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Estimated US infection- and vaccine-induced SARS-CoV-2 seroprevalence based on blood donations, July 2020–May 2021
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredIn the citing paper
“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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Krammer, F., Srivastava, K., Alshammary, H., Amoako, A. A., Awawda, M. H., Beach, K. F., Bermúdez-González, M. C., Bielak, D. A., Carreño, J. M., Chernet, R. L., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmc2101667 · Cited by 696
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Self-citation
Metadata
- 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
- Jones, Jefferson M.
- Stone, Mars
- Sulaeman, Hasan
- Fink, Rebecca V.
- Dave, Honey
- Levy, Matthew E.
- Green, Valerie
- Notari, Edward
- Biggerstaff, Brad J.
- Strauss, Donna
- Kessler, Debra
- Sayers, Merlyn
- Bougie, Daniel W.
- Gorlin, Jed
- Brown, Nicole E.
- Gould, Carolyn V.
- Benoit, Tina J.
- Miller, Maureen J.
- Fry, Alicia M.
- Hall, Aron J.
- MacNeil, Adam
- Gundlapalli, Adi V.
- Basavaraju, Sridhar V.
- Gerber, Susan I.
- Patton, Monica E.
- Custer, Brian
- Simmons, Graham
- Thornburg, Natalie J.
- Kleinman, Steven
- Stramer, Susan L.
- Opsomer, Jean
- Busch, Michael P.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2021-10-12
- Volume
- 326
- Issue
- 14
- Pages
- 1400
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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
- bronze
- doi.org
- 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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