British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC
British Columbia Centre for Disease Control, Communicable Diseases and Immunization Services (Skowronski, Kim, Chuang); University of British Columbia, School of Population and Public Health (Skowronski, Henry); BC Centre for Disease Control, Public Health Laboratory (Kaweski, Sabaiduc, Levett, Krajden, Sekirov); BC Centre for Disease Control, Data and Analytic Services (Irvine, Fraser), Vancouver, BC; Simon Fraser University, Faculty of Health Sciences (Irvine), Burnaby, BC; University of British Columbia, Department of Pathology and Laboratory Medicine (Reyes, Levett, Petric, Krajden, Sekirov), Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Office of the Provincial Health Officer (Henry), Ministry of Health, Victoria, BC.
CMAJ. 2022 Dec 5;194(47):E1599-E1609. doi: 10.1503/cmaj.221335.
BACKGROUND: The evolving proportion of the population considered immunologically naive versus primed for more efficient immune memory response to SARS-CoV-2 has implications for risk assessment. We sought to chronicle vaccine- and infection-induced seroprevalence across the first 7 waves of the COVID-19 pandemic in British Columbia, Canada. METHODS: During 8 cross-sectional serosurveys conducted between March 2020 and August 2022, we obtained anonymized residual sera from children and adults who attended an outpatient laboratory network in the Lower Mainland (Greater Vancouver and Fraser Valley). We used at least 3 immunoassays per serosurvey to detect SARS-CoV-2 spike and nucleocapsid antibodies. We assessed any seroprevalence (vaccineor infection-induced, or both), defined by positivity on any 2 assays, and infection-induced seroprevalence, also defined by dual-assay positivity but requiring both antinucleocapsid and antispike detection. We used estimates of infection-induced seroprevalence to explore underascertainment of infections by surveillance case reports. RESULTS: By January 2021, we estimated that any seroprevalence remained less than 5%, increasing with vaccine rollout to 56% by May-June 2021, 83% by September-October 2021 and 95% by March 2022. Infection-induced seroprevalence remained less than 15% through September-October 2021, increasing across Omicron waves to 42% by March 2022 and 61% by July-August 2022. By August 2022, 70%-80% of children younger than 20 years and 60%-70% of adults aged 20-59 years had been infected, but fewer than half of adults aged 60 years and older had been infected. Compared with estimates of infection-induced seroprevalence, surveillance case reports underestimated infections 12-fold between September 2021 and March 2022 and 92-fold between March 2022 and August 2022. INTERPRETATION: By August 2022, most children and adults younger than 60 years had evidence of both SARS-CoV-2 vaccination and infection. As previous evidence suggests that a history of both exposures may induce stronger, more durable hybrid immunity than either exposure alone, older adults - who have the lowest infection rates but highest risk of severe outcomes - continue to warrant prioritized vaccination.
背景：考虑到 SARS-CoV-2 更有效的免疫记忆反应的免疫上无反应和已致敏人群的比例不断变化，这对风险评估具有重要意义。我们试图记录加拿大不列颠哥伦比亚省 COVID-19 大流行的前 7 波中疫苗和感染引起的血清流行率。
方法：在 2020 年 3 月至 2022 年 8 月期间进行的 8 项横断面血清学调查中，我们从大温哥华和弗雷泽谷的门诊实验室网络中参加的儿童和成人中获得了匿名的剩余血清。我们使用至少 3 种免疫测定法对 SARS-CoV-2 刺突和核衣壳抗体进行检测。我们评估了任何血清流行率（疫苗或感染诱导的，或两者兼有），定义为两种检测方法中的任何一种阳性，以及感染诱导的血清流行率，也定义为双检测阳性，但需要检测抗核衣壳和抗刺突。我们使用感染诱导的血清流行率估计值来探索通过监测病例报告对感染的低估。
结果：到 2021 年 1 月，我们估计任何血清流行率仍低于 5%，随着疫苗的推出，到 2021 年 5 月至 6 月增加到 56%，2021 年 9 月至 10 月增加到 83%，到 2022 年 3 月增加到 95%。到 2021 年 9 月至 10 月，感染诱导的血清流行率仍低于 15%，在奥密克戎波次中增加到 2022 年 3 月的 42%和 7 月至 8 月的 61%。到 2022 年 8 月，70%-80%的 20 岁以下儿童和 60%-70%的 20-59 岁成年人已经感染，但不到一半的 60 岁及以上成年人已经感染。与感染诱导的血清流行率估计值相比，监测病例报告在 2021 年 9 月至 2022 年 3 月期间低估了感染 12 倍，在 2022 年 3 月至 2022 年 8 月期间低估了感染 92 倍。
解释：到 2022 年 8 月，大多数儿童和 60 岁以下的成年人都有 SARS-CoV-2 疫苗接种和感染的证据。由于之前的证据表明，两种暴露都可能比单独暴露产生更强、更持久的混合免疫，因此感染率最低但严重后果风险最高的老年人仍然需要优先接种疫苗。
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