Seroprevalence of SARS-CoV-2 in Brazil: A systematic review and meta-analysis

Figueiredo, Gerusa Maria; Tengan, Fátima Mitiko; Campos, Sergio Roberto; Luna, Expedito José

doi:10.1016/j.clinsp.2023.100233

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Sumário

Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100233 copy

Seroprevalence of SARS-CoV-2 in Brazil: A systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

The seroprevalence of SARS-CoV-2 antibodies in Brazil in 2020 was 11%.
Seroprevalence increased with time, 1% in the first and 83% in the last quarter of the year.
Seroprevalence was higher in the Northern region, decreasing as one moves south.

Abstract

Objectives

To summarize the data on SARS-CoV-2 seroprevalence surveys conducted in Brazil before the introduction of vaccines

Methods

The authors conducted a systematic review and meta-analysis on the seroprevalence of SARS-CoV-2 infection in Brazil. The present review followed the PRISMA guidelines. The authors searched Medline, Embase, and LILACS databases for serologic surveys conducted in the Brazilian population, in the period from 01/10/2019 to 07/11/2021, without language restrictions. The authors included studies that presented data concerning SARS-CoV-2 antibodies seroprevalence in Brazil and had a sample size ≥50 individuals. Considering the expected heterogeneity between studies, all analyses were performed using the random effects model, and heterogeneity was assessed using the I² statistic

Results

Of 586 publications identified in the initial searches, 54 were included in the review and meta-analysis, which contained the results of 135 surveys, with 336,620 participants. The estimated seroprevalence was 11.0%, ranging from 1.0% to 83.0%, with a substantial heterogeneity (I²= 99.55%). In subgroup analyses, the authors observed that the prevalence of SARS-CoV-2 antibodies was 13.0% in blood donors, 9.0% in the population-based surveys, 13% in schoolchildren, and 11.0% in healthcare workers.

Conclusions

Seroprevalence increases over time. Large differences were observed among the regions of the country. It was higher in the Northern region, decreasing towards the South. The present results may contribute to the analysis of the spread of SARS-CoV-2 infection in the Brazilian population before vaccination, one of the factors that may be influencing the clinical presentation of COVID-19 cases related to the new variants, as well as the effectiveness of the vaccination program.

Keywords
Seroprevalence; SARS-CoV-2; Systematic review; Meta-analysis

Author	Publication Year	Type of Participants	Trimester	State	Region	Diagnostic Test	Total	Positives	%Male	%White
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Teresina. FMS ^[23][23] Fundação Municipal de Saúde - Prefeitura de Teresina [Internet]. Pesquisa de Investigação Sorológica. [Cited 2022 Jan 20]. Available from: https://pmt.pi.gov.br/tag/investigacao-sorologica/. https://pmt.pi.gov.br/tag/investigacao-s...	2020	Population Based Randomly Selected	2	PI	NE	ICA	900	98	47.0
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Teresina. FMS ^[23][23] Fundação Municipal de Saúde - Prefeitura de Teresina [Internet]. Pesquisa de Investigação Sorológica. [Cited 2022 Jan 20]. Available from: https://pmt.pi.gov.br/tag/investigacao-sorologica/. https://pmt.pi.gov.br/tag/investigacao-s...	2020	Population Based Randomly Selected	3	PI	NE	ICA	900	180	47.0
Rio de Janeiro. SMS ^[17][17] Secretaria Municipal de Saúde da Prefeitura da Cidade do Rio de Janeiro [Internet]. Painel Inquérito Soroepidemiologico COVID-19. [Cited 2022 Jan 20]. Available from: https://pcrj.maps.arcgis.com/apps/MapSeries/index.html?appid=f3d95aef1cfd4dd08b7ee566627666f9. https://pcrj.maps.arcgis.com/apps/MapSer...	2020	Population Based Randomly Selected	2	RJ	SE	ICA	3211	556	31.1	24.9
Rio de Janeiro. SMS ^[17][17] Secretaria Municipal de Saúde da Prefeitura da Cidade do Rio de Janeiro [Internet]. Painel Inquérito Soroepidemiologico COVID-19. [Cited 2022 Jan 20]. Available from: https://pcrj.maps.arcgis.com/apps/MapSeries/index.html?appid=f3d95aef1cfd4dd08b7ee566627666f9. https://pcrj.maps.arcgis.com/apps/MapSer...	2020	Population Based Randomly Selected	2	RJ	SE	ICA	3202	396	28.5	26.9
Rio de Janeiro. SMS ^[17][17] Secretaria Municipal de Saúde da Prefeitura da Cidade do Rio de Janeiro [Internet]. Painel Inquérito Soroepidemiologico COVID-19. [Cited 2022 Jan 20]. Available from: https://pcrj.maps.arcgis.com/apps/MapSeries/index.html?appid=f3d95aef1cfd4dd08b7ee566627666f9. https://pcrj.maps.arcgis.com/apps/MapSer...	2020	Population Based Randomly Selected	2	RJ	SE	ICA	3200	300	31.3	26.0
Rio de Janeiro. SMS[17]	2020	Population Based Randomly Selected	3	RJ	SE	ICA	3170	319	28.5	27.3
Rio de Janeiro. SMS ^[17][17] Secretaria Municipal de Saúde da Prefeitura da Cidade do Rio de Janeiro [Internet]. Painel Inquérito Soroepidemiologico COVID-19. [Cited 2022 Jan 20]. Available from: https://pcrj.maps.arcgis.com/apps/MapSeries/index.html?appid=f3d95aef1cfd4dd08b7ee566627666f9. https://pcrj.maps.arcgis.com/apps/MapSer...	2020	Population Based Randomly Selected	3	RJ	SE	ICA	3048	233	31.8	29.8
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São Paulo. SMS ^[15][15] Secretaria Municipal de Saúde da Prefeitura de São Paulo. [Homepage da Internet]. FASES 1 a 4 ‒ Prevalência da infecção em escolares das redes públicas e privada da cidade de São Paulo - 13 de outubro de 2020 [Cited 2022 Jan 20]. Available from: https://www.prefeitura.sp.gov.br/cidade/secretarias/saude/vigilancia_em_saude/doencas_e_agravos/coronavirus/?p=291766. https://www.prefeitura.sp.gov.br/cidade/...	2020	Elementary or High School Students	3	SP	SE	ICA	2069	331
Campinas. SMS ^[59][59] Secretaria Municipal de Saúde da Prefeitura de Campinas [Internet]. Inquérito Soroepidemiológico Campinas ‒ (COVID-19) [Cited 2022 Jan 20]. Available from: https://covid-19.campinas.sp.gov.br/pesquisas https://covid-19.campinas.sp.gov.br/pesq...	2020	Population Based Randomly Selected	2	SP	SE	ICA	1937	43	41.4
SoroEpi-MSP ^[14][14] SoroEpi-MSP [Internet]. Serial soroepidemiological survey to monitor the prevalence of SARS-CoV-2 infection in the Municipality of São Paulo, SP, Brazil. [Cited 2022 Jan 20]. Available from: https://www.monitoramentocovid19.org/. https://www.monitoramentocovid19.org/...	2020	Population Based Randomly Selected	2	SP	SE	CLIA	1183	135	46.6
SoroEpi-MSP ^[14][14] SoroEpi-MSP [Internet]. Serial soroepidemiological survey to monitor the prevalence of SARS-CoV-2 infection in the Municipality of São Paulo, SP, Brazil. [Cited 2022 Jan 20]. Available from: https://www.monitoramentocovid19.org/. https://www.monitoramentocovid19.org/...	2020	Population Based Randomly Selected	3	SP	SE	CLIA	1470	127
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Vieira MACS et al. ^[18][18] Vieira M.A.C.S., Vieira C.P.B., Borba A.S., Melo M.C.C., Oliveira M.S., Melo R.M., et al. Sequential serological surveys in the early stages of the coronavirus disease epidemic: limitations and perspectives. Rev Soc Bras Med Trop. 2020;53:e20200351..	2020	Population Based Randomly Selected	2	PI	NE	ICA	900	79
Ceara. SES ^[19][19] Secretaria Executiva de Vigilância em Saúde do Ceará. [Internet]. Soroprevalência de COVID-19. [Cited 2022 Jan 20]. Available from: https://indicadores.integrasus.saude.ce.gov.br/#/indicadores/indicadores-coronavirus/soroprevalencia-covid. https://indicadores.integrasus.saude.ce....	2020	Population Based Randomly Selected	2	CE	NE	ICA	3301	468	34.5	24.1
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Subgroup	Number of Surveys	Seroprevalence% (95% CI)
Population based	79	9.0 (95% CI 6.0‒9.0)
Blood donors	20	13.0 (95% CI 11.0‒16.0)
Schoolchildren	6	13.0 (95% CI 7.0‒20.0)
Healthcare workers	6	11.0 (95% CI 7.0‒15.0)
Trimester (2020)
1	5	1.0 (95% CI 0.00‒0.01)
2	62	7.0 (95% CI 6.0‒7.0)
3	46	73.0 (95% CI 64.0‒81.0)
4	13	83.0 (95% CI 75.0‒89.0)
Region of Brazil
North	15	29.0 (95% CI 24.0‒35.0)
Northeast	35	14.0 (95% CI 12.0‒16.0)
Central-West	3	13.0 (95% CI 3.0‒30.0)
Southeast	67	12.0 (95% CI 11.0‒13.0)
South	15	1.0 (95% CI 1.0‒1.0)

	Meta regression coeficient	p-value	95% (CI)
Peer review	−0.7939297	0.001	−1.25954 ‒ 0.3283196
Pop based	−0.5347804	0.046	−1.059428 ‒ 0.0101331
Sample size	−0.0000966	0.001	−0.0001561 ‒ 0.0000372
Rapid test	−0.5483888	0.066	−1.133172 ‒ 0.0363943
cons	−1.181352	0.000	−1.754376 ‒ 0.6083286

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

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[1] * Corresponding author. E-mail addresses;gfigueiredo@usp.br (G.M. Figueiredo), fatima.tengan@usp.br (F.M. Tengan), srcampos@usp.br (S.R. Campos), eluna@usp.br (E.J. Luna).