SARS-CoV-2 Seroprevalence in a Rural and Urban Household Cohort during First and Second Waves of Infections, South Africa, July 2020–March 2021
Jackie Kleynhans, Stefano Tempia, Nicole Wolter, Anne von Gottberg, Jinal N. Bhiman, Amelia Buys, Jocelyn Moyes, Meredith McMorrow, Kathleen Kahn, F. Xavier Gómez‐Olivé, Stephen Tollman, Neil Martinson, Floidy Wafawanaka, Limakatso Lebina, Jacques du Toit, Waasila Jassat, Mzimasi Neti, Marieke Brauer, Cheryl Cohen, for the PHIRST-C Group1
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections may be underestimated because of limited access to testing. We measured SARS-CoV-2 seroprevalence in South Africa every 2 months during July 2020-March 2021 in randomly selected household cohorts in 2 communities. We compared seroprevalence to reported laboratory-confirmed infections, hospitalizations, and deaths to calculate infection-case, infection-hospitalization, and infection-fatality ratios in 2 waves of infection. Post-second wave seroprevalence ranged from 18% in the rural community children <5 years of age, to 59% in urban community adults 35-59 years of age. The second wave saw a shift in age distribution of case-patients in the urban community (from persons 35-59 years of age to persons at the extremes of age), higher attack rates in the rural community, and a higher infection-fatality ratio in the urban community. Approximately 95% of SARS-CoV-2 infections were not reported to national surveillance.