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Meta-Analysis
. 2023 Sep:134:160-167.
doi: 10.1016/j.ijid.2023.06.009. Epub 2023 Jun 15.

Prepandemic cross-reactive humoral immunity to SARS-CoV-2 in Africa: Systematic review and meta-analysis

John P A Ioannidis  1 , Despina G Contopoulos-Ioannidis  2
Affiliations
Meta-Analysis

Prepandemic cross-reactive humoral immunity to SARS-CoV-2 in Africa: Systematic review and meta-analysis

John P A Ioannidis et al. Int J Infect Dis. 2023 Sep.

Abstract

Objectives: To assess the evidence on the presence of antibodies cross-reactive with SARS-CoV-2 antigens in prepandemic samples from African populations.

Methods: We performed a systematic review and meta-analysis of studies evaluating prepandemic African samples using pre-set assay-specific thresholds for SARS-CoV-2 seropositivity.

Results: In total, 26 articles with 156 datasets were eligible, including 3437 positives among 29,923 measurements (11.5%) with large between-dataset heterogeneity. Positivity was similar for anti-nucleocapsid (14%) and anti-spike antibodies (11%), higher for anti-spike1 (23%), and lower for anti-receptor-binding domain antibodies (7%). Positivity was similar, on average, for immunoglobulin M and immunoglobulin G. Positivity was seen prominently in countries where malaria transmission occurs throughout and in datasets enriched in malaria cases (14%, 95% confidence interval, 12-15% vs 2%, 95% confidence interval 1-2% in other datasets). Substantial SARS-CoV-2 reactivity was seen in high malaria burden with or without high dengue burden (14% and 12%, respectively), and not without high malaria burden (2% and 0%, respectively). Lower SARS-CoV-2 cross-reactivity was seen in settings of high HIV seroprevalence. More sparse individual-level data showed associations of higher SARS-CoV-2 cross-reactivity with Plasmodium parasitemia and lower SARS-CoV-2 cross-reactivity with HIV seropositivity.

Conclusion: Prepandemic samples from Africa show high levels of anti-SARS-CoV-2 seropositivity. At the country level, cross-reactivity tracks especially with malaria prevalence.

Keywords: COVID-19; Cross-reactivity; Malaria; Prepandemic; SARS-CoV-2; Seroprevalence.

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Conflict of interest statement

Declarations of Competing Interest The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Flow diagram for searches and selected eligible studies.
See this image and copyright information in PMC

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