BMJ Global Health (Aug 2022)
SARS-CoV-2 infection in Africa: a systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021
- ,
- Anthony Nardone,
- Jesse Papenburg,
- Marta Valenciano,
- Hude Quan,
- Maria D Van Kerkhove,
- Didier K Ekouevi,
- Tyler Williamson,
- Shobna Sawry,
- Xiaomeng Ma,
- Ambrose Talisuna,
- Thierno Balde,
- Ines Vigan-Womas,
- David Buckeridge,
- Halidou Tinto,
- Michael Liu,
- Tingting Yan,
- Matthew P Cheng,
- Joseph Okeibunor,
- Samiratou Ouedraogo,
- Francine Ntoumi,
- Cheikh Talla,
- David Clifton,
- Tiffany G Harris,
- Ayôla A Adegnika,
- Lorenzo Subissi,
- Laura Steinhardt,
- Niklas Bobrovitz,
- Isidore T Traore,
- Timothy G Evans,
- Judy Chen,
- Cedric P Yansouni,
- Cheryl Cohen,
- Jason M Mwenda,
- Nsenga Ngoy,
- Hannah C Lewis,
- Harriet Ware,
- Mairead Whelan,
- Zihan Li,
- Brianna Cheng,
- Kim Noel,
- Christian Cao,
- Mercedes Yanes-Lane,
- Belinda L Herring,
- Rahul K Arora,
- Isabel Bergeri,
- Rafiou Adamou,
- Samira Z Assoumou,
- Rosemary A Audu,
- Jacob S Barnor,
- Enyew Birru,
- Henry K Bosa,
- Emily L Boucher,
- Annie Chauma-Mwale,
- Tienhan S Dabakuyo-Yonli,
- Gabriel Deveaux,
- Boly Diop,
- Titus H Divala,
- Emily K Dokubo,
- Irene O Donkor,
- Claire Donnici,
- Nathan Duarte,
- Natalie A Duarte,
- Paulin N Essone,
- Lee Fairlie,
- Ousmane Faye,
- Anne von Gottberg,
- Natasha Ilincic,
- Elsie A Ilori,
- Jackie Kleynhans,
- Dayoung Kim,
- Olatunji M Kolawole,
- Jambo C Kondwani,
- Emma Loeschnik,
- Sheila Makiala-Mandanda,
- Alexandre Manirakiza,
- Pinyi N Mawien,
- Portia C Mutevedzi,
- Edgard B Ngoungou,
- Eric M Osoro,
- Sandrine L Oyegue,
- Sara Perlman-Arrow,
- Hannah P Rahim,
- Karampreet Sachathep,
- Mitchell Segal,
- Anabel Selemon,
- Judith Shang,
- Joel F Djoba Siawaya,
- Kristen A Stafford,
- Joe A Theu,
- Caseng Zhang
Affiliations
- 3International Collaboration
- Anthony Nardone
- 2 Public Health England, Health Improvement Directorate, London, UK
- Jesse Papenburg
- McGill University Health Centre, Montreal, Quebec, Canada
- Marta Valenciano
- EpiConcept, Paris, France
- Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maria D Van Kerkhove
- 5 Health Emergencies Programme, WHO, Geneva, Switzerland
- Didier K Ekouevi
- 9 Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lome, Togo
- Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Shobna Sawry
- 1 Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Xiaomeng Ma
- 2 Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Ambrose Talisuna
- Emergency Preparedness, WHO Regional Office for Africa, Brazzaville, Congo
- Thierno Balde
- 1 World Health Organization Regional Office for Africa, Brazzaville, Congo
- Ines Vigan-Womas
- 10 Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- David Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
- Michael Liu
- Department of Internal Medicine, Brown University, Providence, Rhode Island, USA
- Tingting Yan
- State Key Laboratory for Oncogenes and Related Genes; Key Laboratory of Gastroenterology & Hepatology, Ministry of Health; Division of Gastroenterology and Hepatology; Shanghai Cancer Institute; Shanghai Institute of Digestive Disease, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Matthew P Cheng
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Joseph Okeibunor
- Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
- Samiratou Ouedraogo
- McGill University, Montreal, Quebec, Canada
- Francine Ntoumi
- 1Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of the Congo
- Cheikh Talla
- 2Epidemiology Unit, Institut Pasteur of Dakar, Senegal
- David Clifton
- 4 Institute of Biomedical Engineering, University of Oxford, Oxford, UK
- Tiffany G Harris
- 1Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York, USA
- Ayôla A Adegnika
- 1Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Lorenzo Subissi
- 10 Section of Epidemic Intelligence and Response, European Centre for Disease Prevention and Control, Stockholm, Stockholms Län, Sweden
- Laura Steinhardt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Niklas Bobrovitz
- 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
- Isidore T Traore
- 1Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso
- Timothy G Evans
- assistant director general assistant director general
- Judy Chen
- General practitioner
- Cedric P Yansouni
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Québec, Canada
- Cheryl Cohen
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- Jason M Mwenda
- 9WHO Regional Office for Africa, Republic of Congo, Cite du D’Joue, Brazzaville, Congo
- Nsenga Ngoy
- Emergency Preparedness and Response Cluster, WHO Regional Office for Africa, Brazzaville, Congo
- Hannah C Lewis
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
- Harriet Ware
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Mairead Whelan
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Zihan Li
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
- Brianna Cheng
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
- Kim Noel
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Christian Cao
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Mercedes Yanes-Lane
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Belinda L Herring
- Emergency Preparedness and Response Programme, World Health Organization, Regional Office for Africa, Brazzaville, Congo
- Rahul K Arora
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Isabel Bergeri
- WHO Health Emergencies Programme, World Health Organization, Geneva, Switzerland
- Rafiou Adamou
- Samira Z Assoumou
- Rosemary A Audu
- Jacob S Barnor
- Enyew Birru
- Henry K Bosa
- Emily L Boucher
- Annie Chauma-Mwale
- Tienhan S Dabakuyo-Yonli
- Gabriel Deveaux
- Boly Diop
- Titus H Divala
- Emily K Dokubo
- Irene O Donkor
- Claire Donnici
- Nathan Duarte
- Natalie A Duarte
- Paulin N Essone
- Lee Fairlie
- Ousmane Faye
- Anne von Gottberg
- Natasha Ilincic
- Elsie A Ilori
- Jackie Kleynhans
- Dayoung Kim
- Olatunji M Kolawole
- Jambo C Kondwani
- Emma Loeschnik
- Sheila Makiala-Mandanda
- Alexandre Manirakiza
- Pinyi N Mawien
- Portia C Mutevedzi
- Edgard B Ngoungou
- Eric M Osoro
- Sandrine L Oyegue
- Sara Perlman-Arrow
- Hannah P Rahim
- Karampreet Sachathep
- Mitchell Segal
- Anabel Selemon
- Judith Shang
- Joel F Djoba Siawaya
- Kristen A Stafford
- Joe A Theu
- Caseng Zhang
- DOI
- https://doi.org/10.1136/bmjgh-2022-008793
- Journal volume & issue
-
Vol. 7,
no. 8
Abstract
Introduction Estimating COVID-19 cumulative incidence in Africa remains problematic due to challenges in contact tracing, routine surveillance systems and laboratory testing capacities and strategies. We undertook a meta-analysis of population-based seroprevalence studies to estimate SARS-CoV-2 seroprevalence in Africa to inform evidence-based decision making on public health and social measures (PHSM) and vaccine strategy.Methods We searched for seroprevalence studies conducted in Africa published 1 January 2020–30 December 2021 in Medline, Embase, Web of Science and Europe PMC (preprints), grey literature, media releases and early results from WHO Unity studies. All studies were screened, extracted, assessed for risk of bias and evaluated for alignment with the WHO Unity seroprevalence protocol. We conducted descriptive analyses of seroprevalence and meta-analysed seroprevalence differences by demographic groups, place and time. We estimated the extent of undetected infections by comparing seroprevalence and cumulative incidence of confirmed cases reported to WHO.PROSPERO: CRD42020183634.Results We identified 56 full texts or early results, reporting 153 distinct seroprevalence studies in Africa. Of these, 97 (63%) were low/moderate risk of bias studies. SARS-CoV-2 seroprevalence rose from 3.0% (95% CI 1.0% to 9.2%) in April–June 2020 to 65.1% (95% CI 56.3% to 73.0%) in July–September 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 100:1, ranging from 18:1 to 954:1) and steady over time. Seroprevalence was highly heterogeneous both within countries—urban versus rural (lower seroprevalence for rural geographic areas), children versus adults (children aged 0–9 years had the lowest seroprevalence)—and between countries and African subregions.Conclusion We report high seroprevalence in Africa suggesting greater population exposure to SARS-CoV-2 and potential protection against COVID-19 severe disease than indicated by surveillance data. As seroprevalence was heterogeneous, targeted PHSM and vaccination strategies need to be tailored to local epidemiological situations.
