Seroprevalence of SARS-CoV-2 antibodies in an entirely PCR sampled and quarantined community after a COVID-19 outbreak - the CoNAN study

Seroprevalence of SARS-CoV-2 antibodies in an entirely PCR-sampled and quarantined community after a COVID-19 outbreak - the CoNAN study

Sebastian Weis, Andre Scherag, Michael Baier, Michael Kiehntopf, Thomas Kamradt, Steffi Kolanos, Juliane Ankert, Stefan Gloeckner, Oliwia Makarewicz, Stefan Hagel, Christina Bahrs, Aurelia Kimmig, Hans Proquitte, Joel Guerra, Bettina Loeffler, Mathias W. Pletz

Background

Due to the substantial proportion of asymptomatic and mild courses many SARS-CoV-2 infections remain unreported. Therefore, assessment of seroprevalence may detect the real burden of disease. We aimed at determining and characterizing the rate of SARS-CoV-2 infections and the resulting immunity in a defined population. Methods: CoNAN is a population-based cohort study in the previously quarantined community Neustadt-am-Rennsteig, Germany six weeks after a SARS-CoV-2 outbreak with 49 cases identified by PCR screening of all 883 inhabitants. The primary objective of the study was to assess SARS-CoV-2 antibody seroconversion rate using six different IgG detecting immunoassays. Secondary objectives of the study were: i.) to determine the rate of seroconversion in children; ii.) to determine potential risk factors for symptomatic vs. asymptomatic Covid19 courses; iii.) to investigate the rate of virus persistence. Findings: We enrolled 626 participants (71% of the community population). All actual SARS-CoV-2 PCR tests were negative; while a total of 8.4% (52 of 620 tested) had antibodies against SARS-CoV-2 in at least two independent tests. Twenty of the antibody positive participants had previously a positive SARS-CoV-2 PCR. On the contrary, of those 38 participants with SARS-CoV-2 infection, only 20 (52.6%) were antibody positive. Interpretation: Several antibody tests conducted six weeks after an outbreak of SARS-CoV-2 did not detect all previously PCR-positive tested individuals. Cautious evaluation of antibody testing strategies to assess immunity against the infection is warranted.

Competing Interest Statement SW received speakers fees from MSD and Infectopharm. SH received speakers fees from Pfizer, MSD and Astra Zeneca. TK speakers fees from Roche MP has participated in international advisory boards from Pfizer, Novartis, Basilea and Cubist and received speakers fees from the same companies. CB has participated in advisory boards from GSK and received speakers fees from Pfizer. All other authors do not report any conflict of interest

Clinical Trial DRKS00022416 (submitted)

Funding Statement CoNAN was funded by the Thuringian Ministry for Economic Affairs, Science and Digital Society (TMWWDG).

Study Overview

Study nameSeroprevalence of SARS-CoV-2 antibodies in an entirely PCR sampled and quarantined community after a COVID-19 outbreak - the CoNAN study
ProjectCoNAN
Sources of Monetary or Material SupportThuringian Ministry for Economic Affairs, Science and Digital Society (TMWWDG)
Region(s)Germany
Location(s)Neustadt am Rennsteig
Primary outcomeSeroprevalence for SARS-CoV-2
Research QuestionThe primary objective was to determine the SARS-CoV-2 antibody status (sero-conversion rate) of the population of Neustadt-am-Rennsteig with a defined distance to the end of the quarantine period. SARS-CoV-2 antibody status was defined as ”positive” if participants had a positive test result in ≥ 2 of the six antibody tests (details below); otherwise participants were classified as “negative”. The secondary objectives of the study were i.) to determine the rate of seroconversion in children; ii.) to determine potential risk factors for symptomatic vs. asymptomatic Covid19 courses; iii.) to investigate the rate of virus persistence (as part of future follow-up assessments).
Diagnostic test(s) used
  • EDI Novel Coronavirus SARS-CoV-2 IgG ELISA kit , Epitope Diagnostics Inc. (San Diego, USA)
  • SARS-CoV-2 IgG ELISA kit , Euroimmun (Lübeck, Germany)
  • SARS-CoV-2 S1/S2 IgG CLIA kit , DiaSorin (Saluggia, Italy)
  • 2019-nCoV IgG kit , Snibe Co., Ltd. (Shenzhen, China)
  • SARS-CoV-2 IgG CMIA kit , Abbott (Chicago, USA)
  • Elecsys Anti-SARS-CoV-2 kit , Roche (Basel, Switzerland)
Antibody class(es)IgG, IgM
Study population N626
Total population in the area883
Primary outcomeSeroprevalence for SARS-CoV-2
Principal InvestigatorMathias W. Pletz and Sebastian Weis , Institute for Infectious Diseases and Infection Control, Jena University Hospital (07747 Jena, Germany) , Sebastian.Weis@med.uni-jena.de
Team members
  • Mathias W. Pletz, Principal Investigator, Institute for Infectious Diseases and Infection Control, Jena University Hospital (07747 Jena, Germany)
  • Sebastian Weis, Principal Investigator, Institute for Infectious Diseases and Infection Control, Jena University Hospital (07747 Jena, Germany)
WWWhttps://www.medrxiv.org/content/10.1101/2020.07.15.20154112v1
Period2020-05 till 2020-05
Study start2020-05
First results expected2020-07

Study metadata

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   "abbreviation": "CoNAN",
   "draft": false,
   "iscjklanguage": false,
   "lastmod": "2020-07-22T16:10:00+02:00",
   "logo_url": "/img/uploads/jena-logo.png",
   "project_url": "https://www.medrxiv.org/content/10.1101/2020.07.15.20154112v1",
   "recruitment": {
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       "Germany"
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     "group": "general population",
     "location": [
       {
         "latitude": 50.5970644,
         "longitude": 10.8989878,
         "place_name": "Neustadt am Rennsteig"
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     "type": "exploratory population-based cohort study"
   },
   "results": {
     "doi_preprint": "10.1101/2020.07.15.20154112"
   },
   "study_dates": {
     "sample_end": "2020-05",
     "sample_start": "2020-05",
     "study_first_results": "2020-07",
     "study_start": "2020-05"
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   "study_info": {
     "diagnostic_test": [
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         "address": "San Diego, USA",
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         "company": "Epitope Diagnostics Inc.",
         "product": "EDI Novel Coronavirus SARS-CoV-2 IgG ELISA kit"
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       {
         "address": "Lübeck, Germany",
         "antibody_classes": [
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         "product": "SARS-CoV-2 IgG ELISA kit"
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       {
         "address": "Saluggia, Italy",
         "antibody_classes": [
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         "company": "DiaSorin",
         "product": "SARS-CoV-2 S1/S2 IgG CLIA kit"
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       {
         "address": "Shenzhen, China",
         "antibody_classes": [
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         "company": "Snibe Co., Ltd.",
         "product": "2019-nCoV IgG kit"
       },
       {
         "address": "Chicago, USA",
         "antibody_classes": [
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         ],
         "company": "Abbott",
         "product": "SARS-CoV-2 IgG CMIA kit"
       },
       {
         "address": "Basel, Switzerland",
         "antibody_classes": [
           "IgG"
         ],
         "company": "Roche",
         "product": "Elecsys Anti-SARS-CoV-2 kit"
       }
     ],
     "funding_sources": "Thuringian Ministry for Economic Affairs, Science and Digital Society (TMWWDG)",
     "primary_outcomes": "Seroprevalence for SARS-CoV-2",
     "research_question": "The primary objective was to determine the SARS-CoV-2 antibody status (sero-conversion rate) of the population of Neustadt-am-Rennsteig with a defined distance to the end of the quarantine period. SARS-CoV-2 antibody status was defined as ”positive” if participants had a positive test result in ≥ 2 of the six antibody tests (details below); otherwise participants were classified as “negative”. The secondary objectives of the study were i.) to determine the rate of seroconversion in children; ii.) to determine potential risk factors for symptomatic vs. asymptomatic Covid19 courses; iii.) to investigate the rate of virus persistence (as part of future follow-up assessments).",
     "tested_antibody_classes": [
       "IgG",
       "IgM"
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   },
   "study_numbers": {
     "population": 883,
     "study_population": 626
   },
   "study_pi": {
     "email": "Sebastian.Weis@med.uni-jena.de",
     "institution": "Institute for Infectious Diseases and Infection Control, Jena University Hospital (07747 Jena, Germany)",
     "name": "Mathias W. Pletz and Sebastian Weis"
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   "team": [
     {
       "email": "Mathias.Pletz@med.uni-jena.de",
       "institution": "Institute for Infectious Diseases and Infection Control, Jena University Hospital (07747 Jena, Germany)",
       "name": "Mathias W. Pletz",
       "position": "Head of Institute",
       "role": "Principal Investigator",
       "title": "Prof. Dr. med."
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     {
       "email": "Sebastian.Weis@med.uni-jena.de",
       "institution": "Institute for Infectious Diseases and Infection Control, Jena University Hospital (07747 Jena, Germany)",
       "name": "Sebastian Weis",
       "position": "Attending Physician",
       "role": "Principal Investigator",
       "title": "OA PD Dr. med."
     }
   ],
   "title": "Seroprevalence of SARS-CoV-2 antibodies in an entirely PCR sampled and quarantined community after a COVID-19 outbreak - the CoNAN study"
 }