Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 1;5(8):e2227995.
doi: 10.1001/jamanetworkopen.2022.27995.

Utility of Newborn Dried Blood Spots to Ascertain Seroprevalence of SARS-CoV-2 Antibodies Among Individuals Giving Birth in New York State, November 2019 to November 2021

Amanda Damjanovic  1 , Linda M Styer  1   2 , Katherine Nemeth  1 , Erica Yauney  1 , Jean M Rock  1 , Rachel Bievenue  1 , Rebecca Hoen  3 , Dylan Ehrbar  1 , Denise M Kay  1   2 , Michele Caggana  1   2 , Monica M Parker  1
Affiliations

Utility of Newborn Dried Blood Spots to Ascertain Seroprevalence of SARS-CoV-2 Antibodies Among Individuals Giving Birth in New York State, November 2019 to November 2021

Amanda Damjanovic et al. JAMA Netw Open. .

Abstract

Importance: Serosurveys can be used to monitor population-level dynamics of COVID-19 and vaccination. Dried blood spots (DBSs) collected from infants contain maternal IgG antibodies and are useful for serosurveys of individuals recently giving birth.

Objectives: To examine SARS-CoV-2 antibody prevalence in pregnant individuals in New York State, identify associations between SARS-CoV-2 antibody status and maternal and infant characteristics, and detect COVID-19 vaccination among this population.

Design, setting, and participants: A population-based, repeated cross-sectional study was conducted to detect SARS-CoV-2 nucleocapsid (N) and spike (S) IgG antibodies. Deidentified DBS samples and data submitted to the New York State Newborn Screening Program between November 1, 2019, and November 30, 2021, were analyzed.

Exposures: Prenatal exposure to SARS-CoV-2 antibodies.

Main outcomes and measures: The presence of IgG antibodies to SARS-CoV-2 N and S antigens was measured using a microsphere immunoassay. Data were analyzed by geographic region and compared with reported COVID-19 cases and vaccinations among reproductive-aged females (15-44 years of age). Data were stratified by infant birth weight, gestational age, maternal age, and multiple birth status.

Results: Dried blood spot samples from 415 293 infants (median [IQR] age, 1.04 [1.00-1.20] days; 210 805 [51.1%] male) were analyzed for SARS-CoV-2 antibodies. The first known antibody-positive infant in New York State was born on March 29, 2020. SARS-CoV-2 seroprevalence reflected statewide and regional COVID-19 cases among reproductive-aged females in the prevaccine period. From February through November 2021, S seroprevalence was strongly correlated with cumulative vaccinations in each New York State region and in the state overall (rs = 0.92-1.00, P ≤ .001). S and N seroprevalences were significantly lower in newborns with very low birth weight (720 [14.8%] for S and 138 [2.8%] for N, P < .001) and low birth weight (5160 [19.3%] for S and 1233 [4.6%] for N, P = .009) compared with newborns with normal birth weight (77 116 [20.1%] for S and 19 872 [5.2%] for N). Lower N and higher S seroprevalences were observed in multiple births (odds ratio [OR], 0.84; 95% CI, 0.75-0.94; P = .002 for N and OR, 1.24; 95% CI, 1.18-1.31; P < .001 for S) vs single births and for maternal age older than 30 years (OR, 0.87; 95% CI, 0.80-0.94; P < .001 for N and OR, 1.17; 95% CI, 1.11-1.23; P < .001 for S) vs younger than 20 years.

Conclusions and relevance: In this study, seroprevalence in newborn DBS samples reflected COVID-19 case fluctuations and vaccinations among reproductive-aged women during the study period. These results demonstrate the utility of using newborn DBS testing to estimate SARS-CoV-2 seroprevalence in pregnant individuals.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Caggana reported receiving grants from the CDC during the conduct of the study. Dr Parker reported receiving grants from the National Cancer Institute and the CDC during the conduct of the study and subcontract support from the National Heart, Lung, and Blood Institute via the University of Vermont, contract support from the Association of Public Health Laboratories for HIV Reference Center Testing, contract support from City University of New York for hepatitis C virus testing, and contract support from New York University for hepatitis C virus sequencing outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. SARS-CoV-2 Spike S1 and Nucleocapsid Antibodies in Dried Blood Spot (DBS) Samples Collected From November 2019 Through November 2021
A, Spike (S) and nucleocapsid (N) median fluorescence intensity (MFI) indexes for DBS samples collected from infants born from November 2019 through November 2021. Indexes above 1.0 are considered reactive. The N index reactive cutoff is indicated by a solid line. The DBS samples with S indexes of 1.0 or higher are orange and less than 1.0 are gray. The boxes with dashed lines indicate samples with high S (>7) and low N (<0.5) indexes, indicative of recent vaccination. On the x-axis, for each month, the 2 unlabeled tick marks represent S MFI index values of 0 (left) and 20 (right). B, Weekly COVID-19 cases (blue line) and vaccinations (bars) among females aged 15 to 44 years in New York State and percentage of DBS samples reactive for S (orange squares) and N (blue circles) antibodies by week of birth. Week of birth ranges from November 3, 2019 (2019 week 45) through November 29, 2021 (2021 week 49).
Figure 2.
Figure 2.. Newborn SARS-CoV-2 Antibody Reactivity and COVID-19 Cases and Vaccinations in Reproductive-Aged Females in New York State Regions With High COVID-19 Incidence
Percentage of SARS-CoV-2 spike (orange squares) or nucleocapsid (blue circles) antibody reactivity in eluted dried blood spot samples from newborns and COVID-19 cases (blue line) and vaccinations (bars) in females aged 15 to 44 years.
Figure 3.
Figure 3.. Newborn SARS-CoV-2 Antibody Reactivity and COVID-19 Cases and Vaccinations in Reproductive-Aged Females in New York State Regions With Moderate and Low COVID-19 Incidence
Percentage of SARS-CoV-2 spike (orange squares) or nucleocapsid (blue circles) antibody reactivity in eluted dried blood spot samples from newborns and COVID-19 cases (blue line) and vaccinations (bars) in females aged 15 to 44 years.
See this image and copyright information in PMC

References

    1. Gonzalez-Reiche AS, Hernandez MM, Sullivan MJ, et al. . Introductions and early spread of SARS-CoV-2 in the New York City area. Science. 2020;369(6501):297-301. doi:10.1126/science.abc1917 - DOI - PMC - PubMed
    1. Rosenberg ES, Tesoriero JM, Rosenthal EM, et al. . Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York. Ann Epidemiol. 2020;48:23-29.e4. doi:10.1016/j.annepidem.2020.06.004 - DOI - PMC - PubMed
    1. Li K, Huang B, Wu M, et al. . Dynamic changes in anti-SARS-CoV-2 antibodies during SARS-CoV-2 infection and recovery from COVID-19. Nat Commun. 2020;11(1):6044. doi:10.1038/s41467-020-19943-y - DOI - PMC - PubMed
    1. Qu J, Wu C, Li X, et al. . Profile of immunoglobulin G and IgM antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020;71(16):2255-2258. doi:10.1093/cid/ciaa489 - DOI - PMC - PubMed
    1. Zava TT, Zava DT. Validation of dried blood spot sample modifications to two commercially available COVID-19 IgG antibody immunoassays. Bioanalysis. 2021;13(1):13-28. doi:10.4155/bio-2020-0289 - DOI - PMC - PubMed

Publication types