lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Population Based SARS-CoV-2 Sero-Epidemiological Survey and Estimated Infection Incidence and Fatality Risk in Gauteng Province, South Africa

25 Pages Posted: 28 May 2021

See all articles by Portia Chipo Mutevedzi

Portia Chipo Mutevedzi

University of the Witwatersrand

Mary Kawonga

School of Public Health, University of the Witwatersrand

Gaurav Kwatra

University of the Witwatersrand - South African Medical Research Council

Andrew Moultrie

University of the Witwatersrand

Vicky L. Baillie

University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit

Nicoletta Mabhena

ResearchLinkME

Masego Nicole Mathibe

University of the Witwatersrand

Martin Masotho Rafuma

University of the Witwatersrand

Innocent Maposa

University of the Witwatersrand - Division of Epidemiology and Biostatistics

Geoff Abbott

University of Pretoria

Jannie Hugo

University of Pretoria

Bridget Ikalafeng

Gauteng Health Department

Tsholofelo Adelekan

Gauteng Department of Health

Mkhululi Lukhele

University of the Witwatersrand

Shabir A. Madhi

University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit

More...

Abstract

Background: Limitations in laboratory testing capacity undermine the ability to quantify the overall burden of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. We undertook a cross-sectional population based sero-survey for SARS-CoV-2 infection in 26 sub-districts, Gauteng Province (population 15·9 million), South Africa. Furthermore, we estimated SARS-CoV-2 mortality risk triangulating seroprevalence, recorded COVID-19 deaths and excess mortality data.

Methods: We employed multi-stage random household sampling with selection probability proportional to sub-district size, stratifying sub-district census-sampling frame by housing type and selecting clusters within household type strata. Serum SARS-CoV-2 receptor binding domain (RBD) Immunoglobulin G (IgG) was measured using a quantitative assay on Luminex platform.

Findings: Overall RBD IgG seroprevalence was 19·1% (95%Confidence interval [CI]: 18·1-20·1%), being similar in children and adults. Seroprevalence varied from 5·5% to 43·2% across sub-districts. Conservatively, there were 2 897 120 (95%CI: 2 743 907-3 056 866) SARS-CoV-2 infections, yielding an incidence of 19 090 per 100 000 until January 9, 2021, when 330 336 COVID-19 cases were recorded.  The estimated mortality risk using recorded COVID-19 deaths (n=8198) was 0·28% (95%CI: 0·27-0·30) and 0·67% (95%CI: 0·64-0·71) assuming 90% of modelled natural excess deaths were due to COVID-19 (n=21 582). Notably, 53·8% (65/122) of individuals with previous self-reported confirmed SARS-CoV-2 infection were RBD IgG sero-negative.

Interpretation: The imputed number of SARS-CoV-2 infections was 8·8 fold greater than recorded number of COVID-19 cases. The imputed SARS-CoV-2 infection mortality risk varied 2·39 fold when calculated using reported COVID-19 deaths (0·28%) compared with excess mortality derived COVID-19 attributable deaths (0·67%). Waning of RBD IgG may have inadvertently under-estimated number of SARS-CoV-2 infections, and conversely over-estimated mortality risk, by a factor of two. 

Funding Information: Bill and Melinda Gates Foundation.

Declaration of Interests: We declare no competing interests.

Ethics Approval Statement: The University of the Witwatersrand Human Research Ethics Committee granted a waiver for formal approval of the survey, which was deemed to be part of public-health good and surveillance to manage the COVID-19 pandemic. Electronic signed informed consent was administered to individuals older than 15 years age, parental consent obtained for children <12 years of age, and assent and parental consent for adolescents 12-15 years old.

Suggested Citation

Mutevedzi, Portia Chipo and Kawonga, Mary and Kwatra, Gaurav and Moultrie, Andrew and Baillie, Vicky L. and Mabhena, Nicoletta and Mathibe, Masego Nicole and Rafuma, Martin Masotho and Maposa, Innocent and Abbott, Geoff and Hugo, Jannie and Ikalafeng, Bridget and Adelekan, Tsholofelo and Lukhele, Mkhululi and Madhi, Shabir A., Population Based SARS-CoV-2 Sero-Epidemiological Survey and Estimated Infection Incidence and Fatality Risk in Gauteng Province, South Africa (2021). Available at SSRN: https://ssrn.com/abstract=3855442 or http://dx.doi.org/10.2139/ssrn.3855442

Portia Chipo Mutevedzi

University of the Witwatersrand

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Mary Kawonga

School of Public Health, University of the Witwatersrand ( email )

1 Jan Smuts Avenue
Johannesburg, GA Gauteng 2000
South Africa

Gaurav Kwatra

University of the Witwatersrand - South African Medical Research Council

Andrew Moultrie

University of the Witwatersrand

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Vicky L. Baillie

University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit

Nicoletta Mabhena

ResearchLinkME ( email )

South Africa

Masego Nicole Mathibe

University of the Witwatersrand

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Martin Masotho Rafuma

University of the Witwatersrand

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Innocent Maposa

University of the Witwatersrand - Division of Epidemiology and Biostatistics

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Geoff Abbott

University of Pretoria

Jannie Hugo

University of Pretoria

Physical Address Economic and Management Sciences
Pretoria, 0002
South Africa

Bridget Ikalafeng

Gauteng Health Department ( email )

GDOH, 78 Fox Street, Marshalltown
Johannesburg, Gauteng
South Africa

Tsholofelo Adelekan

Gauteng Department of Health ( email )

Mkhululi Lukhele

University of the Witwatersrand

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Shabir A. Madhi (Contact Author)

University of the Witwatersrand - Vaccines and Infectious Diseases Analytics Research Unit ( email )

Click here to go to TheLancet.com

Paper statistics

Downloads
110
Abstract Views
1,696
PlumX Metrics