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. 2020 Nov 28;75(6):489-495.
doi: 10.1136/jech-2020-215678. Online ahead of print.

Nationwide seroprevalence of SARS-CoV-2 and identification of risk factors in the general population of the Netherlands during the first epidemic wave

Eric R A Vos  1 , Gerco den Hartog  1 , Rutger M Schepp  1 , Patricia Kaaijk  1 , Jeffrey van Vliet  1 , Kina Helm  1 , Gaby Smits  1 , Alienke Wijmenga-Monsuur  1 , Janneke D M Verberk  1 , Michiel van Boven  1 , Rob S van Binnendijk  1 , Hester E de Melker  1 , Liesbeth Mollema  1 , Fiona R M van der Klis  2
Affiliations

Nationwide seroprevalence of SARS-CoV-2 and identification of risk factors in the general population of the Netherlands during the first epidemic wave

Eric R A Vos et al. J Epidemiol Community Health. .

Abstract

Background: We aimed to detect SARS-CoV-2 serum antibodies in the general population of the Netherlands and identify risk factors for seropositivity amidst the first COVID-19 epidemic wave.

Methods: Participants (n=3207, aged 2-90 years), enrolled from a previously established nationwide serosurveillance study, provided a self-collected fingerstick blood sample and completed a questionnaire (median inclusion date 3 April 2020). IgG antibodies targeted against the spike S1-protein of SARS-CoV-2 were quantified using a validated multiplex-immunoassay. Seroprevalence was estimated controlling for survey design, individual pre-pandemic concentration, and test performance. Random-effects logistic regression identified risk factors for seropositivity.

Results: Overall seroprevalence in the Netherlands was 2.8% (95% CI 2.1 to 3.7), with no differences between sexes or ethnic background, and regionally ranging between 1.3 and 4.0%. Estimates were highest among 18-39 year-olds (4.9%), and lowest in children 2-17 years (1.7%). Multivariable analysis revealed that persons taking immunosuppressants and those from the Orthodox-Reformed Protestant community had over four times higher odds of being seropositive compared to others. Anosmia/ageusia was the most discriminative symptom between seropositive (53%) and seronegative persons (4%, p<0.0001). Antibody concentrations in seropositive persons were significantly higher in those with fever or dyspnoea in contrast to those without (p=0.01 and p=0.04, respectively).

Conclusions: In the midst of the first epidemic wave, 2.8% of the Dutch population was estimated to be infected with SARS-CoV-2, that is, 30 times higher than reported. This study identified independent groups with increased odds for seropositivity that may require specific surveillance measures to guide future protective interventions internationally, including vaccination once available.

Keywords: Epidemics; Epidemiology; Infection; Public health; Surveillance.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Geographical representation of number of participants in the PICO-study, the Netherlands, first round of inclusion, per municipality. The size of the dots reflect the absolute number of participants. Thicker grey and smaller light grey boundaries represent provinces and municipalities, respectively, and orange and blue boundaries characterise municipalities from the national and low vaccination coverage sample, respectively.
Figure 2
Figure 2
Smooth age-specific SARS-CoV-2 seroprevalence in the general population of the Netherlands, beginning of April 2020.
See this image and copyright information in PMC

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