Interest of seroprevalence surveys for the epidemiological surveillance of the SARS‐CoV ‐2 pandemic in African populations: Insights from the ARIACOV project in Benin

  1. Parfait Houngbégnon
  2. Odilon Nouatin
  3. Anges Yadouléton
  4. Benjamin Hounkpatin
  5. Nadine Fievet
  6. Eloïc Atindégla
  7. Sébastien Dechavanne
  8. Emilande Guichet
  9. Ahidjo Ayouba
  10. Raphaël Pelloquin
  11. David Maman
  12. Guillaume Thaurignac
  13. Martine Peeters
  14. Annonciat Aviansou
  15. Salifou Sourakafou
  16. Eric Delaporte
  17. Achille Massougbodji
  18. Gilles Cottrell

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Abstract

Background

Many SARS‐CoV‐2 seroprevalence surveys since the end of 2020 have disqualified the first misconception that Africa had been spared by the pandemic. Through the analysis of three SARS‐CoV‐2 seroprevalence surveys carried out in Benin as part of the ARIACOV project, we argue that the integration of epidemiological serosurveillance of the SARS‐CoV‐2 infection in the national surveillance packages would be of great use to refine the understanding of the COVID‐19 pandemic in Africa.

Methods

We carried out three repeated cross‐sectional surveys in Benin: two in Cotonou, the economic capital in March and May 2021, and one in Natitingou, a semi‐rural city in the north of the country in August 2021. Total and weighted‐by‐age‐group seroprevalences were estimated and the risk factors for SARS‐CoV‐2 infection were assessed by multivariate logistic regression.

Results

In Cotonou, a slight increase in overall age‐standardised SARS‐CoV‐2 seroprevalence from 29.77% (95% CI: 23.12%–37.41%) at the first survey to 34.86% (95% CI: 31.57%–38.30%) at the second survey was observed. In Natitingou, the globally adjusted seroprevalence was 33.34% (95% CI: 27.75%–39.44%). A trend of high risk for SARS‐CoV 2 seropositivity was observed in adults over 40 versus the young (less than 18 years old) during the first survey in Cotonou but no longer in the second survey.

Conclusions

Our results show that, however, rapid organisation of preventive measures aimed at breaking the chains of transmission, they were ultimately unable to prevent a wide spread of the virus in the population. Routine serological surveillance on strategic sentinel sites and/or populations could constitute a cost‐effective compromise to better anticipate the onset of new waves and define public health strategies.

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  1. Version published to 10.1111/tmi.13895
  2. ScreenIT

    SciScore for 10.1101/2022.04.26.22274330: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethical considerations: Ethics approval (N°131/MS/DRFMT/CNERS/SA) and Statistical approval (N°26/2020/MPD/INSAE/DCSFR) were obtained respectively from the Comité d’Ethique pour la Recherche en Santé and the Conseil National de la Statistique.
    Consent: Adults provided written consent to participate in the study and to be tested for SARS-CoV-2 serology prior to starting the interview.
    Sex as a biological variablenot detected.
    RandomizationAt the first stage, 50 neighborhoods among 143 were randomly drawn with a probability proportional to their population size, and at the second stage 12 households were selected per neighborhood.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    This dual target strategy for SARS-CoV-2 IgG antibodies detection give a great sensitivity (100%) and specificity (99,7%) that was previously validated on an panel of more than 1 000 samples from Africa (including 160 samples from Benin) before COVID-19 (22,24).
    SARS-CoV-2 IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistical analysis: The statistical analysis was performed using STATA 14 (StataCorp, College Station, TX, USA).
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: None

    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 has limitations. In Cotonou, the design was repeated cross-sectional rather than longitudinal surveys. Consequently, the differences between the prevalence by age groups in the two surveys may be because the samples were carried out different neighborhoods of Cotonou. Nonetheless, the relatively small increase in prevalence between the two surveys is consistent with the relatively narrow time interval (2 months) with no epidemic wave in between. Another limitation is that in Natitingou the design does not allow to estimate the prevalences by age group as precisely as in Cotonou. However, all age groups seem to be highly affected, which is consistent with what was observed in Cotonou and in other studies including the ARIACOV project (11). All of these results show the essential value of seroprevalence surveys in providing a more accurate view of the spread and the extent of the COVID19 epidemic than the reported cases from virological PCR-based surveillance only. Virological surveillance seems suitable for describing epidemic waves when they are in progress, but turns out to be inadequate neither for capturing a precise quantitative estimate of the extent and spread of the epidemic in populations. It fails also to apprehend clearly the persistence of the virus and its basal dynamics between epidemic waves. Our results show, along with others in Africa, that a more systematic use of serological surveillance to support an overall strategy of routine epidemiological su...

    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.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.04.26.22274330v1 on medRxiv