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Estimating the asymptomatic proportion of SARS-CoV-2 infection in the general population: Analysis of nationwide serosurvey data in the Netherlands.
McDonald, Scott A; Miura, Fuminari; Vos, Eric R A; van Boven, Michiel; de Melker, Hester E; van der Klis, Fiona R M; van Binnendijk, Rob S; den Hartog, Gerco; Wallinga, Jacco.
  • McDonald SA; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. scott.mcdonald@rivm.nl.
  • Miura F; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  • Vos ERA; Center for Marine Environmental Studies (CMES), Ehime University, Matsuyama, Ehime, 790-8577, Japan.
  • van Boven M; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  • de Melker HE; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  • van der Klis FRM; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  • van Binnendijk RS; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  • den Hartog G; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
  • Wallinga J; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Eur J Epidemiol ; 36(7): 735-739, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1265533
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ABSTRACT

BACKGROUND:

The proportion of SARS-CoV-2 positive persons who are asymptomatic-and whether this proportion is age-dependent-are still open research questions. Because an unknown proportion of reported symptoms among SARS-CoV-2 positives will be attributable to another infection or affliction, the observed, or 'crude' proportion without symptoms may underestimate the proportion of persons without symptoms that are caused by SARS-CoV-2 infection.

METHODS:

Based on two rounds of a large population-based serological study comprising test results on seropositivity and self-reported symptom history conducted in April/May and June/July 2020 in the Netherlands (n = 7517), we estimated the proportion of reported symptoms among those persons infected with SARS-CoV-2 that is attributable to this infection, where the set of relevant symptoms fulfills the ECDC case definition of COVID-19, using inferential methods for the attributable risk (AR). Generalised additive regression modelling was used to estimate the age-dependent relative risk (RR) of reported symptoms, and the AR and asymptomatic proportion (AP) were calculated from the fitted RR.

RESULTS:

Using age-aggregated data, the 'crude' AP was 37% but the model-estimated AP was 65% (95% CI 63-68%). The estimated AP varied with age, from 74% (95% CI 65-90%) for < 20 years, to 61% (95% CI 57-65%) for the 50-59 years age-group.

CONCLUSION:

Whereas the 'crude' AP represents a lower bound for the proportion of persons infected with SARS-CoV-2 without COVID-19 symptoms, the AP as estimated via an attributable risk approach represents an upper bound. Age-specific AP estimates can inform the implementation of public health actions such as targetted virological testing and therefore enhance containment strategies.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Asymptomatic Infections / SARS-CoV-2 / COVID-19 / Antibodies, Viral Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Child / Child, preschool / Female / Humans / Infant / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Eur J Epidemiol Journal subject: Epidemiology Year: 2021 Document Type: Article Affiliation country: S10654-021-00768-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Asymptomatic Infections / SARS-CoV-2 / COVID-19 / Antibodies, Viral Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Child / Child, preschool / Female / Humans / Infant / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Eur J Epidemiol Journal subject: Epidemiology Year: 2021 Document Type: Article Affiliation country: S10654-021-00768-y