Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland, USA.
Johns Hopkins Medicine, Baltimore, Maryland, USA.
Microbiol Spectr. 2023 Aug 17;11(4):e0276522. doi: 10.1128/spectrum.02765-22. Epub 2023 Jun 8.
The objective of the study was to estimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in the Howard County, Maryland, general population and demographic subpopulations attributable to natural infection or coronavirus disease 2019 (COVID-19) vaccination and to identify self-reported social behaviors that may affect the likelihood of recent or past SARS-CoV-2 infection. A cross-sectional, saliva-based serological study of 2,880 residents of Howard County, Maryland, was carried out from July through September 2021. Natural SARS-CoV-2 infection prevalence was estimated by inferring infections among individuals according to anti-nucleocapsid immunoglobin G levels and calculating averages weighted by sample proportions of various demographics. Antibody levels between BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) recipients were compared. Antibody decay rate was calculated by fitting exponential decay curves to cross-sectional indirect immunoassay data. Regression analysis was carried out to identify demographic factors, social behaviors, and attitudes that may be linked to an increased likelihood of natural infection. The estimated overall prevalence of natural infection in Howard County, Maryland, was 11.9% (95% confidence interval, 9.2% to 15.1%), compared with 7% reported COVID-19 cases. Antibody prevalence indicating natural infection was highest among Hispanic and non-Hispanic Black participants and lowest among non-Hispanic White and non-Hispanic Asian participants. Participants from census tracts with lower average household income also had higher natural infection rates. After accounting for multiple comparisons and correlations between participants, none of the behavior or attitude factors had significant effects on natural infection. At the same time, recipients of the mRNA-1273 vaccine had higher antibody levels than those of BNT162b2 vaccine recipients. Older study participants had overall lower antibody levels compared with younger study participants. The true prevalence of SARS-CoV-2 infection is higher than the number of reported COVID-19 cases in Howard County, Maryland. A disproportionate impact of infection-induced SARS-CoV-2 positivity was observed across different ethnic/racial subpopulations and incomes, and differences in antibody levels across different demographics were identified. Taken together, this information may inform public health policy to protect vulnerable populations. We employed a highly innovative noninvasive multiplex oral fluid SARS-CoV-2 IgG assay to ascertain our seroprevalence estimates. This laboratory-developed test has been applied in NCI's SeroNet consortium, possesses high sensitivity and specificity according to FDA Emergency Use Authorization guidelines, correlates strongly with SARS-CoV-2 neutralizing antibody responses, and is Clinical Laboratory Improvement Amendments-approved by the Johns Hopkins Hospital Department of Pathology. It represents a broadly scalable public health tool to improve understanding of recent and past SARS-CoV-2 exposure and infection without drawing any blood. To our knowledge, this is the first application of a high-performance salivary SARS-CoV-2 IgG assay to estimate population-level seroprevalence, including identifying COVID-19 disparities. We also are the first to report differences in SARS-CoV-2 IgG responses by COVID-19 vaccine manufacturers (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]). Our findings demonstrate remarkable consistency with those of blood-based SARS-CoV-2 IgG assays in terms of differences in the magnitude of SARS-CoV-2 IgG responses between COVID-19 vaccines.
研究目的是估计马里兰州霍华德县普通人群和人口亚群中因自然感染或 2019 年冠状病毒病(COVID-19)疫苗接种而导致的严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)血清流行率,并确定可能影响近期或过去 SARS-CoV-2 感染可能性的自我报告社会行为。2021 年 7 月至 9 月,对马里兰州霍华德县的 2880 名居民进行了一项基于唾液的横断面血清学研究。通过根据抗核衣壳免疫球蛋白 G 水平推断个体感染情况,并根据各种人口统计学的样本比例加权平均值来估计自然 SARS-CoV-2 感染的流行率。比较了 BNT162b2(辉瑞-生物技术公司)和 mRNA-1273(Moderna)接受者的抗体水平。通过将指数衰减曲线拟合到横断面间接免疫测定数据来计算抗体衰减率。进行回归分析以确定可能与自然感染可能性增加相关的人口统计学因素、社会行为和态度。马里兰州霍华德县的总体自然感染估计流行率为 11.9%(95%置信区间,9.2%至 15.1%),而报告的 COVID-19 病例为 7%。在西班牙裔和非西班牙裔黑人参与者中,表明自然感染的抗体流行率最高,在非西班牙裔白人和非西班牙裔亚洲参与者中最低。来自平均家庭收入较低的人口普查区的参与者也有更高的自然感染率。在考虑到参与者之间的多次比较和相关性后,没有任何行为或态度因素对自然感染有显著影响。同时,mRNA-1273 疫苗的接受者的抗体水平高于 BNT162b2 疫苗的接受者。与年轻的研究参与者相比,年龄较大的研究参与者的总体抗体水平较低。SARS-CoV-2 感染的真实流行率高于马里兰州霍华德县报告的 COVID-19 病例数。在不同的族裔/种族亚群和收入中观察到感染诱导的 SARS-CoV-2 阳性的不成比例影响,并且确定了不同人口统计学之间的抗体水平差异。总的来说,这些信息可能为保护弱势群体的公共卫生政策提供信息。我们采用了一种高度创新的非侵入性多用途口服液 SARS-CoV-2 IgG 检测方法来确定我们的血清流行率估计值。这种由实验室开发的检测方法已应用于 NCI 的 SeroNet 联盟,根据 FDA 紧急使用授权指南具有高灵敏度和特异性,与 SARS-CoV-2 中和抗体反应密切相关,并且已获得约翰霍普金斯医院病理学部门的临床实验室改进修正案批准。它是一种广泛可扩展的公共卫生工具,可以在不抽取血液的情况下提高对近期和过去 SARS-CoV-2 暴露和感染的认识。据我们所知,这是首次应用高性能唾液 SARS-CoV-2 IgG 检测来估计人群水平的血清流行率,包括确定 COVID-19 差异。我们也是第一个报告 COVID-19 疫苗制造商(BNT162b2[辉瑞-生物技术公司]和 mRNA-1273[Moderna])之间 SARS-CoV-2 IgG 反应差异的人。我们的发现与血液 SARS-CoV-2 IgG 检测在 COVID-19 疫苗之间 SARS-CoV-2 IgG 反应幅度的差异方面具有显著的一致性。