Global seroprevalence of SARS-CoV-2 antibodies: a systematic review and meta-analysis

AbstractBackgroundStudies reporting estimates of the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies have rapidly emerged. We aimed to synthesize seroprevalence data to better estimate the burden of SARS-CoV-2 infection, identify high-risk groups, and inform public health decision making.MethodsIn this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to August 28, 2020. We included studies that reported a sample size, study date, location, and seroprevalence estimate. Estimates were corrected for imperfect test accuracy with Bayesian measurement error models. We conducted meta-analysis to identify demographic differences in the prevalence of SARS-CoV-2 antibodies, and meta-regression to identify study-level factors associated with seroprevalence. We compared region-specific seroprevalence data to confirmed cumulative incidence. PROSPERO: CRD42020183634.FindingsWe identified 338 seroprevalence studies including 2.3 million participants in 50 countries. Seroprevalence was low in the general population (median 3.2%, IQR 1.0-6.4%) and slightly higher in at-risk populations (median 5.4%, IQR 1.5-18.4%). Median seroprevalence varied by WHO Global Burden of Disease region (p < 0.01), from 1.0% in Southeast Asia, East Asia and Oceania to 18.8% in South Asia. National studies had lower seroprevalence estimates than local (p = 0.02) studies. Compared to White persons, Black persons (prevalence ratio [RR] 2.34, 95% CI 1.60-3.43) and Asian persons (RR 1.56, 95% CI 1.22-2.01) were more likely to be seropositive. Seroprevalence was higher among people ages 18-64 compared to 65 and over (RR 1.26, 95% CI 1.04-1.52). Health care workers had a 1.74x (95% CI: 1.18-2.58) higher risk compared to the general population. There was no difference in seroprevalence between sexes. There were 123 studies (36%) at low or moderate risk of bias. Seroprevalence estimates from national studies were median 11.9 (IQR 8.0 - 16.6) times higher than the corresponding SARS-CoV-2 cumulative incidence.InterpretationMost of the population remains susceptible to SARS-CoV-2 infection. Public health measures must be improved to protect disproportionately affected groups, including non-White people and adults. Measures taken in SE Asia, E Asia and Oceania, and Latin America and Caribbean may have been more effective in controlling virus transmission than measures taken in other regions.FundingPublic Health Agency of Canada through the COVID-19 Immunity Task Force.

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The Seroprevalence of SARS-CoV-2 in Europe: A Systematic Review

10.1101/2021.04.12.439425 ◽

2021 ◽

Author(s):

Natasha Marcella Vaselli ◽

Daniel Hungerford ◽

Ben Shenton ◽

Arwa Khashkhusha ◽

Nigel A. Cunliffe ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Age Groups ◽

Significant Heterogeneity ◽

Community Studies ◽

Past Infection ◽

Significant Difference ◽

The Impact

AbstractBackgroundA year following the onset of the COVID-19 pandemic, new infections and deaths continue to increase in Europe. Serological studies, through providing evidence of past infection, can aid understanding of the population dynamics of SARS-CoV-2 infection.ObjectivesThis systematic review of SARS-CoV-2 seroprevalence studies in Europe was undertaken to inform public health strategies including vaccination, that aim to accelerate population immunity.MethodsWe searched the databases Web of Science, MEDLINE, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews and grey literature sources for studies reporting seroprevalence of SARS-CoV-2 antibodies in Europe published between 01/12/2019 - 30/09/20. We provide a narrative synthesis of included studies. Studies were categorized into subgroups including healthcare workers (HCWs), community, outbreaks, pregnancy and children/school. Due to heterogeneity in other subgroups, we only performed a random effects meta-analysis of the seroprevalence amongst HCWs stratified by their country.Results109 studies were included spanning 17 European countries, that estimated the seroprevalence of SAR-CoV2 from samples obtained between November 2019 – August 2020. A total of 53/109 studies included HCWs with a reported seroprevalence among HCWs ranging from 0.7% to 45.3%, which did not differ significantly by country. In community studies significant heterogeneity was reported in the seroprevalence among different age groups and the majority of studies reported there was no significant difference by gender.ConclusionThis review demonstrates a wide heterogeneity in reported seroprevalence of SARS-CoV-2 antibodies between populations. Continued evaluation of seroprevalence is required to understand the impact of public health measures and inform interventions including vaccination programmes.

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INTERNATIONAL PREVALENCE OF CONSULTATION WITH A NATUROPATHIC PRACTITIONER: A SYSTEMATIC REVIEW AND META-ANALYSIS

10.1101/2021.08.08.21261774 ◽

2021 ◽

Author(s):

Amie Steel ◽

Rebecca Redmond ◽

Janet Schloss ◽

Holger Cramer ◽

Joshua Goldenberg ◽

...

Keyword(s):

Systematic Review ◽

General Population ◽

Meta Analysis ◽

Grey Literature ◽

Therapeutic Interventions ◽

World Health ◽

Secondary Outcome ◽

World Region ◽

World Regions ◽

History Of

Objectives: Naturopathy is a traditional medicine system informed by codified philosophies and principles, and an emphasis on non-pharmacologic therapeutic interventions. While naturopathy is practiced by approximately 75 000 to 100 000 naturopathic practitioners in at least 98 countries, little is known about the international prevalence of history of consultation with a naturopathic practitioner. This study reports a systematic review and meta-analysis of studies describing the global prevalence of history of consultation with a naturopathic practitioner by the general population. Setting: The included literature was identified through a systematic search of eight databases between September and October 2019, as well as the grey literature. Participants: Studies were included if they reported the prevalence rate of consultations with a naturopathic practitioner by the general population Interventions: Survey items needed to report consultations with a naturopathic practitioner as defined in the country where data was collected, and not combine naturopathic consultations with other health services or only report consulations for illness populations. Primary and secondary outcome measures: Primary measures used for the analysis was consultations in the previous 12-months. Other prevalence timeframes were reported as secondary measures. Methods: Meta-analysis of prevalence data was conducted using random effects models based on individual countries and World Health Organisation (WHO) world regions. Results: The literature search identified eight manuscripts summarizing 13 studies reporting prevalence for inclusion in the review. All included studies had a low risk of bias. Meta-analysis of the included studies by world region found the 12-month prevalence of history of naturopathy consultations ranged from 1% in the Region of the Americas to 6% in the European and Western Pacific Regions. Conclusions: There are up to 6-fold differences in the prevalence of naturopathy consults over 12-months between and within world regions, which may be driven by a range of policy, legislative and social factors.

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Herpes zoster epidemiology in Latin America: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0255877 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255877

Author(s):

Ariel Esteban Bardach ◽

Carolina Palermo ◽

Tomás Alconada ◽

Macarena Sandoval ◽

Darío Javier Balan ◽

...

Keyword(s):

Systematic Review ◽

Latin America ◽

Herpes Zoster ◽

Cumulative Incidence ◽

Meta Analysis ◽

Grey Literature ◽

Case Fatality ◽

Incidence Density ◽

Bibliographic Databases ◽

Hospitalization Rates

The epidemiology and burden of Herpes Zoster (HZ) are largely unknown, and there are no recent reviews summarizing the available evidence from the Latin America and Caribbean (LAC) region. We conducted a systematic review and meta-analysis to characterize the epidemiology and burden of HZ in LAC. Bibliographic databases and grey literature sources were consulted to find studies published (January 2000 –February 2020) with epidemiological endpoints: cumulative incidence and incidence density (HZ cases per 100,000 person-years), prevalence, case-fatality rates, HZ mortality, hospitalization rates, and rates of each HZ complication. Twenty-six studies were included with most studies coming from Brazil. No studies reported the incidence of HZ in the general population. In population at higher risk, the cumulative incidence ranged from 318–3,423 cases of HZ per 100,000 persons per year of follow-up. The incidence density was 6.4–36.5 cases per 1,000 person-years. Age was identified as a major risk factor towards HZ incidence which increase significantly in people >50 years of age. Hospitalization rates ranged from 3%–35.7%. The in-hospital HZ mortality rate ranged from 0%–36%. Overall, HZ mortality rates were found to be higher in females across all age groups and countries. The incidence of HZ complications (such as post-herpetic neuralgia, ophthalmic herpes zoster, and Ramsay Hunt syndrome) was higher in the immunosuppressed compared to the immunocompetent population. Acyclovir was the most frequently used therapy. Epidemiological data from Ministry of Health databases (Argentina, Brazil, Colombia, Chile y Mexico) and Institute for Health Metrics and Evaluation’s Global Burden of Disease project reported stable rates of hospitalizations and deaths over the last 10 years. High-risk groups for HZ impose a considerable burden in LAC. They could benefit from directed healthcare initiatives, including adult immunization, to prevent HZ occurrence and its complications.

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2195. Incidence of Acute Myocardial Infarction in Patients with Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1875 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S747-S748 ◽

Cited By ~ 1

Author(s):

Alejandro Nieto Dominguez ◽

Stephen Furmanek ◽

Julio Ramirez

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Acute Myocardial Infarction ◽

General Population ◽

Cumulative Incidence ◽

Meta Analysis ◽

Fold Increase ◽

Community Acquired Pneumonia ◽

Forest Plot ◽

Adjusted Incidence

Abstract Background Community-acquired pneumonia (CAP) is a respiratory disease that is responsible for an estimated 3.5 million worldwide deaths annually. In the last few years, it has been hypothesized that CAP is implicated in the development of diseases in other systems such as renal and cardiovascular. Until this moment, multiple studies evaluating incidence of acute myocardial infarction (AMI) in patients with CAP exist, but data are still unclear. Our objective was to summarize several studies available regarding incidence of Acute Myocardial Infarction (AMI) in patients with CAP and to compare such value with the incidence of AMI in the general population. Methods We conducted a systematic review of articles published between January 1980 and January 2019 in the PubMed and PubMed Central databases. Studies describing the incidence of AMI in patients with CAP were included. We extracted their diagnostic criteria for CAP and AMI, and their AMI follow-up periods. In addition to this, we calculated cumulative incidence of AMI in patients with CAP and compared such value with the general population. Results 1841 studies were identified (Figure 1), of which 10 studies were included in our review (Figure 2). From a forest plot-random effects model, the cumulative incidence of AMI among patients hospitalized due to CAP was 2,440 per 100,000 (95% CI: 1,780; 3,320) (Figure 3). Using the age-adjusted incidence of 649 cases of CAP per 100,000 adults described by Ramirez et al., we estimated that 16 per 100,000 adults will have an AMI associated with CAP (95% CI: 12;22) per year in the US Moreover, Yeh et al. found that the incidence of AMI in the general population was 208 per 100,000 people, comparing this value, to the values obtained in our meta-analysis of 2,440 acute myocardial infarctions by 100, 000 people, we can infer that adult patients hospitalized due to CAP have an 11.7-fold increase from the general population for risk of MI. Conclusion A higher risk of AMI was observed among adults hospitalized with CAP compared with the general population. Results must be carefully analyzed given the heterogeneity of the studies. At a clinical level, this increase in AMI incidence in patients with CAP should be taken into account in order to give the best therapeutic management to such patients. Disclosures All authors: No reported disclosures.

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Performance of commercial tests for molecular detection of Shiga toxin-producingEscherichia coli(STEC): a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2018-025950 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025950 ◽

Cited By ~ 1

Author(s):

Gillian A M Tarr ◽

Chu Yang Lin ◽

Diane Lorenzetti ◽

Linda Chui ◽

Phillip I Tarr ◽

...

Keyword(s):

Systematic Review ◽

Shiga Toxin ◽

Clinical Performance ◽

Meta Analysis ◽

Characteristic Curve ◽

Grey Literature ◽

Receiver Operator Characteristic Curve ◽

Nucleic Acid Amplification ◽

Test Accuracy ◽

Cochrane Central Register

IntroductionRapid detection of Shiga toxin-producingEscherichia coli(STEC) enables appropriate treatment. Numerous commercially available molecular tests exist, but they vary in clinical performance. This systematic review aims to synthesise available evidence to compare the clinical performance of enzyme immunoassay (EIA) and nucleic acid amplification tests (NAATs) for the detection of STEC.Methods and analysisThe following databases will be searched employing a standardised search strategy: Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed, Scopus and Web of Science. Grey literature will be searched under advice from a medical librarian. Independent reviewers will screen titles, abstracts and full texts of retrieved studies for relevant studies. Data will be extracted independently by two reviewers, using a piloted template. Quality Assessment of Diagnostic Accuracy Studies-2 will be employed to assess the risk of bias of individual studies, and the quality of evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. A bivariate random-effects model will be used to meta-analyse the sensitivity and specificity of commercial STEC diagnostic tests, and a hierarchical summary receiver operator characteristic curve will be constructed. Studies of single test accuracy of EIA and NAATs and studies of comparative accuracy will be analysed separately.Ethics and disseminationEthics approval was not required for this systematic review and meta-analysis. Findings will be disseminated in conferences, through a peer-reviewed journal and via personal interactions with relevant stakeholders.PROSPERO registration numberCRD42018099119.

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Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20210365 ◽

2021 ◽

Author(s):

Davi de Sá Cavalcante ◽

Paulo Goberlânio de Barros Silva ◽

Francisco Samuel Rodrigues Carvalho ◽

Ana Rosa Pinto Quidute ◽

Lúcio Mitsuo Kurita ◽

...

Keyword(s):

Systematic Review ◽

Fractal Dimension ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Grey Literature ◽

High Sensitivity ◽

Total Sample ◽

Control Group ◽

Test Accuracy ◽

Osteoporosis Screening

Objective: To summarize the evidence on the feasibility of maxillomandibular imaging exams-related fractal dimension (FD) in screening patients with osteoporosis. Methods: This registered systematic review followed the PRISMA-DTA statement. High sensitivity search strategies were developed for six primary databases and grey literature. QUADAS-2 items evaluated the risk of bias, and the GRADE approach assessed the evidence certainty. Results: From 1,034 records initially identified through database searching, four studies were included (total sample of 747 patients [osteoporosis, 136; control group, 611]). The meta-analysis showed that the overall sensitivity and specificity of the FD were 86.17 and 72.68%, respectively. In general, all studies showed low RoB and applicability concern. The certainty of the evidence was very low to moderate. Conclusions: This systematic review showed that the jaw-related FD presented sensitivity and specificity values higher than 70%, and its sensitivity in osteoporosis screening was a better parameter than specificity.

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Burden of chronic kidney disease in the general population and high-risk groups in South Asia: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0258494 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258494

Author(s):

Nipun Shrestha ◽

Sanju Gautam ◽

Shiva Raj Mishra ◽

Salim S. Virani ◽

Raja Ram Dhungana

Keyword(s):

Public Health ◽

Systematic Review ◽

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

General Population ◽

South Asia ◽

Meta Analysis ◽

High Risk Population ◽

Pooled Prevalence

Background Chronic kidney disease (CKD) is an emerging public health issue globally. The prevalence estimates on CKD in South Asia are however limited. This study aimed to examine the prevalence of CKD among the general and high-risk population in South Asia. Methods We conducted a systematic review and meta-analysis of population-level prevalence studies in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). Three databases namely PubMed, Scopus and Web of Science were systematically searched for published reports of kidney disease in South Asia up to 28 October 2020. A random-effect model for computing the pooled prevalence was used. Results Of the 8749 identified studies, a total of 24 studies were included in the review. The pooled prevalence of CKD among the general population was 14% (95% CI 11–18%), and 15% (95% CI 11–20%) among adult males and 13% (95% CI 10–17%) in adult females. The prevalence of CKD was 27% (95% CI 20–35%) in adults with hypertension, 31% (95% CI 22–41%) in adults with diabetes and 14% (95% CI 10–19%) in adults who were overweight/obese. We found substantial heterogeneity across the included studies in the pooled estimates for CKD prevalence in both general and high-risk populations. The prevalence of CKD of unknown origin in the endemic population was 8% (95% CI 3–16%). Conclusion Our study reaffirms the previous reports that CKD represents a serious public health challenge in South Asia, with the disease prevalent among 1 in 7 adults in South Asian countries.

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Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A systematic review and meta-analysis

10.1101/2021.10.09.21264799 ◽

2021 ◽

Author(s):

Ashley K. Matthies ◽

Michael M. Trauer ◽

Karl Chopra ◽

Robert Jarman

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Diagnostic Test ◽

Lung Ultrasound ◽

Point Of Care ◽

Meta Analysis ◽

Grey Literature ◽

Test Accuracy ◽

Emergency Setting ◽

Predictive Values

AbstractBackgroundPoint-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. The necessity for rapid testing combined with the limitations of other diagnostic tests has led to the proposal of various potential roles for LUS during the COVID-19 pandemic. This systematic review and meta-analysis focused specifically on the diagnostic accuracy of LUS in adult patients presenting with suspected COVID-19.MethodsTraditional and grey-literature searches were performed on June 1st 2021. Two authors independently carried out the searches, selected studies and completed the Quality Assessment Tool for Diagnostic Test Accuracy Studies (QUADAS-2). Meta-analysis was carried out using established open-source packages in R. We report overall sensitivity, specificity, positive and negative predictive values and the hierarchical summary receiver operating characteristic curve for LUS. Heterogeneity was determined using the I2 statistic.ResultsTwenty studies were included, providing data from a total of 4,314 patients. The prevalence and admission rates were generally high across all studies. Overall LUS was found to be 87.2% sensitive (95% CI 83.6-90.2) and 69.5% specific (95% CI 62.2-72.5) and demonstrated overall positive and negative predictive values of 3.0 (95% 2.3-4.1) and 0.16 (95% 0.12-0.22) respectively. Separate analyses for each reference standard revealed similar sensitivities and specificities for LUS. Heterogeneity between studies was found to be high, and QUADAS-2 assessment identified risks of bias in many studies.ConclusionDuring a period of high prevalence, LUS is a highly sensitive diagnostic test for COVID-19. However, more research is required to confirm these results in more generalisable populations, including those less likely to be admitted to hospital.

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The seroprevalence of SARS-CoV-2 during the first wave in Europe 2020: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0250541 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0250541

Author(s):

Natasha Marcella Vaselli ◽

Daniel Hungerford ◽

Ben Shenton ◽

Arwa Khashkhusha ◽

Nigel A. Cunliffe ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Age Groups ◽

Significant Heterogeneity ◽

Community Studies ◽

Past Infection ◽

Significant Difference ◽

The Impact

Background A year following the onset of the COVID-19 pandemic, new infections and deaths continue to increase in Europe. Serological studies, through providing evidence of past infection, can aid understanding of the population dynamics of SARS-CoV-2 infection. Objectives This systematic review of SARS-CoV-2 seroprevalence studies in Europe was undertaken to inform public health strategies including vaccination, that aim to accelerate population immunity. Methods We searched the databases Web of Science, MEDLINE, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews and grey literature sources for studies reporting seroprevalence of SARS-CoV-2 antibodies in Europe published between 01/12/2019–30/09/20. We provide a narrative synthesis of included studies. Studies were categorized into subgroups including healthcare workers (HCWs), community, outbreaks, pregnancy and children/school. Due to heterogeneity in other subgroups, we only performed a random effects meta-analysis of the seroprevalence amongst HCWs stratified by their country. Results 115 studies were included spanning 17 European countries, that estimated the seroprevalence of SARS-CoV-2 from samples obtained between November 2019 –August 2020. A total of 54/115 studies included HCWs with a reported seroprevalence among HCWs ranging from 0.7% to 45.3%, which did not differ significantly by country. In community studies significant heterogeneity was reported in the seroprevalence between different age groups and the majority of studies reported there was no significant difference by gender. Conclusion This review demonstrates a wide heterogeneity in reported seroprevalence of SARS-CoV-2 antibodies between populations. Continued evaluation of seroprevalence is required to understand the impact of public health measures and inform interventions including vaccination programmes.

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Global seroprevalence of SARS-CoV-2 antibodies: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0252617 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252617

Author(s):

Niklas Bobrovitz ◽

Rahul Krishan Arora ◽

Christian Cao ◽

Emily Boucher ◽

Michael Liu ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Health Care ◽

Health Care Workers ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Global Burden ◽

Care Workers ◽

Seroprevalence Data ◽

Sub Saharan

Background Many studies report the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. We aimed to synthesize seroprevalence data to better estimate the level and distribution of SARS-CoV-2 infection, identify high-risk groups, and inform public health decision making. Methods In this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to December 31, 2020. We included studies that reported a sample size, study date, location, and seroprevalence estimate. We corrected estimates for imperfect test accuracy with Bayesian measurement error models, conducted meta-analysis to identify demographic differences in the prevalence of SARS-CoV-2 antibodies, and meta-regression to identify study-level factors associated with seroprevalence. We compared region-specific seroprevalence data to confirmed cumulative incidence. PROSPERO: CRD42020183634. Results We identified 968 seroprevalence studies including 9.3 million participants in 74 countries. There were 472 studies (49%) at low or moderate risk of bias. Seroprevalence was low in the general population (median 4.5%, IQR 2.4–8.4%); however, it varied widely in specific populations from low (0.6% perinatal) to high (59% persons in assisted living and long-term care facilities). Median seroprevalence also varied by Global Burden of Disease region, from 0.6% in Southeast Asia, East Asia and Oceania to 19.5% in Sub-Saharan Africa (p<0.001). National studies had lower seroprevalence estimates than regional and local studies (p<0.001). Compared to Caucasian persons, Black persons (prevalence ratio [RR] 3.37, 95% CI 2.64–4.29), Asian persons (RR 2.47, 95% CI 1.96–3.11), Indigenous persons (RR 5.47, 95% CI 1.01–32.6), and multi-racial persons (RR 1.89, 95% CI 1.60–2.24) were more likely to be seropositive. Seroprevalence was higher among people ages 18–64 compared to 65 and over (RR 1.27, 95% CI 1.11–1.45). Health care workers in contact with infected persons had a 2.10 times (95% CI 1.28–3.44) higher risk compared to health care workers without known contact. There was no difference in seroprevalence between sex groups. Seroprevalence estimates from national studies were a median 18.1 times (IQR 5.9–38.7) higher than the corresponding SARS-CoV-2 cumulative incidence, but there was large variation between Global Burden of Disease regions from 6.7 in South Asia to 602.5 in Sub-Saharan Africa. Notable methodological limitations of serosurveys included absent reporting of test information, no statistical correction for demographics or test sensitivity and specificity, use of non-probability sampling and use of non-representative sample frames. Discussion Most of the population remains susceptible to SARS-CoV-2 infection. Public health measures must be improved to protect disproportionately affected groups, including racial and ethnic minorities, until vaccine-derived herd immunity is achieved. Improvements in serosurvey design and reporting are needed for ongoing monitoring of infection prevalence and the pandemic response.

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