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Cited by 202SARS-CoV-2 and COVID-19 ResearchCOVID-19 epidemiological studiesVaccine Coverage and Hesitancy

Estimated US infection- and vaccine-induced SARS-CoV-2 seroprevalence based on blood donations, July 2020–May 2021

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Jones, Jefferson M., Stone, Mars, Sulaeman, Hasan, Fink, Rebecca V., Dave, Honey, Levy, Matthew E., Di Germanio, Clara, Green, Valerie +41 more·2021·JAMA
DOI 10.1001/jama.2021.15161PMC PMC8414359
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Abstract

Importance: People who have been infected with or vaccinated against SARS-CoV-2 have reduced risk of subsequent infection, but the proportion of people in the US with SARS-CoV-2 antibodies from infection or vaccination is uncertain. Objective: To estimate trends in SARS-CoV-2 seroprevalence related to infection and vaccination in the US population. Design, Setting, and Participants: In a repeated cross-sectional study conducted each month during July 2020 through May 2021, 17 blood collection organizations with blood donations from all 50 US states; Washington, DC; and Puerto Rico were organized into 66 study-specific regions, representing a catchment of 74% of the US population. For each study region, specimens from a median of approximately 2000 blood donors were selected and tested each month; a total of 1 594 363 specimens were initially selected and tested. The final date of blood donation collection was May 31, 2021. Exposure: Calendar time. Main Outcomes and Measures: Proportion of persons with detectable SARS-CoV-2 spike and nucleocapsid antibodies. Seroprevalence was weighted for demographic differences between the blood donor sample and general population. Infection-induced seroprevalence was defined as the prevalence of the population with both spike and nucleocapsid antibodies. Combined infection- and vaccination-induced seroprevalence was defined as the prevalence of the population with spike antibodies. The seroprevalence estimates were compared with cumulative COVID-19 case report incidence rates. Results: Among 1 443 519 specimens included, 733 052 (50.8%) were from women, 174 842 (12.1%) were from persons aged 16 to 29 years, 292 258 (20.2%) were from persons aged 65 years and older, 36 654 (2.5%) were from non-Hispanic Black persons, and 88 773 (6.1%) were from Hispanic persons. The overall infection-induced SARS-CoV-2 seroprevalence estimate increased from 3.5% (95% CI, 3.2%-3.8%) in July 2020 to 20.2% (95% CI, 19.9%-20.6%) in May 2021; the combined infection- and vaccination-induced seroprevalence estimate in May 2021 was 83.3% (95% CI, 82.9%-83.7%). By May 2021, 2.1 SARS-CoV-2 infections (95% CI, 2.0-2.1) per reported COVID-19 case were estimated to have occurred. Conclusions and Relevance: Based on a sample of blood donations in the US from July 2020 through May 2021, vaccine- and infection-induced SARS-CoV-2 seroprevalence increased over time and varied by age, race and ethnicity, and geographic region. Despite weighting to adjust for demographic differences, these findings from a national sample of blood donors may not be representative of the entire US population.

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  • Reliance on healthy blood donors and voluntary child participants did not result in a material underestimate of COVID-19 seroprevalence in the general population.

    “These independent estimates provide confidence that our reliance on healthy blood donors and voluntary child participants did not result in a material underestimate of COVID-19 seroprevalence in the general population.”

    From Real-world COVID-19 vaccine effectiveness against the Omicron BA.2 variant in a SARS-CoV-2 infection-naive population (2023) · cites this paper as [50]

    The Limitations section says the blood-donor infection-induced estimates were similar to those from a nationwide study using commercial laboratory specimens, which lends some support to the claim about donors. It also says donor estimates might be underestimated because people with COVID-19 symptoms could be excluded. The study did not include children under 16, so it cannot assess whether voluntary child participation caused an underestimate. (LLM, conf=0.84)

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  • Some studies have used seroprevalence surveys, while others have made estimates of infections by assuming a particular infection-detection ratio (IDR).

    “Some of these studies have used seroprevalence surveys, while others have made estimates of infections by assuming a particular infection–detection ratio (IDR).7, 10, 11, 12”

    From Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis (2022) · cites this paper as [12]

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Authors
Jones, J. M., Stone, M., Sulaeman, H., Fink, R. V., Dave, H., Levy, M. E., Di Germanio, C., Green, V., Notari, E., Saa, P., Biggerstaff, B. J., Strauss, D., Kessler, D., Vassallo, R., Reik, R., Rossmann, S., Destree, M., Nguyen, K.-A., Sayers, M., Lough, C., Bougie, D. W., Ritter, M., Latoni, G., Weales, B., Sime, S., Gorlin, J., Brown, N. E., Gould, C. V., Berney, K., Benoit, T. J., Miller, M. J., Freeman, D., Kartik, D., Fry, A. M., Azziz-Baumgartner, E., Hall, A. J., MacNeil, A., Gundlapalli, A. V., Basavaraju, S. V., Gerber, S. I., Patton, M. E., Custer, B., Williamson, P., Simmons, G., Thornburg, N. J., Kleinman, S., Stramer, S. L., Opsomer, J., & Busch, M. P.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Vitalant Research Institute (US)
  • Westat (United States) (US)
  • Vitalant Research Institute, San Francisco, California
  • Temple University, Japan (JP)
  • American Red Cross (US)
  • Scientific Affairs, American Red Cross, Gaithersburg, Maryland
  • New York Blood Center (US)
  • OneBlood (US)
  • Gulf Coast Regional Blood Center, Houston, Texas
  • Bloodworks Northwest (US)
  • Blood Bank of Hawaii, Honolulu
  • Carter BloodCare (US)
  • LifeSouth Community Blood Centers, Gainesville, Florida
  • Versiti Blood Center of Wisconsin (US)
  • Blood Bank of Alaska, Anchorage
  • Banco de Sangre de Servicios Mutuos, San Juan, Puerto Rico
  • The Blood Center, New Orleans, Louisiana
  • LifeServe, Des Moines, Iowa
  • Minnesota Historical Society (US)
  • Georgia Tech Research Institute (US)
  • COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
  • University of British Columbia (CA)
Corresponding author
Jones, Jefferson M.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2021-10-12
Volume
326
Issue
14
Pages
1400
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2021.15161
PMC
PMC8414359
OpenAlex
W3197430550
Cited by
201
References
31
Citations by year
2026: 13 · 2025: 23 · 2024: 19 · 2023: 57 · 2022: 80 · 2021: 9
FWCI
13.05
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
Keywords
SARS-CoV-2, COVID-19 pandemic, seroprevalence, blood donors, COVID-19 vaccination, SARS-CoV-2 antibodies, spike antibodies, nucleocapsid antibodies, antibody waning, COVID-19 incidence, United States
MeSH terms
COVID-19, SARS-CoV-2, COVID-19 Vaccines, COVID-19 Serological Testing, Adolescent, Adult, Age Factors, Aged, Antibodies, Viral, Blood Donors, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, United States, Prevalence, Seroepidemiologic Studies, Young Adult

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