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The authors have withdrawn this manuscript for the following reasons: O_LIOur latest analysis (mid-February, 2022) that includes the addition of 59 children with 3 completed timepoints shows a decrease in N antibodies at T2, versus this preprint that showed an increase in N antibodies from T1 to T2. C_LIO_LIThis preprint did not include those infected with the Omicron variant, which has had a substantial impact on the increase in pediatric infections and has important implications for antibody durability moving forward as such. C_LI Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
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As COVID-19 continues to spread rapidly and vaccine uptake stagnates, questions remain about the amount of SARS-CoV-2 antibodies present in the population induced by either SARS-CoV-2 infection, by a COVID-19 vaccine, or both. The TEXAS Coronavirus Antibody REsponse Survey (CARES) is a statewide seroprevalence program which utilizes the Roche S-test to detect antibodies to the SARS-CoV-2 spike protein and the Roche N-test to detect antibodies to the SARS-CoV-2 nucleocapsid protein, to monitor the combined impact of prior infection and the COVID-19 vaccine. The current sample size having both S- and N-test data and reported vaccination status is 8,846. Participants with prior infection (i.e. N+) and with either partial or full vaccination have the highest proportion of those showing the maximum value of the S-test (80.95% and 83.07%, respectively). Using a permutation test, there is no statistically significant difference between the median S-test value for those that have had prior infection and are partially vaccinated versus those that have had prior infection and are fully vaccinated. These groups both show significantly higher median amount compared to the other three groups: N+/not vaccinated, N-/partially vaccinated, and N-/fully vaccinated (all p-values < 0.0001). Unvaccinated individuals with prior infection have one of the lowest median S-test values. For participants with previous SARS-CoV-2 infection and a COVID-19 vaccine, the median S-test value is high and is not statistically different between those who are partially vaccinated and those who are fully vaccinated.
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Given the underestimate of seroprevalence in the US due to insufficient testing, accurate estimates of population immunity to SARS-CoV-2 or vaccinations do not exist. Although model-based estimates have been proposed, they require inputting unknown parameters such as viral reproduction number, longevity of immune response, and other dynamic factors. In contrast to a model-based approach for estimating population immunity, or simplistic summing of natural- and vaccine-induced immunity, the current study presents a data-driven statistical procedure for estimating the total immunity rate in a region using prospectively collected serological data along with state-level vaccination data. We present a detailed procedure so that efforts can be replicated regionally to inform policy-making decisions relevant to SARS-CoV-2. Specifically, we conducted a prospective longitudinal statewide cohort serological survey with 10,482 participants and more than 14,000 blood samples beginning on September 30, 2020. Along with Department of State Health Services vaccination data, as of July 4, 2021, the estimated percentage of those with naturally occurring antibodies to SARS-CoV-2 in Texas is 35.3% (95% CI = (33.7%, 36.9%) and total estimated immunity is 69.1%. We conclude the seroprevalence of SARS-CoV-2 is 4 times higher than the state-confirmed COVID-19 cases (8.8%). This methodology is integral to pandemic preparedness.
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IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and immunity remains uncertain in populations. The state of Texas ranks 2nd in infection with over 2.71 million cases and has seen a disproportionate rate of death across the state. The TX CARES project was funded by the state of Texas to estimate the prevalence of SARS-CoV-2 antibody status in children and adults. Materials and MethodsThe TX CARES (Texas Coronavirus Antibody Response Survey) is an ongoing prospective population-based convenience sample from the Texas general population that commenced in October 2020. Volunteer participants are recruited across the state to participate in a 3-time point data collection TX CARES to assess antibody response over time. We use the Roche Elecsys(R) Anti-SARS-CoV-2 Immunoassay to determine SARS-CoV-2 antibody status. ResultsThe crude antibody positivity prevalence in Phase I was 26.1% (80/307). The fully adjusted seroprevalence of the sample was 31.5%. Specifically, 41.1% of males and 21.9% of females were seropositive. For age categories, 33.5% of those 18-34; 24.4% of those 35-44; 33.2% of those 45-54; and 32.8% of those 55+ were seropositive. In this sample,42.2% (89/211) of those negative for the antibody test reported having had a COVID-19 test. ConclusionsIn this survey we enrolled and analyzed data for 319 participants, demonstrating a high survey and antibody test completion rate, and ability to implement a questionnaire and SARS-CoV-2 antibody testing within FQHC clinical settings. We were also able to determine our capability to estimate the cross-sectional seroprevalence within Texass FQHC clinical settings. The crude positivity prevalence for SARS-CoV-2 antibodies in this sample was 26.1% indicating potentially high exposure to COVID-19 for FQHC clinic employees and patients. These methods are being used to guide the completion of a large longitudinal survey in the state of Texas with implications for practice and population health.
