High Seroprevalence of Anti-SARS-CoV-2 Antibodies Among Ethiopian Healthcare Workers

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Abstract

Background

COVID-19 pandemic has a devastating impact on the economies and health care system of sub-Saharan Africa. Healthcare workers (HWs), the main actors of the health system, are at higher-risk because of their occupation. Serology-based estimates of SARS-CoV-2 infection among HWs represent a measure of HWs’ exposure to the virus and a guide to the prevalence of SARS-CoV-2 in the community. This information is currently lacking in Ethiopia and other African countries. This study aimed to develop an in-house antibody testing assay, assess the prevalence of SARS-CoV-2 antibodies among Ethiopian high-risk frontline HWs.

Methods

A cross-sectional seroprevalence study was conducted among HWs in five public hospitals located in different geographic regions of Ethiopia. Socio-demographic and clinical data were collected using questionnaire-based interviews. From consenting HWs, blood samples were collected between December 2020 and February 2021, the period between the two peaks of COVID-19 in Ethiopia. The collected sera were tested using an in-house immunoglobin G (IgG) enzyme-linked immunosorbent assay (ELISA) for SARS-CoV-2 specific antibodies on sera collected from HWs.

Results

Of 1,997 HWs who provided a blood sample, demographic and clinical data, 50.5% were female, 74.0% had no symptoms compatible with COVID-19, and 29.0% had history of contact with suspected or confirmed patient with SARS-CoV-2 infection. The overall seroprevalence was 39.6%. The lowest (24.5%) and the highest (48.0%) seroprevalence rates were found in Hiwot Fana Specialized Hospital in Harar and ALERT Hospital in Addis Ababa, respectively. Of the 821 seropositive HWs, 224(27.3%) had history of symptoms consistent with COVID-19. A history of close contact with suspected/confirmed COVID-19 cases was strongly associated with seropositivity (Adjusted odds Ratio (AOR) =1.4, 95% CI 1.1–1.8; p=0.015).

Conclusion

High SARS-CoV-2 seroprevalence levels were observed in the five Ethiopian hospitals. These findings highlight the significant burden of asymptomatic infection in Ethiopia, and may reflect the scale of transmission in the general population.

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Most cited references 17

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Estimates of the severity of coronavirus disease 2019: a model-based analysis

Robert Verity, Lucy C Okell, Ilaria Dorigatti … (2020)

Summary Background In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring and ascertainment biases. Methods We collected individual-case data for patients who died from COVID-19 in Hubei, mainland China (reported by national and provincial health commissions to Feb 8, 2020), and for cases outside of mainland China (from government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, until Feb 25, 2020). These individual-case data were used to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the case fatality ratio by relating the aggregate distribution of cases to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for demography and age-based and location-based under-ascertainment. We also estimated the case fatality ratio from individual line-list data on 1334 cases identified outside of mainland China. Using data on the prevalence of PCR-confirmed cases in international residents repatriated from China, we obtained age-stratified estimates of the infection fatality ratio. Furthermore, data on age-stratified severity in a subset of 3665 cases from China were used to estimate the proportion of infected individuals who are likely to require hospitalisation. Findings Using data on 24 deaths that occurred in mainland China and 165 recoveries outside of China, we estimated the mean duration from onset of symptoms to death to be 17·8 days (95% credible interval [CrI] 16·9–19·2) and to hospital discharge to be 24·7 days (22·9–28·1). In all laboratory confirmed and clinically diagnosed cases from mainland China (n=70 117), we estimated a crude case fatality ratio (adjusted for censoring) of 3·67% (95% CrI 3·56–3·80). However, after further adjusting for demography and under-ascertainment, we obtained a best estimate of the case fatality ratio in China of 1·38% (1·23–1·53), with substantially higher ratios in older age groups (0·32% [0·27–0·38] in those aged <60 years vs 6·4% [5·7–7·2] in those aged ≥60 years), up to 13·4% (11·2–15·9) in those aged 80 years or older. Estimates of case fatality ratio from international cases stratified by age were consistent with those from China (parametric estimate 1·4% [0·4–3·5] in those aged <60 years [n=360] and 4·5% [1·8–11·1] in those aged ≥60 years [n=151]). Our estimated overall infection fatality ratio for China was 0·66% (0·39–1·33), with an increasing profile with age. Similarly, estimates of the proportion of infected individuals likely to be hospitalised increased with age up to a maximum of 18·4% (11·0–7·6) in those aged 80 years or older. Interpretation These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death. Funding UK Medical Research Council.

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Persistence of serum and saliva antibody responses to SARS-CoV-2 spike antigens in COVID-19 patients

Baweleta Isho, Kento T. Abe, Michelle Zuo … (2020)

Saliva is an alternative biofluid to serum for detecting and monitoring IgG to SARS-CoV-2 spike and RBD antigens in COVID-19. While the antibody response to SARS-CoV-2 has been extensively studied in blood, relatively little is known about the antibody response in saliva and its relationship to systemic antibody levels. Here, we profiled by enzyme-linked immunosorbent assays (ELISAs) IgG, IgA and IgM responses to the SARS-CoV-2 spike protein (full length trimer) and its receptor-binding domain (RBD) in serum and saliva of acute and convalescent patients with laboratory-diagnosed COVID-19 ranging from 3–115 days post-symptom onset (PSO), compared to negative controls. Anti-SARS-CoV-2 antibody responses were readily detected in serum and saliva, with peak IgG levels attained by 16–30 days PSO. Longitudinal analysis revealed that anti-SARS-CoV-2 IgA and IgM antibodies rapidly decayed, while IgG antibodies remained relatively stable up to 105 days PSO in both biofluids. Lastly, IgG, IgM and to a lesser extent IgA responses to spike and RBD in the serum positively correlated with matched saliva samples. This study confirms that serum and saliva IgG antibodies to SARS-CoV-2 are maintained in the majority of COVID-19 patients for at least 3 months PSO. IgG responses in saliva may serve as a surrogate measure of systemic immunity to SARS-CoV-2 based on their correlation with serum IgG responses.

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Seroprevalence of antibodies against SARS-CoV-2 among health care workers in a large Spanish reference hospital

Alberto García-Basteiro, Gemma Moncunill, Marta Tortajada … (2020)

Health care workers (HCW) are a high-risk population to acquire SARS-CoV-2 infection from patients or other fellow HCW. This study aims at estimating the seroprevalence against SARS-CoV-2 in a random sample of HCW from a large hospital in Spain. Of the 578 participants recruited from 28 March to 9 April 2020, 54 (9.3%, 95% CI: 7.1–12.0) were seropositive for IgM and/or IgG and/or IgA against SARS-CoV-2. The cumulative prevalence of SARS-CoV-2 infection (presence of antibodies or past or current positive rRT-PCR) was 11.2% (65/578, 95% CI: 8.8–14.1). Among those with evidence of past or current infection, 40.0% (26/65) had not been previously diagnosed with COVID-19. Here we report a relatively low seroprevalence of antibodies among HCW at the peak of the COVID-19 epidemic in Spain. A large proportion of HCW with past or present infection had not been previously diagnosed with COVID-19, which calls for active periodic rRT-PCR testing in hospital settings.

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Author and article information

Contributors

Tesfaye Gelanew

Berhanu Seyoum

Andargachew Mulu

Adane Mihret

Markos Abebe

Liya Wassie

Baye Gelaw

Abebe Sorsa

Yared Merid

Yilkal Muchie

Zelalem Teklemariam

Bezalem Tesfaye

Mahlet Osman

Gutema Jebessa

Abay Atinafu

Tsegaye Hailu

Antenehe. Habte

Dagaga Kenea

Anteneh Gadissa

Desalegn Admasu

Emmet Tesfaye

Timothy A. Bates

Jote Bulcha

Rea Tschopp

Dareskedar Tsehay

Kim Mullholand

Rawleigh Howe

Abebe Genetu

Fikadu G. Tafesse

Alemseged Abdissa

Journal

Journal ID (nlm-ta): Res Sq

Journal ID (publisher-id): ResearchSquare

Title: Research Square

Publisher: American Journal Experts

Publication date (Electronic): 19 July 2021

Electronic Location Identifier: rs.3.rs-676935

Affiliations

Armauer Hansen Research Institute

University of Gondar

Arsi University, Asella College of Health Sciences

Hawassa University

Armauer Hansen Research Institute

Haramaya University

Armauer Hansen Research Institute

Arsi University, Asella College of Health Sciences

Hawassa University

Haramaya University

Hawassa University

Oregon Health & Sciences University

University of Massachusetts Medical School

Armauer Hansen Research Institute

London School of Hygiene and Tropical Medicine, London, UK

Armauer Hansen Research Institute

Oregon Health & Sciences University

Armauer Hansen Research Institute

Author notes

Authors’ contributions

TG, AM, AMi MA, AA and FG conceived the study. TG, BS, AM, and AA wrote the first draft of the protocol, and revised by all authors. TG, AM, MA, AA and FGT developed the serologic assay, TAB purified the antigen. TG, BS, AM, AMi and AA coordinated the sample collection. BG, AS, YM, YM, ZT, DK, AG, DA and ET collected the blood samples and data. BT, MO, GJ, AA, AH and DT conducted the sample testing, TH content. TG, AA, FGT were responsible for the decision to submit for publication, and approved the final cleaned the data, TH and TG analyzed the data, TG accessed and verified the data underlying the study and take responsibility for the data. TG and AA drafted the manuscript. All authors edited the final manuscript. All authors contributed to study design, revising the protocol and the manuscript for important intellectual submitted version of the manuscript.

tesfaye.gelanew@ 123456ahri.gov.et

Article

Other ID: 10.21203/rs.3.rs-676935

DOI: 10.21203/rs.3.rs-676935/v1

PMC ID: 8312903

PubMed ID: 34312618

SO-VID: 74e03ed7-6d5c-4e6d-bad7-9912336b52ed

License:

This work is licensed under a Creative Commons Attribution 4.0 International License, which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.

High Seroprevalence of Anti-SARS-CoV-2 Antibodies Among Ethiopian Healthcare Workers

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Abstract

Background

Methods

Results

Conclusion

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 17

Estimates of the severity of coronavirus disease 2019: a model-based analysis

Persistence of serum and saliva antibody responses to SARS-CoV-2 spike antigens in COVID-19 patients

Seroprevalence of antibodies against SARS-CoV-2 among health care workers in a large Spanish reference hospital

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