Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
Fundação Getúlio Vargas, Rio de Janeiro, Brazil.
Lancet Glob Health. 2020 Nov;8(11):e1390-e1398. doi: 10.1016/S2214-109X(20)30387-9. Epub 2020 Sep 23.
BACKGROUND: Population-based data on COVID-19 are essential for guiding policies. There are few such studies, particularly from low or middle-income countries. Brazil is currently a hotspot for COVID-19 globally. We aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence by city and according to sex, age, ethnicity group, and socioeconomic status, and compare seroprevalence estimates with official statistics on deaths and cases. METHODS: In this repeated cross-sectional study, we did two seroprevalence surveys in 133 sentinel cities in all Brazilian states. We randomly selected households and randomly selected one individual from all household members. We excluded children younger than 1 year. Presence of antibodies against SARS-CoV-2 was assessed using a lateral flow point-of-care test, the WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech, Guangzhou, China), using two drops of blood from finger prick samples. This lateral-flow assay detects IgG and IgM isotypes that are specific to the SARS-CoV-2 receptor binding domain of the spike protein. Participants also answered short questionnaires on sociodemographic information (sex, age, education, ethnicity, household size, and household assets) and compliance with physical distancing measures. FINDINGS: We included 25 025 participants in the first survey (May 14-21) and 31 165 in the second (June 4-7). For the 83 (62%) cities with sample sizes of more than 200 participants in both surveys, the pooled seroprevalence increased from 1·9% (95% CI 1·7-2·1) to 3·1% (2·8-3·4). City-level prevalence ranged from 0% to 25·4% in both surveys. 11 (69%) of 16 cities with prevalence above 2·0% in the first survey were located in a stretch along a 2000 km of the Amazon river in the northern region. In the second survey, we found 34 cities with prevalence above 2·0%, which included the same 11 Amazon cities plus 14 from the northeast region, where prevalence was increasing rapidly. Prevalence levels were lower in the south and centre-west, and intermediate in the southeast, where the highest level was found in Rio de Janeiro (7·5% [4·2-12·2]). In the second survey, prevalence was similar in men and women, but an increased prevalence was observed in participants aged 20-59 years and those living in crowded conditions (4·4% [3·5-5·6] for those living with households with six or more people). Prevalence among Indigenous people was 6·4% (4·1-9·4) compared with 1·4% (1·2-1·7) among White people. Prevalence in the poorest socioeconomic quintile was 3·7% (3·2-4·3) compared with 1·7% (1·4-2·2) in the wealthiest quintile. INTERPRETATION: Antibody prevalence was highly heterogeneous by country region, with rapid initial escalation in Brazil's north and northeast. Prevalence is strongly associated with Indigenous ancestry and low socioeconomic status. These population subgroups are unlikely to be protected if the policy response to the pandemic by the national government continues to downplay scientific evidence. FUNDING: Brazilian Ministry of Health, Instituto Serrapilheira, Brazilian Collective Health Association, and the JBS Fazer o Bem Faz Bem.
背景:基于人群的 COVID-19 数据对于指导政策至关重要。此类研究很少,特别是来自低收入和中等收入国家的研究。巴西目前是全球 COVID-19 的热点地区。我们旨在根据城市、性别、年龄、族裔群体和社会经济地位,调查严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)抗体的流行率,并将血清流行率估计值与官方死亡和病例统计数据进行比较。
方法:在这项重复的横断面研究中,我们在巴西所有州的 133 个哨点城市进行了两次血清流行率调查。我们随机选择家庭,并从所有家庭成员中随机选择一名个体。我们排除了年龄小于 1 岁的儿童。使用横向流动即时检验(WONDFO SARS-CoV-2 抗体检测试剂盒,Wondfo Biotech,广州,中国)评估针对 SARS-CoV-2 的抗体存在情况,使用指尖采血的两滴血样。这种侧向流动分析检测针对 Spike 蛋白受体结合域的 SARS-CoV-2 特异性 IgG 和 IgM 同种型。参与者还回答了关于社会人口统计学信息(性别、年龄、教育、族裔、家庭规模和家庭资产)和遵守身体距离措施的简短问卷。
结果:我们在第一次调查(5 月 14 日至 21 日)中纳入了 25025 名参与者,在第二次调查(6 月 4 日至 7 日)中纳入了 31165 名参与者。对于两次调查样本量均超过 200 名的 83 个城市(62%),汇总的血清流行率从 1.9%(95%CI 1.7-2.1)增加到 3.1%(2.8-3.4)。城市级流行率在两次调查中均为 0%-25.4%。第一次调查中流行率超过 2.0%的 16 个城市中有 11 个(69%)位于亚马逊河北部 2000 公里长的地段。在第二次调查中,我们发现有 34 个城市的流行率超过 2.0%,其中包括上述 11 个亚马逊城市以及东北部的 14 个城市,东北部的流行率正在迅速上升。南部和中西部的流行率较低,东南部的流行率居中,里约热内卢的流行率最高(7.5%[4.2-12.2])。在第二次调查中,男性和女性的流行率相似,但在 20-59 岁的参与者以及居住在拥挤条件下的参与者中观察到流行率增加(居住在有 6 人或更多人的家庭中的参与者为 4.4%[3.5-5.6])。与白人(1.4%[1.2-1.7])相比,土著人的流行率为 6.4%(4.1-9.4)。在最贫困的五个社会经济阶层中,流行率为 3.7%(3.2-4.3),而在最富裕的五个阶层中,流行率为 1.7%(1.4-2.2)。
解释:抗体流行率在国家区域内高度异质,巴西北部和东北部最初迅速上升。流行率与土著血统和低社会经济地位密切相关。如果国家政府对大流行的政策应对继续轻视科学证据,这些人群亚组不太可能得到保护。
结论:巴西 COVID-19 血清流行率呈高度异质性,北部和东北部快速上升。血清流行率与土著血统和低社会经济地位有关。如果国家政府继续忽视科学证据,这些人群亚组不太可能得到保护。
资金:巴西卫生部、Instituto Serrapilheira、巴西集体卫生协会和 JBS Fazer o Bem Faz Bem。
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