Seroprevalence trends of anti-SARS-CoV-2 antibodies in the adult population of the São Paulo Municipality, Brazil: Results from seven serosurveys from June 2020 to April 2022. The SoroEpi MSP Study

by Beatriz Helena Tess, Celina Maria Turchi Martelli, Maria Cecília Goi Porto Alves, Fanny Cortes, Regina Tomie Ivata Bernal, Wayner Vieira de Souza, Expedito José de Albuquerque Luna, Laura da Cunha Rodrigues, Marcia Cavallari Nunes, Fernando de Castro Reinach, Celso Francisco Hernandes Granato, Edgar Gil Rizzatti, Maria Carolina Tostes Pintão

Background

Sequential population-based household serosurveys of SARS-CoV-2 covering the COVID-19 pre- and post-vaccination periods are scarce in Brazil. This study investigated seropositivity trends in the municipality of São Paulo.

Methods

We conducted seven cross-sectional surveys of adult population-representative samples between June 2020 and April 2022. The study design included probabilistic sampling, test for SARS-CoV-2 antibodies using the Roche Elecsys anti-nucleocapsid assay, and statistical adjustments for population demographics and non-response. The weighted seroprevalences with 95% confidence intervals (CI) were estimated by sex, age group, race, schooling, and mean income study strata. Time trends in seropositivity were assessed using the Joinpoint model. We compared infection-induced seroprevalences with COVID-19 reported cases in the pre-vaccination period.

Results

The study sample comprised 8,134 adults. The overall SARS-CoV-2 seroprevalence increased from 11.4% (95%CI: 9.2–13.6) in June 2020 to 24.9% (95%CI: 21.0–28.7) in January 2021; from 38.1% (95%CI: 34.3–41.9) in April 2021 to 77.7% (95%CI: 74.4–81.0) in April 2022. The prevalence over time was higher in the subgroup 18–39 years old than in the older groups from Survey 3 onwards. The self-declared Black or mixed (Pardo) group showed a higher prevalence in all surveys compared to the White group. Monthly prevalence rose steeply from January 2021 onwards, particularly among those aged 60 years or older. The infection-to-case ratios ranged from 8.9 in June 2020 to 4.3 in January 2021.

Conclusions

The overall seroprevalence rose significantly over time and with age and race subgroup variations. Increases in the 60 years or older age and the White groups were faster than in younger ages and Black or mixed (Pardo) race groups in the post-vaccination period. Our data may add to the understanding of the complex and changing population dynamics of the SARS-CoV-2 infection, including the impact of vaccination strategies and the modelling of future epidemiological scenarios.