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Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study.
Lancet Microbe. 2020 Jul; 1(3):e111-e118.LM

Abstract

Background

The role of subclinical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in perpetuating the COVID-19 pandemic is unknown because population seroprevalence data are absent. We aimed to establish the sensitivity and specificity of our enzyme immunoassay and microneutralisation assay, and the seroprevalence of SARS-CoV-2 in Hong Kong before and after the pandemic, as well as in Hong Kong residents evacuated from Hubei province, China.

Methods

We did a multicohort study in a hospital and university in Hong Kong. We evaluated the sensitivity of our enzyme immunoassay and microneutralisation assay with RT-PCR data from patients positive for SARS-CoV-2 and the specificity of our enzyme immunoassay and microneutralisation assay with archived serum samples collected before 2019. We compared the seropositivity of the general population of Hong Kong before and after the pandemic had begun, and determined the seropositivity of Hong Kong residents evacuated from Hubei province, China, in March, 2020.

Findings

Between Feb 26 and March 18, 2020, we assessed RT-PCR samples from 45 patients who had recovered from COVID-19 to establish the sensitivity of our enzyme immunoassay and microneutralisation assay. To establish the specificity of these assays, we retrieved archived serum. The sensitivity was 91·1% (41 of 45 [95% CI 78·8-97·5]) for the microneutralisation assay, 57·8% (26 of 45 [42·2-72·3]) for anti-nucleoprotein IgG, 66·7% (30 of 45 [51·1-80·0]) for anti-spike protein receptor binding domain (RBD) IgG, and 73·3% (33 of 45 [58·1-85·4]) for enzyme immunoassay (either positive for anti-nucleoprotein or anti-RBD IgG). The specificity was 100% (152 of 152 [95% CI 97·6-100·0]) for both the enzyme immunoassay and microneutralisation assay. Among the Hong Kong general population, 53 (2·7%) of 1938 were enzyme immunoassay positive, but of those who were positive, all 53 were microneutralisation negative, and no significant increase was seen in the seroprevalence between April 12, 2018, and Feb 13, 2020. Among asymptomatic Hubei returnees, 17 (4%) of 452 were seropositive with the enzyme immunoassay or the microneutralisation assay, with 15 (88%) of 17 seropositive with the microneutralisation assay, and two familial clusters were identified.

Interpretation

Our serological data suggest that SARS-CoV-2 is a new emerging virus. The seropositivity rate in Hubei returnees indicates that RT-PCR-confirmed patients only represent a small proportion of the total number of cases. The low seroprevalence suggests that most of the Hong Kong and Hubei population remain susceptible to COVID-19. Future waves of the outbreak are inevitable without a vaccine or antiviral prophylaxis. The role of age-related cross reactive non-neutralising antibodies in the pathogenesis of COVID-19 warrants further investigation.

Funding

Richard and Carol Yu, May Tam Mak Mei Yin, Shaw Foundation (Hong Kong), Michael Tong, Marina Lee, and the Government Consultancy Service (see acknowledgments for full list).

Authors+Show Affiliations

State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China. Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China. Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China.Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China.Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China.State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China. Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China. Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.Professional Development and Quality Assurance Service, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China.Quality & Safety Division (Infection, Emergency, and Contingency), Hospital Authority, Hong Kong Special Administrative Region, China.State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Medicine, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China.State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, Pokfulam, The University of Hong Kong, Hong Kong Special Administrative Region, China. Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China. Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33230504

Citation

To, Kelvin Kai-Wang, et al. "Seroprevalence of SARS-CoV-2 in Hong Kong and in Residents Evacuated From Hubei Province, China: a Multicohort Study." The Lancet. Microbe, vol. 1, no. 3, 2020, pp. e111-e118.
To KK, Cheng VC, Cai JP, et al. Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study. Lancet Microbe. 2020;1(3):e111-e118.
To, K. K., Cheng, V. C., Cai, J. P., Chan, K. H., Chen, L. L., Wong, L. H., Choi, C. Y., Fong, C. H., Ng, A. C., Lu, L., Luo, C. T., Situ, J., Chung, T. W., Wong, S. C., Kwan, G. S., Sridhar, S., Chan, J. F., Fan, C. Y., Chuang, V. W. M., ... Yuen, K. Y. (2020). Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study. The Lancet. Microbe, 1(3), e111-e118. https://doi.org/10.1016/S2666-5247(20)30053-7
To KK, et al. Seroprevalence of SARS-CoV-2 in Hong Kong and in Residents Evacuated From Hubei Province, China: a Multicohort Study. Lancet Microbe. 2020;1(3):e111-e118. PubMed PMID: 33230504.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Seroprevalence of SARS-CoV-2 in Hong Kong and in residents evacuated from Hubei province, China: a multicohort study. AU - To,Kelvin Kai-Wang, AU - Cheng,Vincent Chi-Chung, AU - Cai,Jian-Piao, AU - Chan,Kwok-Hung, AU - Chen,Lin-Lei, AU - Wong,Lok-Hin, AU - Choi,Charlotte Yee-Ki, AU - Fong,Carol Ho-Yan, AU - Ng,Anthony Chin-Ki, AU - Lu,Lu, AU - Luo,Cui-Ting, AU - Situ,Jianwen, AU - Chung,Tom Wai-Hin, AU - Wong,Shuk-Ching, AU - Kwan,Grace See-Wai, AU - Sridhar,Siddharth, AU - Chan,Jasper Fuk-Woo, AU - Fan,Cecilia Yuen-Man, AU - Chuang,Vivien W M, AU - Kok,Kin-Hang, AU - Hung,Ivan Fan-Ngai, AU - Yuen,Kwok-Yung, Y1 - 2020/06/03/ PY - 2020/11/24/entrez PY - 2020/11/25/pubmed PY - 2020/11/25/medline SP - e111 EP - e118 JF - The Lancet. Microbe JO - Lancet Microbe VL - 1 IS - 3 N2 - Background: The role of subclinical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in perpetuating the COVID-19 pandemic is unknown because population seroprevalence data are absent. We aimed to establish the sensitivity and specificity of our enzyme immunoassay and microneutralisation assay, and the seroprevalence of SARS-CoV-2 in Hong Kong before and after the pandemic, as well as in Hong Kong residents evacuated from Hubei province, China. Methods: We did a multicohort study in a hospital and university in Hong Kong. We evaluated the sensitivity of our enzyme immunoassay and microneutralisation assay with RT-PCR data from patients positive for SARS-CoV-2 and the specificity of our enzyme immunoassay and microneutralisation assay with archived serum samples collected before 2019. We compared the seropositivity of the general population of Hong Kong before and after the pandemic had begun, and determined the seropositivity of Hong Kong residents evacuated from Hubei province, China, in March, 2020. Findings: Between Feb 26 and March 18, 2020, we assessed RT-PCR samples from 45 patients who had recovered from COVID-19 to establish the sensitivity of our enzyme immunoassay and microneutralisation assay. To establish the specificity of these assays, we retrieved archived serum. The sensitivity was 91·1% (41 of 45 [95% CI 78·8-97·5]) for the microneutralisation assay, 57·8% (26 of 45 [42·2-72·3]) for anti-nucleoprotein IgG, 66·7% (30 of 45 [51·1-80·0]) for anti-spike protein receptor binding domain (RBD) IgG, and 73·3% (33 of 45 [58·1-85·4]) for enzyme immunoassay (either positive for anti-nucleoprotein or anti-RBD IgG). The specificity was 100% (152 of 152 [95% CI 97·6-100·0]) for both the enzyme immunoassay and microneutralisation assay. Among the Hong Kong general population, 53 (2·7%) of 1938 were enzyme immunoassay positive, but of those who were positive, all 53 were microneutralisation negative, and no significant increase was seen in the seroprevalence between April 12, 2018, and Feb 13, 2020. Among asymptomatic Hubei returnees, 17 (4%) of 452 were seropositive with the enzyme immunoassay or the microneutralisation assay, with 15 (88%) of 17 seropositive with the microneutralisation assay, and two familial clusters were identified. Interpretation: Our serological data suggest that SARS-CoV-2 is a new emerging virus. The seropositivity rate in Hubei returnees indicates that RT-PCR-confirmed patients only represent a small proportion of the total number of cases. The low seroprevalence suggests that most of the Hong Kong and Hubei population remain susceptible to COVID-19. Future waves of the outbreak are inevitable without a vaccine or antiviral prophylaxis. The role of age-related cross reactive non-neutralising antibodies in the pathogenesis of COVID-19 warrants further investigation. Funding: Richard and Carol Yu, May Tam Mak Mei Yin, Shaw Foundation (Hong Kong), Michael Tong, Marina Lee, and the Government Consultancy Service (see acknowledgments for full list). SN - 2666-5247 UR - https://www.unboundmedicine.com/medline/citation/33230504/Seroprevalence_of_SARS_CoV_2_in_Hong_Kong_and_in_residents_evacuated_from_Hubei_province_China:_a_multicohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2666-5247(20)30053-7 DB - PRIME DP - Unbound Medicine ER -
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