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Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study
The Lancet (British edition), 2020-08, Vol.396 (10250), p.535-544
2020
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Autor(en) / Beteiligte
Titel
Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study
Ist Teil von
  • The Lancet (British edition), 2020-08, Vol.396 (10250), p.535-544
Ort / Verlag
England: Elsevier Ltd
Erscheinungsjahr
2020
Quelle
Access via ScienceDirect (Elsevier)
Beschreibungen/Notizen
  • Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). Seroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay, with a specificity–sensitivity range of 3·7% (3·3–4·0; both tests positive) to 6·2% (5·8–6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1–92·1; both tests positive) to 91·8% (86·3–95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8–16·8) to 19·3% (17·7–21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1–24·9) to 35·8% (33·1–38·5). Only 19·5% (16·3–23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.
Sprache
Englisch
Identifikatoren
ISSN: 0140-6736
eISSN: 1474-547X
DOI: 10.1016/S0140-6736(20)31483-5
Titel-ID: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7336131
Format
–
Schlagworte
Adolescent, Adult, Aged, Anosmia, Antibodies, Antibodies, Viral - blood, Betacoronavirus - immunology, Chemiluminescence, Child, Child, Preschool, Coastal zone, Coronavirus Infections - epidemiology, Coronaviruses, COVID-19, Diagnostic systems, Disease hot spots, Epidemics, Epidemiology, Female, Health aspects, Households, Humans, Immunoassay, Immunoglobulin G, Immunoglobulin G - blood, Immunoglobulin M - blood, Infant, Infant, Newborn, Laboratories, Male, Microparticles, Middle Aged, Olfaction disorders, Pandemics, Pneumonia, Viral - epidemiology, Point-of-Care Testing, Population studies, Population-based studies, Prevalence, Public health, Random sampling, Risk analysis, Risk Factors, Sampling, SARS-CoV-2, Sensitivity, Seroepidemiologic Studies, Seroepidemiology, Serological surveys, Serology, Severe acute respiratory syndrome coronavirus 2, Sex, Spain - epidemiology, Statistical sampling, Viral diseases, Young Adult

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