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High SARS-CoV-2 seroprevalence in Health Care Workers but relatively low numbers of deaths in urban Malawi.

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Chibwana, Marah Grace, Jere, Khuzwayo Chidiwa, Kamng'ona, Raphael, Mandolo, Jonathan, Katunga-Phiri, Vincent, Tembo, Dumizulu, Mitole, Ndaona, Musasa, Samantha, Sichone, Simon, Lakudzala, Agness, Sibale, Lusako, Matambo, Prisca, Kadwala, Innocent, Byrne, Rachel, Mbewe, Alice, Henrion, Marc, Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854, Phiri, Chimota, Mallewa, Jane, Mwandumba, Henry ORCID: https://orcid.org/0000-0003-4470-3608, Adams, Emily ORCID: https://orcid.org/0000-0002-0816-2835, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116 and Jambo, Kondwani ORCID: https://orcid.org/0000-0002-3195-2210 (2020) 'High SARS-CoV-2 seroprevalence in Health Care Workers but relatively low numbers of deaths in urban Malawi.'. Wellcome Open Research, Vol 5, p. 199.

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Abstract

Background In low-income countries, like Malawi, important public health measures including social distancing or a lockdown, have been challenging to implement owing to socioeconomic constraints, leading to predictions that the COVID-19 pandemic would progress rapidly. However, due to limited capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are no reliable estimates of the true burden of infection and death. We, therefore, conducted a SARS-CoV-2 serosurvey amongst health care workers (HCW) in Blantyre city to estimate the cumulative incidence of SARS-CoV-2 infection in urban Malawi. Methods Five hundred otherwise asymptomatic HCWs were recruited from Blantyre City (Malawi) from 22nd May 2020 to 19th June 2020 and serum samples were collected all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum. We run local negative samples (2018 - 2019) to verify the specificity of the assay. To estimate the seroprevalence of SARS CoV-2 antibodies, we adjusted the proportion of positive results based on local specificity of the assay. Results Eighty-four participants tested positive for SARS-CoV-2 antibodies. The HCW with a positive SARS-CoV-2 antibody result came from different parts of the city. The adjusted seroprevalence of SARS-CoV-2 antibodies was 12.3% [CI 9.0-15.7]. Using age-stratified infection fatality estimates reported from elsewhere, we found that at the observed adjusted seroprevalence, the number of predicted deaths was 8 times the number of reported deaths. Conclusion The high seroprevalence of SARS-CoV-2 antibodies among HCW and the discrepancy in the predicted versus reported deaths, suggests that there was early exposure but slow progression of COVID-19 epidemic in urban Malawi. This highlights the urgent need for development of locally parameterised mathematical models to more accurately predict the trajectory of the epidemic in sub-Saharan Africa for better evidence-based policy decisions and public health response planning.

Item Type: Article
Subjects: WA Public Health > WA 105 Epidemiology
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 505 Viral respiratory tract infections
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.12688/wellcomeopenres.16188.1
Depositing User: Julie Franco
Date Deposited: 08 Sep 2020 13:21
Last Modified: 08 Sep 2020 13:21
URI: https://archive.lstmed.ac.uk/id/eprint/15525

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