Prevalence and determinants of serum antibodies to SARS-CoV-2 in the general population of the Gardena Valley
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Abstract
Background
Community-based studies are essential to quantify the spread of SARS-CoV-2 infection and for unbiased characterization of its determinants and outcomes. We conducted a cross-sectional study in the Gardena valley, a major Alpine touristic destination which was struck in the expansion phase of the COVID-19 pandemic over the winter 2020.
Methods
We surveyed 2244 representative study participants who underwent swab and serum antibody tests. We made multiple comparisons among the Abbott and Diasorin bioassays and serum neutralization titers. Seroprevalence accounted for the stratified design, non-response and test accuracy. Determinants and symptoms predictive of infection were analyzed by weighted multiple logistic regression.
Results
SARS-CoV-2 seroprevalence was 26.9% (95% confidence interval: 25.2%, 28.6%) by June 2020. The serum antibody bioassays had modest agreement with each other. Receiver operating characteristic curve analysis on the serum neutralizing capacity showed better performance of the Abbott test at lower than the canonical threshold. Socio-demographic characteristics showed no clear evidence of association with seropositivity, which was instead associated with place of residence and economic activity. Loss of taste or smell, fever, difficulty in breathing, pain in the limbs, and weakness were the most predictive symptoms of positive antibody test results. Fever and weakness associations were age-dependent.
Conclusion
The Gardena valley had one of the highest SARS-CoV-2 infection prevalence in Europe. The age-dependent risk associated with COVID-19 related symptoms implies targeted strategies for screening and prophylaxis planning.
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SciScore for 10.1101/2021.03.19.21253883: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The Ethics Committee of the Healthcare System of the Autonomous Province of Bolzano/Bozen authorized the study.
Consent: Each participant gave written informed consent.Randomization In the latter approach, we randomly split the sample set into 80% and 20% training and test sets, respectively, corresponding to 239 and 60 observations, repeatedly 5000 times. Blinding not detected. Power Analysis not detected. Sex as a biological variable (StataCorp LLC) and were restricted to 6+ year old individuals and non-pregnant women using the ‘subpop’ option. Cell Line Authentication not detected. Table 2: Resources
Antibodies Sentences Resources Antibody response was tested using … SciScore for 10.1101/2021.03.19.21253883: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The Ethics Committee of the Healthcare System of the Autonomous Province of Bolzano/Bozen authorized the study.
Consent: Each participant gave written informed consent.Randomization In the latter approach, we randomly split the sample set into 80% and 20% training and test sets, respectively, corresponding to 239 and 60 observations, repeatedly 5000 times. Blinding not detected. Power Analysis not detected. Sex as a biological variable (StataCorp LLC) and were restricted to 6+ year old individuals and non-pregnant women using the ‘subpop’ option. Cell Line Authentication not detected. Table 2: Resources
Antibodies Sentences Resources Antibody response was tested using the Abbott SARS-CoV-2 IgG assay (Sligo, Ireland), designed to detect immunoglobulin class G (IgG) antibodies to the nucleocapsid (N) protein of SARS-CoV-2. immunoglobulin class G (IgGsuggested: NoneCells were fixed for 5 minutes with 96% ethanol and subsequently stained using the serum from a SARS-CoV-2 recovered patient and a horse radish peroxidase-conjugated anti-human secondary antibody (Dianova). anti-human secondary antibody ( Dianova) .suggested: NonePrevalence of serum antibodies to SARS-CoV-2 (seroprevalence) in the overall sample was also estimated using the Rogan and Gladen formula to account for the serological test inaccuracy.[12] Statistical analyses were run with the ‘svyset’ suite of commands in Stata software v16.1 SARS-CoV-2suggested: NoneExperimental Models: Cell Lines Sentences Resources Serum/virus mixes were incubated for 1 hour at 37°C and subsequently transferred to 96-wells containing 90% confluent Vero cells expressing TMPRSS2 seeded one day before. Verosuggested: CLS Cat# 605372/p622_VERO, RRID:CVCL_0059)Software and Algorithms Sentences Resources Participants were selected with known extraction probability from the municipality registries, excluding nursing homes, using the ‘surveyselect’ program in SAS v9.2. SASsuggested: (SASqPCR, RRID:SCR_003056)Antibody response was tested using the Abbott SARS-CoV-2 IgG assay (Sligo, Ireland), designed to detect immunoglobulin class G (IgG) antibodies to the nucleocapsid (N) protein of SARS-CoV-2. Abbottsuggested: (Abbott, RRID:SCR_010477)Within 6 hours from collection, assessment of IgG antibodies to SARS-CoV-2 was performed using the Abbott Architect i2000SR system, which implements a two-step chemiluminescent microparticle immunoassay, at Laboratory of Clinical Pathology of the Bressanone/Brixen Hospital, Abbott Architectsuggested: (Abbott ARCHITECT i1000sr System, RRID:SCR_019328)Prevalence of serum antibodies to SARS-CoV-2 (seroprevalence) in the overall sample was also estimated using the Rogan and Gladen formula to account for the serological test inaccuracy.[12] Statistical analyses were run with the ‘svyset’ suite of commands in Stata software v16.1 Statasuggested: (Stata, RRID:SCR_012763)(StataCorp LLC) and were restricted to 6+ year old individuals and non-pregnant women using the ‘subpop’ option. StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study also comes with several limitations. First, antibody testing methods have imperfect accuracy. We corrected seroprevalence analyses for the test sensitivity and specificity to overcome this limitation. Second, certain social groups such as, for instance, non-Italian residents might have been underrepresented. While we corrected all analyses for differential participation in known groups, we could not prevent participation bias of unknown sources such as, for example, COVID-19-related mortality and possible self-selection of severely ill individuals. A third limitation is the questionnaire self-administration: while this was the only way to collect essential information, response bias might affect some analyses. For instance, symptom onset estimation might not be totally accurate as the question was not specific to each possible symptom. Similarly, we cannot exclude that symptoms were due to competitive seasonal diseases such as flu or allergies. A nearly 30% seroprevalence is a large figure compared to other studies.[4] This estimate aligns with those of nearby Italian regions.[13, 14] However, the Manaus case shows that it might still result in a non-negligible underestimation of the true infection rate.[15] Several reasons suggest that our estimate should be considered as a lower bound of the real seroprevalence. First, the survey had missed people who already died. In 2020, the raw excess all-cause mortality rate over the previous five years was between +32.8% and...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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- No protocol registration statement was detected.
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