Original article
Vol. 151 No. 5152 (2021)
Seroprevalence of the SARS-CoV-2 virus in the population of the southern Switzerland (Canton Ticino) – cohort study, results at 12 months
- Ottavio Beretta
- Simona Casati Pagani
- Mario Lazzaro
- Giorgio Merlani
- Martine Bouvier Gallacchi
Summary
AIMS OF THE STUDY: A new emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China, in December 2019 and then spread rapidly, causing a global pandemic. In Europe, the first case was identified in Italy on 21 February 2020, in the Lombardy region bordering on the southern part of Switzerland (Canton Ticino), where 4 days later the first case was identified . Ticino was the most affected canton in Switzerland during the first wave of pandemic. In order to provide a reliable indicator for the spread of the virus in this region and help decision making at the public health level, a seroprevalence study of SARS-CoV-2 was conducted.
METHODS: A cohort study was implemented on a randomly selected sample of 1500 persons. The sample is representative of the general population of the Canton of Ticino, stratified by sex and age from 5 years old. Antibodies against the SARS-CoV-2 nucleocapsid protein were detected using a rapid qualitative test in 4 data collection periods over the course of 12 months (from May–June 2020 to May–June 2021).
RESULTS: The seroprevalence of SARS-CoV-2 was estimated at 9.0% in spring 2020 (weeks 20–26), 8.4% in summer 2020 (weeks 32–38), 14.1% in autumn 2020 (weeks 45–52) and 22.3% in spring 2021 (weeks 18–23). In none of these four phases was evidence of an association between sex or specific age groups and presence of anti-SARS-CoV-2 antibodies detected. For risk factors, the only strong and significant association found was with diabetes in the first three data collection periods but not in the fourth. Among people who participated in all four phases of the study and tested positive anti-SARS-CoV-2 antibodies in the first test, 61.8% were still positive even in the fourth, 12 months later.
CONCLUSIONS: The results support the hypothesis that, after one year and despite the severe burden in terms of hospitalisations and deaths experienced by the Canton Ticino, SARS-CoV-2 infection affected only a minority of the population (20%) and also suggest that the anti-nucleocapsid antibodies persist after 12 months in the majority of infected persons.
References
- World Health Organisation (WHO). Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update [Internet]. [cited 2021 Feb 10]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
- World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard [Internet]. [cited 2021 Oct 28]. Available from: https://covid19.who.int/
- Centers for Disease Control and Prevention (CDC). People with Certain Medical Conditions [Internet]. [cited 2021 Feb 10]; Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
- Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA. 2020 Apr;323(14):1335. https://doi.org/10.1001/jama.2020.4344
- Lai CC, Wang CY, Ko WC, Hsueh PR. In vitro diagnostics of coronavirus disease 2019: technologies and application. J Microbiol Immunol Infect. 2021 Apr;54(2):164–74. https://doi.org/10.1016/j.jmii.2020.05.016
- Lai CC, Wang JH, Hsueh PR. Population-based seroprevalence surveys of anti-SARS-CoV-2 antibody: an up-to-date review. Int J Infect Dis. 2020 Dec;101:314–22. https://doi.org/10.1016/j.ijid.2020.10.011
- Rostami A, Sepidarkish M, Leeflang MM, Riahi SM, Nourollahpour Shiadeh M, Esfandyari S, et al. SARS-CoV-2 seroprevalence worldwide: a systematic review and meta-analysis. Clin Microbiol Infect. 2021 Mar;27(3):331–40. https://doi.org/10.1016/j.cmi.2020.10.020
- Caruso A, Bonfanti C (Università degli studi di Brescia, Dipartimento di medicina molecolare e traslazionale, Brescia, Italy). Analytical and diagnostic performances of a Covid-19 serology POCT method to assess anti-SARS-CoV-2 IgG and IgM antibodies. Available upon request. Letter to: D Zanelli and S De Rosa (Technogenetics, Italy). 2020 Sept 21. 14 p.
- Rogan WJ, Gladen B. Estimating prevalence from the results of a screening test. Am J Epidemiol. 1978 Jan;107(1):71–6. https://doi.org/10.1093/oxfordjournals.aje.a112510
- Blaker H. Confidence curves and improved exact confidence intervals for discrete distributions. Can J Stat. 2000;28(4):783–98. https://doi.org/10.2307/3315916
- R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; 2020. Available from: https://www.R-project.org
- Pollán M, Pérez-Gómez B, Pastor-Barriuso R, Oteo J, Hernán MA, Pérez-Olmeda M, et al.; ENE-COVID Study Group. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet. 2020 Aug;396(10250):535–44. https://doi.org/10.1016/S0140-6736(20)31483-5
- Stringhini S, Wisniak A, Piumatti G, Azman AS, Lauer SA, Baysson H, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet. 2020 Aug;396(10247):313–9. https://doi.org/10.1016/S0140-6736(20)31304-0
- Havers FP, Reed C, Lim T, Montgomery JM, Klena JD, Hall AJ, et al. Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020. JAMA Intern Med. 2020 Jul;180(12):1576–86. https://doi.org/10.1001/jamainternmed.2020.4130
- Pagani G, Giacomelli A, Conti F, Bernacchia D, Rondanin R, Prina A, et al. Prevalence of SARS-CoV-2 in an area of unrestricted viral circulation: mass seroepidemiological screening in Castiglione d’Adda, Italy. PLoS One. 2021 Feb;16(2):e0246513. https://doi.org/10.1371/journal.pone.0246513
- Tess BH, Granato CF, Alves MC, Pintão MC, Nunes MC, Rizzatti EG, et al. Assessment of initial SARS-CoV-2 seroprevalence in the most affected districts in the municipality of São Paulo, Brazil. Braz J Infect Dis. 2021 Jul-Aug;25(4):101604. https://doi.org/10.1016/j.bjid.2021.101604
- Melotti R, Scaggiante F, Falciani M, Weichenberger CX, Foco L, Lombardo S, et al. Prevalence and determinants of serum antibodies to SARS-CoV-2 in the general population of the Gardena valley. Epidemiol Infect. 2021 Aug;149 e194:e194. https://doi.org/10.1017/S0950268821001886
- Corona Immunitas. Study overview [Internet]. [cited 2021 Mar 01]. Available from: https://www.corona-immunitas.ch/en/program/studies/
- Stringhini S, Zaballa ME, Pullen N, Perez-Saez J, de Mestral C, Loizeau A, et al. Seroprevalence of anti-SARS-CoV-2 antibodies six months into the vaccination campaign in Geneva, Switzerland. medRxiv 2021.08.12.21261929; doi: https://doi.org/10.1101/2021.08.12.21261929
- Santé publique France. Estimation de la séroprévalence des infections à SARS-CoV-2. COVID-19: point épidémiologique [Internet]. 2020 Dec 31 [cited 2021 Apr 7]: 41-43. French. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/documents/bulletin-national/covid-19-point-epidemiologique-du-31-decembre-2020
- Statistik Austria. COVID-19 Prävalenzstudien [Internet]. [cited 2021 Apr 3]. German. Available from: http://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/gesundheit/covid19/index.html
- Santos-Hövener C, Neuhauser HK, Rosario AS, Busch M, Schlaud M, Hoffmann R, et al.; CoMoLo Study Group. Serology- and PCR-based cumulative incidence of SARS-CoV-2 infection in adults in a successfully contained early hotspot (CoMoLo study), Germany, May to June 2020. Euro Surveill. 2020 Nov;25(47): Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.47.2001752 https://doi.org/10.2807/1560-7917.ES.2020.25.47.2001752
- Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020 May;94:91–5. https://doi.org/10.1016/j.ijid.2020.03.017
- Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020 Jul - Aug;14(4):535–45. https://doi.org/10.1016/j.dsx.2020.04.044
- Yan Y, Yang Y, Wang F, Ren H, Zhang S, Shi X, et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Res Care. 2020 Apr;8(1):e001343. https://doi.org/10.1136/bmjdrc-2020-001343
- Huang J, Xiao Y, Zheng P, Zhou W, Wang Y, Huang G, et al. Distinct neutrophil counts and functions in newly diagnosed type 1 diabetes, latent autoimmune diabetes in adults, and type 2 diabetes. Diabetes Metab Res Rev. 2019 Jan;35(1):e3064. https://doi.org/10.1002/dmrr.3064
- Lecube A, Pachón G, Petriz J, Hernández C, Simó R. Phagocytic activity is impaired in type 2 diabetes mellitus and increases after metabolic improvement. PLoS One. 2011;6(8):e23366. https://doi.org/10.1371/journal.pone.0023366
- Menart-Houtermans B, Rütter R, Nowotny B, Rosenbauer J, Koliaki C, Kahl S, et al.; German Diabetes Study Group. Leukocyte profiles differ between type 1 and type 2 diabetes and are associated with metabolic phenotypes: results from the German Diabetes Study (GDS). Diabetes Care. 2014 Aug;37(8):2326–33. https://doi.org/10.2337/dc14-0316
- Reading PC, Allison J, Crouch EC, Anders EM. Increased susceptibility of diabetic mice to influenza virus infection: compromise of collectin-mediated host defense of the lung by glucose? J Virol. 1998 Aug;72(8):6884–7. https://doi.org/10.1128/JVI.72.8.6884-6887.1998
- Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19. Diabetes Metab Res Rev. 2020 Mar;e3319(7):e3319. https://doi.org/10.1002/dmrr.3319
- Roca-Ho H, Riera M, Palau V, Pascual J, Soler MJ. Characterization of ACE and ACE2 expression within different organs of the NOD mouse. Int J Mol Sci. 2017 Mar;18(3):563. https://doi.org/10.3390/ijms18030563
- Health Information and Quality Authority (HIQA). Duration of immunity (protection from reinfection) following SARSCoV-2 infection. Dublin (Ireland): 2021. Available from: https://www.hiqa.ie/sites/default/files/2021-03/Duration-of-protective-immunity_Evidence-Summary.pdf
- Syangtan G, Bista S, Dawadi P, Rayamajhee B, Shrestha LB, Tuladhar R, et al. Asymptomatic SARS-CoV-2 Carriers: A Systematic Review and Meta-Analysis. Front Public Health. 2021 Jan;8:587374. https://doi.org/10.3389/fpubh.2020.587374
- Ling Z, Xu X, Gan Q, Zhang L, Luo L, Tang X, et al. Asymptomatic SARS-CoV-2 infected patients with persistent negative CT findings. Eur J Radiol. 2020 May;126:108956. https://doi.org/10.1016/j.ejrad.2020.108956
- Keeley AJ, Evans CM, de Silva TI. Asymptomatic SARS-CoV-2 infection: the tip or the iceberg? Thorax. 2020 Aug;75(8):621–2. https://doi.org/10.1136/thoraxjnl-2020-215337
- Alene M, Yismaw L, Assemie MA, Ketema DB, Mengist B, Kassie B, et al. Magnitude of asymptomatic COVID-19 cases throughout the course of infection: A systematic review and meta-analysis. PLoS One. 2021 Mar;16(3):e0249090. https://doi.org/10.1371/journal.pone.0249090
- L’Huillier AG, Meyer B, Andrey DO, Arm-Vernez I, Baggio S, Didierlaurent A, et al.; Geneva Centre for Emerging Viral Diseases. Antibody persistence in the first 6 months following SARS-CoV-2 infection among hospital workers: a prospective longitudinal study. Clin Microbiol Infect. 2021 Jan;27(5):784.e1–8. https://doi.org/10.1016/j.cmi.2021.01.005
- Van Elslande J, Gruwier L, Godderis L, Vermeersch P. Estimated half-life of SARS-CoV-2 anti-spike antibodies more than double the half-life of anti-nucleocapsid antibodies in healthcare workers. Clin Infect Dis. 2021 Mar;•••:ciab219. https://doi.org/10.1093/cid/ciab219