Trends of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence in selected regions across Ghana

  1. Peter Kojo Quashie
  2. Joe Kimanthi Mutungi
  3. Francis Dzabeng
  4. Daniel Oduro-Mensah
  5. Precious C. Opurum
  6. Kesego Tapela
  7. Aniefiok John Udoakang
  8. WACCBIP COVID-19 Team
  9. Ivy Asante
  10. Lily Paemka
  11. Frederick Kumi-Ansah
  12. Osbourne Quaye
  13. Emmanuela Amoako
  14. Ralph Armah
  15. Charlyne Kilba
  16. Nana Afia Boateng
  17. Michael Ofori
  18. George B. Kyei
  19. Yaw Bediako
  20. Nicaise Ndam
  21. James Abugri
  22. Patrick Ansah
  23. William K. Ampofo
  24. Francisca Mutapi
  25. Gordon A. Awandare

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Abstract

Background : We set out to estimate the community-level exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ghana.

Methods : Phased seroprevalence studies of 2729 participants at selected locations across Ghana were conducted. Phase I (August 2020) sampled 1305 individuals at major markets/lorry stations, shopping malls, hospitals and research institutions involved in coronavirus disease 2019 (COVID-19) work. The study utilized a lateral flow rapid diagnostic test (RDT) which detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein.

Results : During Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure was significantly higher at markets/lorry stations (26.9%) compared to malls (9.4%), with 41–60-year group demonstrating highest seropositivity (27.2%). Exposure was higher in participants with no formal education (26.2%) than those with tertiary education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Results from phases II and III, in October and December 2020 respectively, implied either reduced transmissions or loss of antibody expression in some participants. The Upper East region showed the lowest seropositivity (2%). Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Reflective of second wave hospitalisation trends, the 21-40 age group demonstrated modal seropositivity (24.9) in Phase IV whilst 40-60 years and 60+ previously demonstrated highest prevalence.

Conclusions : Overall, the data indicates higher COVID-19 seroprevalence than officially acknowledged, likely implying a considerably lower-case fatality rate than the current national figure of 0.84%. The data also suggests that COVID-19 is predominantly asymptomatic COVID-19 in Ghana. The observed trends mimic clinical trends of infection and imply that the methodology used was appropriate.

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  1. Version published to 10.12688/wellcomeopenres.16890.1
  2. ScreenIT

    SciScore for 10.1101/2021.04.25.21256067: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: Informed consent was obtained from all study participants.
    Sex as a biological variablenot detected.
    RandomizationA representative set of randomly chosen positive and negative test results are shown in Figure S2.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Exposure to COVID-19 was detected using a strip-in-cassette lateral flow rapid diagnostic test kit which simultaneously detects IgM and IgG antibodies against SARS-CoV-2 antigens.
    SARS-CoV-2
    suggested: None
    Testing kit: The ‘UNSCIENCE COVID-19 IgG/IgM antibody Rapid Test Kit’ (Catalogue# UNCOV-40, Lot Number 20200326) was registered with the Ghana FDA, and the kit validation report was submitted to the Ghana Food and Drug Authority (FDA).
    COVID-19 IgG/IgM
    suggested: None
    Software and Algorithms
    SentencesResources
    The data, including the antibody test results were entered and managed using Research Electronic Data Capture suite (REDCap) [28].
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    Cleaned data were analyzed with Stata 16 (StataCorp, College Station, Texas, USA) and R/Rstudio [29, 30].
    StataCorp
    suggested: (Stata, RRID:SCR_012763)
    GraphPad Prism version 8.0.0 [31] was used for some additional analysis and generation of figures.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    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:
    Strengths and Limitations of this study: By surveying participants at different sites and times, representing categories of different perceived risk factors, this study obtained credible estimates for population-level prevalence across these sites and how that changed over the sampling period. This will allow future screening at these sites to determine the seroprevalence trends. However, most seroprevalence studies only reflect past disease burden. Using Markets and Lorry Stations enabled sampling of a broad cross-section of the Ghanaian populace. Phase I of the study was conducted in the region with the greatest burden of reported infections and it was expected that a country-wide survey would yield less seroprevalence. Site H3, situated in the town of Cape Coast, a tourist hub and Central regional capital, exhibited a very high prevalence at 18.5% during Phase II, but this was not surprising given that M4, located in Kasoa, also in the Central Region, exhibited an exposure rate of 28% during Phase I. The low seroprevalence observed at C1 (2%) during Phase III hinted that community size/density may play a role in COVID-19 transmission. Given the geographical remoteness of C1 to the major hotspots of Accra and Kumasi, another small community (C3) in the country’s Southern belt with higher population density was screened, yielding an observed prevalence rate of 17%, and showing that SARS-CoV-2 exposure is not just a metropolitan burden, but one that needs to be tracked across...

    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.

    About SciScore

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  3. Version published to 10.1101/2021.04.25.21256067v2 on medRxiv
  4. Version published to 10.1101/2021.04.25.21256067v1 on medRxiv