Journal Article

Relative contribution of COVID-19 vaccination and SARS-CoV-2 infection to population-level seroprevalence of SARS-CoV-2 spike antibodies in a large integrated health system

Quesenberry, Charles P., Corley, Douglas A., Elkin, Eric P., Habel, Laurel A., Schapiro, Jeffery M., Amsden, Laura B., Munneke, Julie R., Saelee, Gina N., Ergas, Isaac J., Chervo, Tyler C., Skarbinski, Jacek, Flores, Monica, Kushi, Lawrence H., Valice, Emily, Hsiao, Crystal A., Nugent, Joshua R.

2024

Overview

Understanding the relative contributions of SARS-CoV-2 infection-induced and vaccine-induced seroprevalence is key to measuring overall population-level seroprevalence and help guide policy decisions. Using a series of six population-based cross-sectional surveys conducted among persons aged ≥7 years in a large health system with over 4.5 million members between May 2021 and April 2022, we combined data from the electronic health record (EHR), an electronic survey and SARS-CoV-2 spike antibody binding assay, to assess the relative contributions of infection and vaccination to population-level SARS-CoV-2 seroprevalence. EHR and survey data were incorporated to determine spike antibody positivity due to SARS-CoV-2 infection and COVID-19 vaccination. We used sampling and non-response weighting to create population-level estimates. We enrolled 4,319 persons over six recruitment waves. SARS-CoV-2 spike antibody seroprevalence increased from 83.3% (CI 77.0-88.9) in May 2021 to 93.5% (CI 89.5-97.5) in April 2022. By April 2022, 68.5% (CI 61.9-74.3) of the population was seropositive from COVID-19 vaccination only, 13.9% (10.7-17.9) from COVID-19 vaccination and prior diagnosed SARS-CoV-2 infection, 8.2% (CI 4.5-14.5) from prior diagnosed SARS-CoV-2 infection only and 2.9% (CI 1.1-7.6) from prior undiagnosed SARS-CoV-2 infection only. We found high agreement (≥97%) between EHR and survey data for ascertaining COVID-19 vaccination and SARS-CoV-2 infection status. By April 2022, 93.5% of persons had detectable SARS-CoV-2 spike antibody, predominantly from COVID-19 vaccination. In this highly vaccinated population and over 18 months into the pandemic, SARS-CoV-2 infection without COVID-19 vaccination was a small contributor to overall population-level seroprevalence.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Age groups / Aged / Aged, 80 and over / Algorithms / Antibodies / Antibodies, Viral - blood / Antibodies, Viral - immunology / Biology and life sciences / Black people / Blood & organ donations / Body mass index / Child / Comorbidity / Computer and Information Sciences / COVID-19 / COVID-19 - epidemiology / COVID-19 - immunology / COVID-19 - prevention & control / COVID-19 vaccines / COVID-19 Vaccines - immunology / Cross-Sectional Studies / Demographics / Diabetes / Disease prevention / Electronic health records / Electronic medical records / Electronic records / Ethnicity / Female / Health care industry / Health care policy / Humans / Immunization / Infection / Infections / Male / Medical records / Medical research / Medicine and health sciences / Medicine, Experimental / Middle Aged / Pandemics / People and places / Polls & surveys / Population / SARS-CoV-2 - immunology / Seroepidemiologic Studies / Serology / Severe acute respiratory syndrome coronavirus 2 / Spike Glycoprotein, Coronavirus - immunology / Surveys / Vaccination / Vaccines / Viral diseases / Young Adult