ABSTRACT
BackgroundComplete reporting of seroepidemiologic studies (e.g. sampling and measurement methods, immunoassay characteristics) are critical to their interpretation, comparison, and utility in evidence synthesis. The Reporting of Seroepidemiologic studies--SARS_JCoV_J2 (ROSES-S) guideline is a reporting checklist that aims to improve the quality and transparency of reporting in SARS-CoV-2 seroepidemiological studies. While the synthesis of seroepidemiologic studies played a crucial role in public health decision-making during the COVID-19 pandemic, adherence of SARS-CoV-2 seroepidemiologic studies to the ROSES-S guideline has not yet been evaluated. ObjectivesTo evaluate the completeness of SARS-CoV-2 seroepidemiologic study reporting over the first two years of the COVID-19 pandemic by assessing adherence to the ROSES-S reporting guideline, determine whether publication of the ROSES-S guideline was associated with changes in reporting completeness, and identify study characteristics associated with reporting completeness. MethodsA stratified random sample of SARS-CoV-2 seroepidemiologic studies from the SeroTracker living systematic review database was evaluated for adherence to the ROSES-S guideline. We categorized study adherence to each reporting item in the guideline as "reported", "not reported", or "not applicable". For each reporting item we calculated the percentage of studies that were adherent. We also calculated the median and interquartile range (IQR) adherence across all items and by item domain. Piecewise and multivariable beta regression analyses were used to determine whether publication date of the ROSES-S guideline was associated with changes in the overall adherence scores and to identify study characteristics associated with overall adherence scores. Results199 studies were included and analyzed. The median adherence to reporting items was 48.1% (IQR 40.0%-55.2%) per study. Adherence to reporting items ranged from 8.8% to 72.7% per study. The laboratory methods domain (e.g. description of testing algorithm) had the lowest median adherence (33.3% [IQR 25.0%-41.7%%]), while the discussion domain had the highest median adherence (75.0% [IQR 50.0%-100.0%])). There were no significant changes in reporting adherence to ROSES-S before and after guideline publication. Article publication source (p<0.001), study risk of bias (p=0.001), and sampling method (p=0.004) were significantly associated with adherence to the ROSES-S guideline. ConclusionsThe completeness of reporting in SARS-CoV-2 seroepidemiologic studies was suboptimal, especially in laboratory methods, and was associated with key study characteristics. Publication of the ROSES-S guideline was not associated with changes in reporting practices. Given that reporting is necessary to improve the standardization and utility of seroprevalence data in evidence synthesis, authors should improve adherence to the ROSES-S guideline with support from stakeholders.
Subject(s)
COVID-19ABSTRACT
First Few X cases (FFX) investigations and Household transmission investigations (HHTI) are essential epidemiological tools for early characterisation of novel infectious pathogens and their variants. We aimed to estimate the household secondary infection attack rate (hSAR) of SARS-CoV-2 in investigations aligned with the WHO Unity Studies HHTI protocol. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines (PROSPERO registration: CRD42021260065). We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for Unity-aligned FFX and HHTI published between 1 December 2019 and 26 July 2021. Standardised early results were shared by WHO Unity Studies Collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta-analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by WHO Unity Studies collaborators) were retained in the systematic review and 62 were included in the primary meta-analysis. hSAR point estimates ranged from 2%-90% (95% prediction interval: 3%-71%; I2 = 99.7%); I2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. The large, unexplained variance in hSAR estimates emphasises the need for improved standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs, to guide evidence-based pandemic preparedness and response efforts for SARS-CoV-2, influenza and future novel respiratory viruses.
ABSTRACT
IntroductionEstimating COVID-19 cumulative incidence in Africa remains problematic due to challenges in contact tracing, routine surveillance systems and laboratory testing capacities and strategies. We undertook a meta-analysis of population-based seroprevalence studies to estimate SARS-CoV-2 seroprevalence in Africa to inform evidence-based decision making on Public Health and Social Measures (PHSM) and vaccine strategy. MethodsWe searched for seroprevalence studies conducted in Africa published 01-01-2020 to 30-12-2021 in Medline, Embase, Web of Science, and Europe PMC (preprints), grey literature, media releases and early results from WHO Unity studies. All studies were screened, extracted, assessed for risk of bias and evaluated for alignment with the WHO Unity protocol for seroepidemiological investigations. We conducted descriptive analyses of seroprevalence and meta-analysed seroprevalence differences by demographic groups, place and time. We estimated the extent of undetected infections by comparing seroprevalence and cumulative incidence of confirmed cases reported to WHO. PROSPERO: CRD42020183634. ResultsWe identified 54 full texts or early results, reporting 151 distinct seroprevalence studies in Africa Of these, 95 (63%) were low/moderate risk of bias studies. SARS-CoV-2 seroprevalence rose from 3.0% [95% CI: 1.0-9.2%] in Q2 2020 to 65.1% [95% CI: 56.3-73.0%] in Q3 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 97:1, ranging from 10:1 to 958:1) and steady over time. Seroprevalence was highly heterogeneous both within countries - urban vs. rural (lower seroprevalence for rural geographic areas), children vs. adults (children aged 0-9 years had the lowest seroprevalence) - and between countries and African sub-regions (Middle, Western and Eastern Africa associated with higher seroprevalence). ConclusionWe report high seroprevalence in Africa suggesting greater population exposure to SARS-CoV-2 and protection against COVID-19 disease than indicated by surveillance data. As seroprevalence was heterogeneous, targeted PHSM and vaccination strategies need to be tailored to local epidemiological situations.
Subject(s)
COVID-19ABSTRACT
Background COVID-19 case data underestimates infection and immunity, especially in low- and middle-income countries (LMICs). We meta-analyzed standardized SARS-CoV-2 seroprevalence studies to estimate global seroprevalence. Objectives/Methods We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence studies aligned with the WHO UNITY protocol published between 2020-01-01 and 2021-10-29. Eligible studies were extracted and critically appraised in duplicate. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate under-ascertainment; meta-analyzed differences in seroprevalence between demographic subgroups; and identified national factors associated with seroprevalence using meta-regression. PROSPERO: CRD42020183634. Results We identified 396 full texts reporting 736 distinct seroprevalence studies (41% LMIC), including 355 low/moderate risk of bias studies with national/sub-national scope in further analysis. By April 2021, global SARS-CoV-2 seroprevalence was 26.1%, 95% CI [24.6-27.6%]. Seroprevalence rose steeply in the first half of 2021 due to infection in some regions (e.g., 18.2% to 45.9% in Africa) and vaccination and infection in others (e.g., 11.3% to 57.4% in the Americas high-income countries), but remained low in others (e.g., 0.3% to 1.6% in the Western Pacific). In 2021 Q1, median seroprevalence to case ratios were 1.9:1 in HICs and 61.9:1 in LMICs. Children 0-9 years and adults 60+ were at lower risk of seropositivity than adults 20-29. In a multivariate model using data pre-vaccination, more stringent public health and social measures were associated with lower seroprevalence. Conclusions Global seroprevalence has risen considerably over time and with regional variation, however much of the global population remains susceptible to SARS-CoV-2 infection. True infections far exceed reported COVID-19 cases. Standardized seroprevalence studies are essential to inform COVID-19 control measures, particularly in resource-limited regions.