血清阳性率作为一个大型详细描述队列中新冠病毒病病例漏报情况的指标
Seroprevalence as an Indicator of Undercounting of COVID-19 Cases in a Large Well-Described Cohort.
作者信息
Taylor Kevin M, Ricks Keersten M, Kuehnert Paul A, Eick-Cost Angelia A, Scheckelhoff Mark R, Wiesen Andrew R, Clements Tamara L, Hu Zheng, Zak Samantha E, Olschner Scott P, Herbert Andrew S, Bazaco Sara L, Creppage Kathleen E, Fan Michael T, Sanchez Jose L
机构信息
Armed Forces Health Surveillance Division, Defense Health Agency, Silver Spring, Maryland.
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
出版信息
AJPM Focus. 2023 Aug 15;2(4):100141. doi: 10.1016/j.focus.2023.100141. eCollection 2023 Dec.
INTRODUCTION
Reported confirmed cases represent a small portion of overall true cases for many infectious diseases. The undercounting of true cases can be considerable when a significant portion of infected individuals are asymptomatic or minimally symptomatic, as is the case with COVID-19. Seroprevalence studies are an efficient way to assess the extent to which true cases are undercounted during a large-scale outbreak and can inform efforts to improve case identification and reporting.
METHODS
A longitudinal seroprevalence study of active duty U.S. military members was conducted from May 2020 through June 2021. A random selection of service member serum samples submitted to the Department of Defense Serum Repository was analyzed for the presence of antibodies reactive to SARS-CoV-2. The monthly seroprevalence rates were compared with those of cumulative confirmed cases reported during the study period.
RESULTS
Seroprevalence was 2.3% in May 2020 and increased to 74.0% by June 2021. The estimated true case count based on seroprevalence was 9.3 times greater than monthly reported cases at the beginning of the study period and fell to 1.7 by the end of the study.
CONCLUSIONS
In our sample, confirmed case counts significantly underestimated true cases of COVID-19. The increased availability of testing over the study period and enhanced efforts to detect asymptomatic and minimally symptomatic cases likely contributed to the fall in the seroprevalence to reported case ratio.
引言
对于许多传染病而言，报告的确诊病例仅占总体实际病例的一小部分。当很大一部分感染者无症状或症状轻微时，实际病例的漏报情况可能相当严重，新冠病毒病（COVID-19）就是如此。血清流行率研究是评估在大规模疫情期间实际病例漏报程度的有效方法，可为改进病例识别和报告工作提供参考。
方法
2020年5月至2021年6月对美国现役军人进行了一项纵向血清流行率研究。对随机选取的提交至国防部血清库的军人血清样本进行分析，以检测是否存在对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）有反应的抗体。将每月的血清流行率与研究期间报告的累计确诊病例的流行率进行比较。
结果
2020年5月血清流行率为2.3%，到2021年6月增至74.0%。基于血清流行率估计的实际病例数在研究初期是每月报告病例数的9.3倍，到研究结束时降至1.7倍。
结论
在我们的样本中，确诊病例数显著低估了COVID-19的实际病例数。研究期间检测可及性的提高以及对无症状和症状轻微病例检测力度的加大，可能是血清流行率与报告病例数之比下降的原因。
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