Immunity Against SARS-CoV-2 in the German Population

Abstract

Background: Early during the SARS-CoV-2 pandemic, national population-based seroprevalence surveys were conducted in some countries; however, this was not done in Germany. In particular, no seroprevalence surveys were planned for the summer of 2022. In the context of the IMMUNEBRIDGE project, the GUIDE study was carried out to estimate seroprevalence on the national and regional levels.

Methods: To obtain an overview of the population-wide immunity against SARS-CoV-2 among adults in Germany that would be as statistically robust as possible, serological tests were carried out using self-sampling dried blood spot cards in conjunction with surveys, one by telephone and one online. Blood samples were analyzed for the presence of antibodies to the S and N antigens of SARS-CoV-2.

Results: Among the 15 932 participants, antibodies to the S antigen were detected in 95.7%, and to the N antigen in 44.4%. In the higher-risk age groups of persons aged 65 and above and persons aged 80 and above, anti-S antibodies were found in 97,4% and 98.8%, respectively. Distinct regional differences in the distribution of anti-S and anti-N antibodies emerged. Immunity gaps were found both regionally and in particular subgroups of the population. High anti-N antibody levels were especially common in eastern German states, and high anti-S antibody levels in western German states.

Conclusion: These findings indicate that a large percentage of the adult German population has formed antibodies against the SARS-CoV-2 virus. This will markedly lower the probability of an overburdening of the health care system by hospitalization and high occupancy of intensive care units due to future SARS-CoV-2 waves, depending on the viral characteristics of then prevailing variants.

Figure 1

Proportions of persons with proven positive S-antigen immunity in %, stratified by rural and urban districts (NUTS-3) and weighted by population data

Figure 2

Proportions of persons with proven positive N-antigen immunity in %, stratified by rural and urban districts (NUTS-3) and weighted by population data

eFigure 1

Presentation of the sample survey process

eFigure 2

Proportions of persons without declared vaccination, infection, or proof of immunity in %, stratified by rural and urban districts (NUTS-3) and weighted by population variables

eFigure 3

Proportions of persons with proof of immunity to S antigen in %, stratified by administrative district (NUTS-2) and weighted by population data

eFigure 4

Proportions of persons with proof of immunity to N antigen in %, stratified by administrative district (NUTS-2) and weighted by population data

eFigure 5

Proportion of persons 60+ with two booster vaccinations according to the STIKO recommendation in %, stratified by rural and urban districts (NUTS-3)