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Rogawski McQuade ET, Guertin KA, Becker L, Operario D, Gratz J, Guan D, Khan F, White J, McMurry TL, Shah B, Garofalo S, Southerland M, Bear K, Brush J, Allen C, Frayser A, Vokes R, Pershad R, Peake L, deFilippi C, Barackman K, Bearman G, Bidanset A, Farrell F, Trump D, Houpt ER. Assessment of Seroprevalence of SARS-CoV-2 and Risk Factors Associated With COVID-19 Infection Among Outpatients in Virginia. JAMA Netw Open 2021; 4:e2035234. [PMID: 33555331 PMCID: PMC7871191 DOI: 10.1001/jamanetworkopen.2020.35234] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
Importance Data from seroepidemiologic surveys measuring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure in diverse communities and ascertaining risk factors associated with infection are important to guide future prevention strategies. Objective To assess the prevalence of previous SARS-CoV-2 infection across Virginia and the risk factors associated with infection after the first wave of coronavirus disease 2019 (COVID-19) infections in the US. Design, Setting, and Participants In this statewide cross-sectional surveillance study, 4675 adult outpatients presenting for health care not associated with COVID-19 in Virginia between June 1 and August 14, 2020, were recruited to participate in a questionnaire and receive venipuncture to assess SARS-CoV-2 serology. Eligibility was stratified to meet age, race, and ethnicity quotas that matched regional demographic profiles. Main Outcomes and Measures The main outcome was SARS-CoV-2 seropositivity, as measured by the Abbott SARS-CoV-2 immunoglobulin G assay. Results Among 4675 adult outpatients (mean [SD] age, 48.8 [16.9] years; 3119 women [66.7%]; 3098 White [66.3%] and 4279 non-Hispanic [91.5%] individuals) presenting for non-COVID-19-associated health care across Virginia, the weighted seroprevalence was 2.4% (95% CI, 1.8%-3.1%) and ranged from 0% to 20% by zip code. Seroprevalence was notably higher among participants who were Hispanic (10.2%; 95% CI, 6.1%-14.3%), residing in the northern region (4.4%; 95% CI, 2.8%-6.1%), aged 40 to 49 years (4.4%; 95% CI, 1.8%-7.1%), and uninsured (5.9%; 95% CI, 1.5%-10.3%). Higher seroprevalence was associated with Hispanic ethnicity (adjusted odds ratio [aOR], 3.56; 95% CI, 1.76-7.21), residence in a multifamily unit (aOR, 2.55; 95% CI, 1.25-5.22), and contact with an individual with confirmed COVID-19 infection (aOR, 4.33; 95% CI, 1.77-10.58). The sensitivity of serology results was 94% (95% CI, 70%-100%) among those who reported receiving a previous polymerase chain reaction test for COVID-19 infection. Among 101 participants with seropositive results, 67 individuals (66.3%) were estimated to have asymptomatic infection. These data suggested a total estimated COVID-19 burden that was 2.8-fold higher than that ascertained by PCR-positive case counts. Conclusions and Relevance This large statewide serologic study estimated that 2.4% of adults in Virginia had exposure to SARS-CoV-2, which was 2.8-fold higher than confirmed case counts. Hispanic ethnicity, residence in a multifamily unit, and contact with an individual with confirmed COVID-19 infection were significant risk factors associated with exposure. Most infections were asymptomatic. As of August 2020, the population in Virginia remained largely immunologically naive to the virus.
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Affiliation(s)
- Elizabeth T. Rogawski McQuade
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
- Department of Public Health Sciences, University of Virginia, Charlottesville
| | - Kristin A. Guertin
- Department of Public Health Sciences, University of Virginia, Charlottesville
| | - Lea Becker
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Darwin Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Dave Guan
- Research and Clinical Trial Analytics Team, Division of Quality Performance Improvement, University of Virginia, Charlottesville
| | - Fauzia Khan
- Research and Clinical Trial Analytics Team, Division of Quality Performance Improvement, University of Virginia, Charlottesville
| | - Jennifer White
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Timothy L. McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville
| | - Bhruga Shah
- Inova Heart and Vascular Institute, Inova Health System, Falls Church, Virginia
| | - Stephanie Garofalo
- Inova Heart and Vascular Institute, Inova Health System, Falls Church, Virginia
| | - Matt Southerland
- Inova Heart and Vascular Institute, Inova Health System, Falls Church, Virginia
| | - Kelly Bear
- Inova Heart and Vascular Institute, Inova Health System, Falls Church, Virginia
| | - John Brush
- Office of Clinical Research, Sentara Healthcare, Norfolk, Virginia
| | - Cynthia Allen
- Office of Clinical Research, Sentara Healthcare, Norfolk, Virginia
| | - Amy Frayser
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond
| | - Rebecca Vokes
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond
| | - Rashmi Pershad
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond
| | | | | | | | - Gonzalo Bearman
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond
| | | | | | | | - Eric R. Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
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