key: cord-0997805-6bv2w1f0
authors: Chisolm, T.; Walker, J. P.; Leys, Y.; Butterfield, T. R.; Medley, C.; Thompson, T. K.; Reynolds-Campbell, G.; Mulder, W. H.; Campbell Mitchell, M.; Anzinger, J. J.
title: SARS-CoV-2 Seroprevalence Among Antenatal Clinic Attendees in Kingston, Jamaica, September-November 2020
date: 2021-02-11
journal: nan
DOI: 10.1101/2021.02.08.21251367
sha: 42df8ac52c025094e7959fb0819f82e65773a2eb
doc_id: 997805
cord_uid: 6bv2w1f0

SARS-CoV-2 seroprevalence in an antenatal population in Kingston, Jamaica was assessed for September-November 2020 in a repeated cross-sectional study using the Abbott Architect SARS-CoV-2 IgG assay. After adjusting for test performance, seroprevalence was 6.9% for September, 16.9% for October, and 24.0% for November. Of the 37 pregnant women testing SARS-CoV-2 IgG positive, only 3 were symptomatic. One symptomatic woman testing SARS-CoV-2 IgG positive had multiple co-morbidities and succumbed to COVID-19 pneumonia. Up to January 31, 2021, 8 women identified as SARS-CoV-2 IgG positive delivered, all without complications. Comparison of test adjusted seroprevalence data with cumulative PCR-confirmed COVID-19 cases within the Kingston Metropolitan Area indicated that as many as 44.4 times more people were infected with SARS-CoV-2 than identified with PCR testing. These findings provide the first evidence for the extent of SARS-CoV-2 infections in Jamaica and will inform future SARS-CoV-2 testing strategies.

Keywords: SARS-CoV-2, seroprevalence, antibody test, pregnancy, Jamaica 23 24 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted February 11, 2021. ; https://doi.org/10.1101/2021.02.08.21251367 doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted February 11, 2021. ; https://doi.org/10.1101/2021.02.08.21251367 doi: medRxiv preprint Abstract 31 SARS-CoV-2 seroprevalence in an antenatal population in Kingston, Jamaica was assessed for 32 September-November 2020 in a repeated cross-sectional study using the Abbott Architect 33 SARS-CoV-2 IgG assay. After adjusting for test performance, seroprevalence was 6.9% for 34 September, 16.9% for October, and 24.0% for November. Of the 37 pregnant women testing 35 SARS-CoV-2 IgG positive, only 3 were symptomatic. One symptomatic woman testing SARS-36

CoV-2 IgG positive had multiple co-morbidities and succumbed to COVID-19 pneumonia. Up to 37 January 31, 2021, 8 women identified as SARS-CoV-2 IgG positive delivered, all without 38 complications. Comparison of test adjusted seroprevalence data with cumulative PCR-confirmed 39 COVID-19 cases within the Kingston Metropolitan Area indicated that as many as 44.4 times 40 more people were infected with SARS-CoV-2 than identified with PCR testing. These findings 41 provide the first evidence for the extent of SARS-CoV-2 infections in Jamaica and will inform 42 future SARS-CoV-2 testing strategies. 43 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted February 11, 2021. ; https://doi.org/10.1101/2021.02.08.21251367 doi: medRxiv preprint 4 The first confirmed COVID-19 cases in the Caribbean occurred in March 2020, with the first 44 confirmed case of COVID-19 in Jamaica occurring on March 10, 2020. 1 Subsequent to the 45 introduction of SARS-CoV-2 in Jamaica, governmental restrictions were imposed that included 46 school closures (March 13, 2020), closure of international borders (March 21, 2020), and 47 implementation of daily island-wide curfews (April 1, 2020). Restrictions were eased on June 1, 48 2020 to reopen international borders, but up to January 2021 most schools have remained closed 49 (virtual schooling) and island-wide curfews remain in effect. Up to August 2020, confirmed 50 cases of COVID-19 in Jamaica remained below 1,000 and only 10 deaths were reported for the 51 entire population of approximately 2.7 million people. Several weeks after the Emancipation Day 52 (August 1, 2020) and Independence Day (August 6, 2020) holidays COVID-19 PCR-confirmed 53 cases increased rapidly, followed by increased COVID-19 deaths, and on August 30, 2020 the 54 Government of Jamaica declared COVID-19 community transmission. Up to January 31, 2021 55 there have been 15,973 confirmed COVID-19 cases and 353 deaths in Jamaica. 56

Although it is clear that SARS-CoV-2 community transmission in Jamaica has led to a great 57 increase in COVID-19 cases and deaths, it remains unknown as to the extent of transmission, as 58 even in the most resourced countries most cases are not identified. 2,3 SARS-CoV-2 59 seroprevalence studies can determine the extent of transmission within a population that can 60 inform the public health response. This information can indicate whether the amount of testing is 61 adequate and also informs transmission dynamics due to persons likely having some degree of 62 immunity that have been infected recently. 4 63 Samples collected from pregnant women seeking routine antenatal care are commonly used to 64 provide prevalence estimates of disease, as is done in some sub-Saharan African countries to 65 determine HIV prevalence. 5 More recently antenatal samples have been examined to provide a 66 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted February 11, 2021. ; https://doi.org/10.1101/2021.02.08.21251367 doi: medRxiv preprint prevalence estimate of SARS-CoV-2 infections. 6 Residual serum samples from pregnant women 67 attending antenatal clinics provide a valuable tool to determine the extent of SARS-CoV-2 68 infections in a population and are also a unique population due to possible risks of infectious 69 disease not only to the pregnant woman but also to the fetus. Although SARS-CoV-2-infected 70 pregnant women are commonly asymptomatic, 7-9 symptomatic pregnant women were recently 71

shown to be at increased risk of severe disease. 10 Thus far, studies of COVID-19 in pregnancy 72

show that poor outcomes are uncommon for both the mother and child, and vertical transmission 73 appears to be rare. been reported previously for the Abbott Architect SARS-CoV-2 IgG assay. 15-18 Crude 128 seroprevalences were adjusted for test performance alone and with adjustment for seroreversion 129 as described in the supplementary methods (Table 1) . Adjusting for test performance only 130 resulted in SARS-CoV-2 prevalences of 6.9% in September, 16.9% in October, and 24.0% in 131

November. Adjusting for both test performance and seroreversion showed SARS-CoV-2 132 prevalences of 6.9% in September, 18.2% in October, and 28.5% in November. 133

Our data identifies an underappreciated prevalence of SARS-CoV-2 infections among 134 antenatal women in the Kingston Metropolitan Area and provides an approximation of the extent 135 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CoV-2 PCR confirmed cases and those identified by antibody in this study highlights the 145 difficulty of identifying SARS-CoV-2 cases with PCR testing, particularly in a resource-limited 146 setting, and the utility of SARS-CoV-2 antibody testing to approximate population exposure. 147

Although our study provides the first assessment of the extent of SARS-CoV-2 infections in 148 Jamaica, SARS-CoV-2 has not spread throughout the island uniformly, limiting our ability to 149 draw conclusions about the extent of virus infections throughout Jamaica. Future studies 150 examining additional populations in Jamaica will be informative to identify the extent of SARS-151

CoV-2 circulation across the island. 152

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) Jamaica, E-mail: willem.mulder@uwimona.edu.jm 175 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted February 11, 2021. ; https://doi.org/10.1101/2021.02.08.21251367 doi: medRxiv preprint

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Virol 133:104663. 225 226 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted February 11, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted February 11, 2021. ; https://doi.org/10.1101/2021.02.08.21251367 doi: medRxiv preprint 15 

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted February 11, 2021. ; https://doi.org/10.1101/2021.02.08.21251367 doi: medRxiv preprint