PreprintCited by 177COVID-19 epidemiological studiesSARS-CoV-2 and COVID-19 ResearchSARS-CoV-2 detection and testing

SARS-CoV-2 infection in Africa: A systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021

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Lewis, HC, Ware, H, Whelan, M, Subissi, L, Li, Z, Ma, X, Nardone, A, Valenciano, M +16 more·2022·BMJ Global Health

Preprint — published as 10.1136/bmjgh-2022-008793

Abstract

INTRODUCTION: Estimating COVID-19 cumulative incidence in Africa remains problematic due to challenges in contact tracing, routine surveillance systems and laboratory testing capacities and strategies. We undertook a meta-analysis of population-based seroprevalence studies to estimate SARS-CoV-2 seroprevalence in Africa to inform evidence-based decision making on public health and social measures (PHSM) and vaccine strategy. METHODS: We searched for seroprevalence studies conducted in Africa published 1 January 2020-30 December 2021 in Medline, Embase, Web of Science and Europe PMC (preprints), grey literature, media releases and early results from WHO Unity studies. All studies were screened, extracted, assessed for risk of bias and evaluated for alignment with the WHO Unity seroprevalence protocol. We conducted descriptive analyses of seroprevalence and meta-analysed seroprevalence differences by demographic groups, place and time. We estimated the extent of undetected infections by comparing seroprevalence and cumulative incidence of confirmed cases reported to WHO. PROSPERO: CRD42020183634. RESULTS: We identified 56 full texts or early results, reporting 153 distinct seroprevalence studies in Africa. Of these, 97 (63%) were low/moderate risk of bias studies. SARS-CoV-2 seroprevalence rose from 3.0% (95% CI 1.0% to 9.2%) in April-June 2020 to 65.1% (95% CI 56.3% to 73.0%) in July-September 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 100:1, ranging from 18:1 to 954:1) and steady over time. Seroprevalence was highly heterogeneous both within countries-urban versus rural (lower seroprevalence for rural geographic areas), children versus adults (children aged 0-9 years had the lowest seroprevalence)-and between countries and African subregions. CONCLUSION: We report high seroprevalence in Africa suggesting greater population exposure to SARS-CoV-2 and potential protection against COVID-19 severe disease than indicated by surveillance data. As seroprevalence was heterogeneous, targeted PHSM and vaccination strategies need to be tailored to local epidemiological situations.

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Authors
Lewis, H., Ware, H., Whelan, M., Subissi, L., Li, Z., Ma, X., Nardone, A., Valenciano, M., Cheng, B., Noel, K., Cao, C., Yanes-Lane, M., Herring, B., Talisuna, A., Nsenga, N., Balde, T., Clifton, D., Van Kerkhove, M., Buckeridge, D., Bobrovitz, N., Okeibunor, J., Arora, R., Bergeri, I., & the UNITY Studies Collaborator Group
Affiliations
  • University of Calgary (CA)
  • World Health Organization (CH)
  • University of Waterloo (CA)
  • University of Toronto (CA)
  • World Health Organization Regional Office for Africa (CG)
Venue
BMJ Global Health
Publisher
openRxiv
Published
2022-02-15
Volume
7
Issue
8
Pages
e008793-e008793
ISSN
2059-7908 (ISSN-L)
OpenAlex
W4292774342
Cited by
177
References
46
Citations by year
2026: 25 · 2025: 30 · 2024: 39 · 2023: 47 · 2022: 36
FWCI
4.07
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Global Health (publishedVersion, cc-by-nc)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, cc-by-nc-nd)
  • HAL (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • World Health Organization
  • Public Health Agency of Canada
  • Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
  • Public Health Agency
  • Bundesministerium für Gesundheit
  • Canadian Medical Association
  • Robert Koch Institut
  • Centers for Disease Control and Prevention
  • Medical Research Council (MR/T008822/1)
Topics
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 detection and testing
Keywords
SARS-CoV-2, COVID-19 pandemic, seroprevalence, Africa, underreporting of infections, urban-rural differences, age differences in infection, subregional variation, public health and social measures, risk of bias assessment, SARS-CoV-2 reinfection
MeSH terms
COVID-19, SARS-CoV-2, Adult, Africa, Child, Europe, Humans, Seroepidemiologic Studies

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