Moreira-Soto Andres, García Maria Paquita, Arotinco-Garayar Gloria, Figueroa-Romero Dana, Merino-Sarmiento Nancy, Marcelo-Ñique Adolfo, Málaga-Trillo Edward, Cabezas Sanchez César, Drexler Jan Felix
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Virology, Berlin, Germany.
Tropical Disease Research Program, School of Veterinary Medicine, Universidad Nacional, Heredia, Costa Rica.
Am J Trop Med Hyg. 2024 Oct 1;111(6):1290-1294. doi: 10.4269/ajtmh.24-0260. Print 2024 Dec 4.
During early 2021, Peru had the highest COVID-19-associated per-capita mortality rate. Socioeconomic inequality, insufficiently prepared healthcare, and surveillance systems are factors explaining the mortality rate, which can be severely worsened by early undetected SARS-CoV-2 circulation. We tested 1,441 individuals with fever sampled during August 2019-May 2021, several months before the first SARS-CoV-2 seroprevalence study available so far in Lima, Peru, for SARS-CoV-2-specific antibodies. The testing algorithm included a chemiluminescence immunoassay and surrogate virus neutralization test. Early positive samples (N = 24) from January-March 2020 were further tested using a plaque-reduction neutralization test (PRNT) and avidity test against the SARS-CoV-2 spike and nucleoprotein. None of the early samples were PRNT-confirmed, in contrast to 81.8% (18/22) of a subsample from April 2020 onward (Fisher exact test; P <0.0001). Therefore, we excluded non-PRNT-confirmed samples from subsequent analyses. The SARS-CoV-2 antibody detection rate was 0.9% in mid-April 2020 (1/104; 95% CI: 0.1-5.8%), suggesting viral circulation in early-middle March 2020, consistent with the first molecular detection of SARS-CoV-2 in Peru on March 2020. Mean avidity increase of 62-77% to 81-94% from all PRNT-confirmed SARS-CoV-2-positive samples during early 2020 were consistent with onset of SARS-CoV-2 circulation during late February/March 2020. Early circulation was also confirmed in a susceptible, exposed, infected, and recovered mathematical model that calculated an effective reproduction number >1 during February-March 2020. Early introduction of SARS-CoV-2 thus contributed to the high COVID-19 mortality rate in Peru. Emphasizing the role of diagnostic confirmation in understanding the pandemic's trajectory, this study highlights the importance of early detection and accurate testing in managing infectious disease outbreaks.
2021年初，秘鲁的新冠肺炎人均死亡率最高。社会经济不平等、医疗保健准备不足以及监测系统是导致死亡率的因素，而早期未被发现的新冠病毒传播可能会使情况严重恶化。我们对2019年8月至2021年5月期间采集的1441名发热患者进行了检测，这比秘鲁利马迄今为止开展的第一项新冠病毒血清流行率研究早几个月，检测他们是否存在新冠病毒特异性抗体。检测算法包括化学发光免疫测定和替代病毒中和试验。对2020年1月至3月的早期阳性样本（N = 24）进一步使用空斑减少中和试验（PRNT）以及针对新冠病毒刺突蛋白和核蛋白的亲和力试验进行检测。与2020年4月及以后的一个子样本中81.8%（18/22）的样本不同，早期样本均未通过PRNT确认（Fisher精确检验；P <0.0001）。因此，我们在后续分析中排除了未通过PRNT确认的样本。2020年4月中旬的新冠病毒抗体检测率为0.9%（1/104；95%置信区间：0.1 - 5.8%），这表明2020年3月中下旬存在病毒传播，与2020年3月在秘鲁首次进行的新冠病毒分子检测结果一致。2020年初所有通过PRNT确认的新冠病毒阳性样本的平均亲和力从62 - 77%增加到81 - 94%，这与2020年2月下旬/3月期间新冠病毒开始传播一致。在一个易感、暴露、感染和康复的数学模型中也证实了早期传播，该模型计算出2020年2月至3月期间有效繁殖数>1。因此，新冠病毒的早期传入导致了秘鲁较高的新冠肺炎死亡率。本研究强调了诊断确认在理解疫情发展轨迹中的作用，突出了早期检测和准确检测在管理传染病暴发中的重要性。
