5 years and older. We tested each participant for anti-SARS-CoV-2-IgG antibodies using a commercially available ELISA. We estimated seroprevalence using a Bayesian logistic regression model taking into account test performance and adjusting for the age and sex of Geneva's population. Here we present results from the first 5 weeks of the study. FINDINGS: Between April 6 and May 9, 2020, we enrolled 2766 participants from 1339 households, with a demographic distribution similar to that of the canton of Geneva. In the first week, we estimated a seroprevalence of 4·8% (95% CI 2·4-8·0, n=341). The estimate increased to 8·5% (5·9-11·4, n=469) in the second week, to 10·9% (7·9-14·4, n=577) in the third week, 6·6% (4·3-9·4, n=604) in the fourth week, and 10·8% (8·2-13·9, n=775) in the fifth week. Individuals aged 5-9 years (relative risk [RR] 0·32 [95% CI 0·11-0·63]) and those older than 65 years (RR 0·50 [0·28-0·78]) had a significantly lower risk of being seropositive than those aged 20-49 years. After accounting for the time to seroconversion, we estimated that for every reported confirmed case, there were 11·6 infections in the community. INTERPRETATION: These results suggest that most of the population of Geneva remained uninfected during this wave of the pandemic, despite the high prevalence of COVID-19 in the region (5000 reported clinical cases over <2·5 months in the population of half a million people). Assuming that the presence of IgG antibodies is associated with immunity, these results highlight that the epidemic is far from coming to an end by means of fewer susceptible people in the population. Further, a significantly lower seroprevalence was observed for children aged 5-9 years and adults older than 65 years, compared with those aged 10-64 years. These results will inform countries considering the easing of restrictions aimed at curbing transmission. FUNDING: Swiss Federal Office of Public Health, Swiss School of Public Health (Corona Immunitas research program), Fondation de Bienfaisance du Groupe Pictet, Fondation Ancrage, Fondation Privée des Hôpitaux Universitaires de Genève, and Center for Emerging Viral Diseases.
背景:鉴于其依赖于检测策略、不断变化的病例定义和疾病表现,根据有医疗记录的病例数来评估 COVID-19 的负担并不理想。基于人群的血清学调查,测量针对严重急性呼吸综合征冠状病毒 2(抗-SARS-CoV-2)的抗体,是一种估计感染率和监测疫情进展的方法。在这里,我们估计了瑞士日内瓦人口在疫情期间抗 SARS-CoV-2 抗体的每周血清流行率。
方法:SEROCoV-POP 研究是对 Bus Santé 研究的前参与者及其家庭成员进行的一项基于人群的研究。我们计划在以前的人群代表性调查中随机选择的参与者及其 5 岁及以上的家庭成员中进行连续 12 周的血清学调查。我们使用商业上可用的 ELISA 检测每个参与者的抗 SARS-CoV-2-IgG 抗体。我们使用贝叶斯逻辑回归模型估计血清流行率,该模型考虑了检测性能,并根据日内瓦人口的年龄和性别进行了调整。这里我们展示了该研究的前 5 周的结果。
结果:在 2020 年 4 月 6 日至 5 月 9 日期间,我们从 1339 户家庭中招募了 2766 名参与者,他们的人口统计学分布与日内瓦州相似。在第一周,我们估计的血清流行率为 4.8%(95%CI 2.4-8.0,n=341)。第二周的估计值上升到 8.5%(5.9-11.4,n=469),第三周为 10.9%(7.9-14.4,n=577),第四周为 6.6%(4.3-9.4,n=604),第五周为 10.8%(8.2-13.9,n=775)。5-9 岁(相对风险[RR]0.32[95%CI 0.11-0.63])和年龄大于 65 岁(RR 0.50[0.28-0.78])的个体与 20-49 岁的个体相比,血清阳性的风险显著降低。在考虑到血清转阳时间后,我们估计每报告一例确诊病例,社区中就有 11.6 例感染。
解释:这些结果表明,尽管该地区 COVID-19 的发病率很高(在 50 万人口中不到 2.5 个月报告了 5000 例临床病例),但在这一波大流行中,日内瓦的大部分人口仍然没有感染。假设 IgG 抗体的存在与免疫有关,这些结果突出表明,通过减少人群中的易感人群,疫情远未结束。此外,与 10-64 岁的人相比,5-9 岁的儿童和 65 岁以上的成年人的血清流行率显著较低。这些结果将为考虑放宽旨在遏制传播的限制措施的国家提供信息。
资助:瑞士联邦公共卫生办公室、瑞士公共卫生学院(Corona Immunitas 研究计划)、Pictet 集团慈善基金会、Ancrage 基金会、日内瓦大学附属医院基金会和新兴病毒疾病中心。
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