Author:
Wiens Kirsten E.,Mawien Pinyi Nyimol,Rumunu John,Slater Damien,Jones Forrest K.,Moheed Serina,Caflish Andrea,Bior Bior K.,Jacob Iboyi Amanya,Lako Richard Lino Loro,Guyo Argata Guracha,Olu Olushayo Oluseun,Maleghemi Sylvester,Baguma Andrew,Hassen Juma John,Baya Sheila K.,Deng Lul,Lessler Justin,Demby Maya N.,Sanchez Vanessa,Mills Rachel,Fraser Clare,Charles Richelle C.,Harris Jason B.,Azman Andrew S.,Wamala Joseph F.
Abstract
AbstractBackgroundRelatively few COVID-19 cases and deaths have been reported through much of sub-Saharan Africa, including South Sudan, although the extent of SARS-CoV-2 spread remains unclear due to weak surveillance systems and few population-representative serosurveys.MethodsWe conducted a representative household-based cross-sectional serosurvey in Juba, South Sudan. We quantified IgG antibody responses to SARS-CoV-2 spike protein receptor-binding domain and estimated seroprevalence using a Bayesian regression model accounting for test performance.ResultsWe recruited 2,214 participants from August 10 to September 11, 2020 and 22.3% had anti-SARS-CoV-2 IgG titers above levels in pre-pandemic samples. After accounting for waning antibody levels, age, and sex, we estimated that 38.5% (32.1 - 46.8) of the population had been infected with SARS-CoV-2. For each RT-PCR confirmed COVID-19 case, 104 (87-126) infections were unreported. Background antibody reactivity was higher in pre-pandemic samples from Juba compared to Boston, where the serological test was validated. The estimated proportion of the population infected ranged from 30.1% to 60.6% depending on assumptions about test performance and prevalence of clinically severe infections.ConclusionsSARS-CoV-2 has spread extensively within Juba. Validation of serological tests in sub-Saharan African populations is critical to improve our ability to use serosurveillance to understand and mitigate transmission.
Publisher
Cold Spring Harbor Laboratory
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