Title
SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru
Date Issued
01 April 2021
Access level
open access
Resource Type
journal article
Publisher(s)
Lancet Publishing Group
Abstract
Background: Worldwide, Peru has one of the highest infection fatality rates of COVID-19, and its capital city, Lima, accumulates roughly 50% of diagnosed cases. Despite surveillance efforts to assess the extent of the pandemic, reported cases and deaths only capture a fraction of its impact due to COVID-19′s broad clinical spectrum. This study aimed to estimate the seroprevalence of SARS-CoV-2 in Lima, stratified by age, sex, region, socioeconomic status (SES), overcrowding, and symptoms. Methods: We conducted a multi-stage, population-based serosurvey in Lima, between June 28th and July 9th, 2020, after 115 days of the index case and after the first peak cases. We collected whole blood samples by finger-prick and applied a structured questionnaire. A point-of-care rapid serological test assessed IgM and IgG antibodies against SARS-CoV-2. Seroprevalence estimates were adjusted by sampling weights and test performance. Additionally, we performed RT-PCR molecular assays to seronegatives and estimated the infection prevalence. Findings: We enrolled 3212 participants from 797 households and 241 sample clusters from Lima in the analysis. The SARS-CoV-2 seroprevalence was 20·8% (95%CI 17·2–23·5), and the prevalence was 25·2% (95%CI 22·5–28·2). Seroprevalence was equally distributed by sex (aPR=0·96 [95%CI 0·85–1·09, p = 0·547]) and across all age groups, including ≥60 versus ≤11 years old (aPR=0·96 [95%CI 0·73–1·27, p = 0·783]). A gradual decrease in SES was associated with higher seroprevalence (aPR=3·41 [95%CI 1·90–6·12, p<0·001] in low SES). Also, a gradual increase in the overcrowding index was associated with higher seroprevalence (aPR=1·99 [95%CI 1·41–2·81, p<0·001] in the fourth quartile). Seroprevalence was also associated with contact with a suspected or confirmed COVID-19 case, whether a household member (48·9%, aPR=2·67 [95%CI 2·06–3·47, p<0·001]), other family members (27·3%, aPR=1·66 [95%CI 1·15–2·40, p = 0·008]) or a workmate (34·1%, aPR=2·26 [95%CI 1·53–3·35, p<0·001]). More than half of seropositive participants reported never having had symptoms (56·1%, 95% CI 49·7–62·3). Interpretation: This first estimate of SARS-CoV-2 seroprevalence in Lima shows an intense transmission scenario, despite the government's numerous interventions early established. Susceptibles across age groups show that physical distancing interventions must not be relaxed. SES and overcrowding households are associated with seroprevalence. This study highlights the importance of considering the existing social inequalities for implementing the response to control transmission in low- and middle-income countries.
Volume
34
Language
English
OCDE Knowledge area
Epidemiología Salud pública, Salud ambiental
Scopus EID
2-s2.0-85111260504
Source
EClinicalMedicine
ISSN of the container
25895370
Sponsor(s)
This research was supported by the Peruvian Ministry of Health's regular budget as part of the epidemiological surveillance activities. The funding source did not have any role in the study design, collection, analysis, or interpretation of the data, the writing of this manuscript, or the decision to submit it for publication. We thank DIRIS Lima Este, Lima Norte, Lima Sur, Lima Centro, and DIRESA Callao to participate in the field data acquisition activities in their respective regions and all the work done by the rapid response teams. We thank all the logistical and administrative staff at CDC Peru, who supported the study's operational processes. We are grateful to the Geo Peru Team, who kindly shared the data dictionary of their hosted datasets. A list of Working Group members is available in the appendix.
Sources of information: Directorio de Producción Científica Scopus