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

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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, Cheng, B, Noel, K, Cao, C, Yanes-Lane, M, Herring, B, Talisuna, A, Nsenga, N, Balde, T, Clifton, DA, Van Kerkhove, M, Buckeridge, DL, Bobrovitz, N, Okeibunor, J, Arora, RK, Bergeri, I, the UNITY Studies Collaborator Group·2022·BMJ Global Health

DOI 10.1101/2022.02.14.22270934PMC PMC9402450

Preprint — published as 10.1136/bmjgh-2022-008793

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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)
ORCID: Lewis, HC
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
Van Kerkhove, M
Buckeridge, DL
Bobrovitz, N
Okeibunor, J
Arora, RK
Bergeri, I
Venue: BMJ Global Health
Publisher: openRxiv
Published: 2022-02-15
Volume: 7
Issue: 8
Pages: e008793-e008793
ISSN: 2059-7908 (ISSN-L)
DOI: 10.1101/2022.02.14.22270934
PMC: PMC9402450
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: gold
doi.org
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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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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