2021年6月至10月在多米尼加共和国进行的一项多阶段全国住户调查及建模研究：严重急性呼吸综合征冠状病毒2型血清流行率、累积感染情况及对有症状感染的免疫力
SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection - A multistage national household survey and modelling study, Dominican Republic, June-October 2021.
作者信息
Nilles Eric J, Paulino Cecilia Then, de St Aubin Michael, Restrepo Angela Cadavid, 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, Puello Yosanly Cornelio, Durski Kara, Baldwin Margaret, Baez Amado Alejandro, Merchant Roland C, Barouch Dan H, Skewes-Ramm Ronald, Gutiérrez Emily Zielinski, Kucharski Adam, Lau Colleen L
机构信息
Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
出版信息
Lancet Reg Health Am. 2022 Dec;16:100390. doi: 10.1016/j.lana.2022.100390. Epub 2022 Nov 8.
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 SARS-CoV-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.
背景
目前对人群层面的新冠病毒免疫保护了解不足，但这可为疫苗接种和非药物干预重点提供指导。我们的目标是描述多米尼加共和国的累积感染情况和免疫保护情况。
方法
在多米尼加共和国，≥5岁的家庭成员参与了一项分三个阶段的全国性家庭群组血清学调查。我们检测了针对新冠病毒刺突蛋白（抗S）和核衣壳糖蛋白的全免疫球蛋白抗体，以及针对原始毒株和B.1.617.2（德尔塔）毒株的假病毒中和活性。血清阳性率和累积既往感染率经过加权处理，并针对检测性能和血清逆转进行了调整。使用二元分类机器学习方法和保护的假病毒中和相关指标来估计预防有症状感染的50%和80%保护率。
结果
在2021年6月30日至10月12日期间，我们从3832个家庭中招募了6683名个体。我们估计，≥5岁人群中85.0%（95%置信区间82.1 - 88.0）有过免疫暴露，77.5%（95%置信区间71.3 - 83）曾被感染。估计分别有78.1%（95%置信区间74.3 - 82）和66.3%（95%置信区间62.8 - 70）的人群针对原始毒株和德尔塔毒株具有足以提供至少50%预防有症状新冠病毒感染的保护性免疫。年龄较小（5 - 14岁，比值比0.47 [95%置信区间0.36 - 0.61]）和较大（≥75岁，0.40 [95%置信区间0.28 - 0.56]）、户外工作（0.53 [0.39 - 0.73]）、吸烟（0.66 [0.52 - 0.84]）、城市环境（1.30 [1.14 - 1.49]）以及接种三剂与未接种疫苗（18.41 [10.69 - 35.04]）与针对原始毒株的50%保护相关。
解读
累积感染大幅超过先前估计，总体免疫暴露程度较高。在控制混杂因素后，在某些亚组中观察到针对原始毒株和德尔塔毒株的免疫保护明显较低，这些发现可为公共卫生干预提供指导，并且可能适用于其他环境和病毒毒株。
资助
本研究由美国疾病控制与预防中心资助。
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