SARS-CoV-2 exposure in Malawian blood donors: an analysis of seroprevalence and variant dynamics between January 2020 and July 2021
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Abstract
Background: By August 2021, the COVID-19 pandemic has been less severe in sub-Saharan Africa than elsewhere. In Malawi, there have been three subsequent epidemic waves. We therefore aimed to describe the dynamics of SARS-CoV-2 exposure in Malawi. Methods: We measured the seroprevalence of anti-SARS-CoV-2 antibodies amongst randomly selected blood transfusion donor sera in Malawi from January 2020 to July 2021 using a cross-sectional study design. In a subset, we also assessed in vitro neutralisation against the original variant (D614G WT) and the Beta variant. Results: A total of 5085 samples were selected from the blood donor database, of which 4075 (80.1%) were aged 20–49 years. Of the total, 1401 were seropositive. After adjustment for assay characteristics and applying population weights, seropositivity reached peaks in October 2020 (18.5%) and May 2021 (64.9%) reflecting the first two epidemic waves. Unlike the first wave, both urban and rural areas had high seropositivity in the second wave, Balaka (rural, 66.2%, April 2021), Blantyre (urban, 75.6%, May 2021), Lilongwe (urban, 78.0%, May 2021), and Mzuzu (urban, 74.6%, April 2021). Blantyre and Mzuzu also show indications of the start of a third pandemic wave with seroprevalence picking up again in July 2021 (Blantyre, 81.7%; Mzuzu, 71.0%). More first wave sera showed in vitro neutralisation activity against the original variant (78% [7/9]) than the beta variant (22% [2/9]), while more second wave sera showed neutralisation activity against the beta variant (75% [12/16]) than the original variant (63% [10/16]). Conclusion: The findings confirm extensive SARS-CoV-2 exposure in Malawi over two epidemic waves with likely poor cross-protection to reinfection from the first on the second wave. The dynamics of SARS-CoV-2 exposure will therefore need to be taken into account in the formulation of the COVID-19 vaccination policy in Malawi and across the region. Future studies should use an adequate sample size for the assessment of neutralisation activity across a panel of SARS-CoV-2 variants of concern/interest to estimate community immunity.
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Several serosurveys suggest that Africa experienced large waves of infection but that most cases went unreported, in part because they did not lead to severe disease.
“Several serosurveys suggest that Africa experienced large waves of infection but that most cases went unreported, in part because they did not lead to severe disease.”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [186]
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“However, these studies existing were limited by either their cross-sectional designs 12 , or reliance on convenience samples (i.e., health care workers 10 and blood donors 11 .”
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“Recent serosurvey studies in South Africa (3–6) and Africa (7,8) have demonstrated high levels of sero-positivity from infection or vaccination two years after the emergence of SARS-CoV-2.”
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Prevalence of Endemic Respiratory Viruses During the COVID-19 Pandemic in Urban and Rural Malawi
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IoT and AI Technological Empowered Covid-19 Control Approaches
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“9%) from different Malawian cities, during the period October 2020 - May-2021 [32].”
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“By mid-2021, seroprevalence increased substantially in urban areas, reaching 81.7% in Blantyre and 71.0% in Mzuzu, with measurable neutralising activity against ancestral B.1 and Beta variants [9].”
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“Early studies conducted in 2020 reported very low prevalence in African populations [16, 17], whereas studies conducted in 2021 showed substantially higher prevalence in the region [5, 18].”
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- Authors
- Mandolo, J., Msefula, J., Henrion, M. Y. R., Brown, C., Moyo, B., Samon, A., Moyo-Gwete, T., Makhado, Z., Ayres, F., Motlou, T., Mzindle, N., Kalata, N., Muula, A. S., Kwatra, G., Nsamala, N., Likaka, A., Mfune, T., Moore, P. L., Mbaya, B., French, N., Heyderman, R. S., Swarthout, T., & Jambo, K. C.
- Affiliations
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MW)
- Liverpool School of Tropical Medicine (GB)
- Malawi Blood Transfusion Service (MW)
- National Health Laboratory Service (ZA)
- Kamuzu University of Health Sciences (MW)
- Christian Medical College, Vellore (IN)
- University of Liverpool (GB)
- University College London (GB)
- Corresponding author
- Jambo, Kondwani C.
- ORCID
- Venue
- BMC Medicine
- Published
- 2021-11-19
- Volume
- 19
- Issue
- 1
- Pages
- 303-303
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC8601780
- OpenAlex
- W3213745049
- Cited by
- 61
- References
- 30
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 6 · 2023: 18 · 2022: 27 · 2021: 1
- FWCI
- 4.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health Research NIHR, UK) (16/136/46)
- Medical Research Council (MR/T008822/1)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, seroprevalence, blood donors, SARS-CoV-2 variants, Beta variant, Omicron variant, neutralizing antibodies, epidemic waves, cross-protection, reinfection, Malawi, sub-Saharan Africa, urban-rural differences, transfusion safety, serological surveillance
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Vaccines, Antibodies, Viral, Blood Donors, Cross-Sectional Studies, Humans, Seroepidemiologic Studies, Pandemics
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