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SARS-CoV-2 Seroprevalence in a Rural and Urban Household Cohort during First and Second Waves of Infections, South Africa, July 2020–March 2021
Emerging Infectious Diseases  (IF6.883),  Pub Date : 2021-09-03, DOI: 10.3201/eid2712.211465
Jackie Kleynhans, Stefano Tempia, Nicole Wolter, Anne von Gottberg, Jinal N. Bhiman, Amelia Buys, Jocelyn Moyes, Meredith L. McMorrow, Kathleen Kahn, F. Xavier Gómez-Olivé, Stephen Tollman, Neil A. Martinson, Floidy Wafawanaka, Limakatso Lebina, Jacques du Toit, Waasila Jassat, Mzimasi Neti, Marieke Brauer, Cheryl Cohen

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.