美国斯坦福大学医学院Shuchi Anand团队研究了美国范围内透析患者中SARS-CoV-2抗体的检出率。2020年9月25日，该研究发表在《柳叶刀》杂志上。

美国许多接受透析的患者均居住在医疗服务不足的社区，他们每月接受实验室例行的SARS-CoV-2血清阳性率检测。

在这项横断面研究中，研究组与一家中心实验室合作，从美国各地约1300个透析机构中接收样品，共检测了2020年7月接受透析的28503名成年患者的血浆。抽样人群的年龄、性别、种族和种族分布与美国透析人群相似，但与美国成年人口相比，老年人、男性和居住在黑人和西班牙裔社区的居民比例更高。

样本中SARS-CoV-2的血清阳性率为8.0％，按美国透析人群标准化后为8.3％，按美国成年人口标准化后为9.3％。按照美国透析人群的标准，血清阳性率从西部的3.5％到东北的27.2％不等。通过比较每100000人群的血清阳性率和病例数，研究组发现血清阳性的患者占9.2％。

与其他SARS-CoV-2传播方式相比，血清阳性率与每100000人口的死亡率呈正相关。与非西班牙裔白人社区居民相比，非西班牙裔黑人和西班牙裔社区居民的血清阳性率更高。与人口密度最低五分位的居民相比，最高五分位的居民血清阳性率更高。县级流动人口限制使2020年3月上旬的工作场所访问至少降低了5％，与2020年7月血清阳性率较低相关。

总之，COVID-19第一波疫情期间，不到10%的美国成年人产生了针对SARS-CoV-2的抗体。

附：英文原文

Title: Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study

Author: Shuchi Anand, Maria Montez-Rath, Jialin Han, Julie Bozeman, Russell Kerschmann, Paul Beyer, Julie Parsonnet, Glenn M Chertow

Issue&Volume: 2020-09-25

Abstract:

Background

Many patients receiving dialysis in the USA share the socioeconomic characteristics of underserved communities, and undergo routine monthly laboratory testing, facilitating a practical, unbiased, and repeatable assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence.

Methods

For this cross-sectional study, in partnership with a central laboratory that receives samples from approximately 1300 dialysis facilities across the USA, we tested the remainder plasma of 28503 randomly selected adult patients receiving dialysis in July, 2020, using a spike protein receptor binding domain total antibody chemiluminescence assay (100% sensitivity, 99·8% specificity). We extracted data on age, sex, race and ethnicity, and residence and facility ZIP codes from the anonymised electronic health records, linking patient-level residence data with cumulative and daily cases and deaths per 100000 population and with nasal swab test positivity rates. We standardised prevalence estimates according to the overall US dialysis and adult population, and present estimates for four prespecified strata (age, sex, region, and race and ethnicity).

Findings

The sampled population had similar age, sex, and race and ethnicity distribution to the US dialysis population, with a higher proportion of older people, men, and people living in majority Black and Hispanic neighbourhoods than in the US adult population. Seroprevalence of SARS-CoV-2 was 8·0% (95% CI 7·7–8·4) in the sample, 8·3% (8·0–8·6) when standardised to the US dialysis population, and 9·3% (8·8–9·9) when standardised to the US adult population. When standardised to the US dialysis population, seroprevalence ranged from 3·5% (3·1–3·9) in the west to 27·2% (25·9–28·5) in the northeast. Comparing seroprevalent and case counts per 100000 population, we found that 9·2% (8·7–9·8) of seropositive patients were diagnosed. When compared with other measures of SARS-CoV-2 spread, seroprevalence correlated best with deaths per 100000 population (Spearman's ρ=0·77). Residents of non-Hispanic Black and Hispanic neighbourhoods experienced higher odds of seropositivity (odds ratio 3·9 [95% CI 3·4–4·6] and 2·3 [1·9–2·6], respectively) compared with residents of predominantly non-Hispanic white neighbourhoods. Residents of neighbourhoods in the highest population density quintile experienced increased odds of seropositivity (10·3 [8·7–12·2]) compared with residents of the lowest density quintile. County mobility restrictions that reduced workplace visits by at least 5% in early March, 2020, were associated with lower odds of seropositivity in July, 2020 (0·4 [0·3–0·5]) when compared with a reduction of less than 5%.

Interpretation

During the first wave of the COVID-19 pandemic, fewer than 10% of the US adult population formed antibodies against SARS-CoV-2, and fewer than 10% of those with antibodies were diagnosed. Public health efforts to limit SARS-CoV-2 spread need to especially target racial and ethnic minority and densely populated communities.

DOI: 10.1016/S0140-6736(20)32009-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32009-2/fulltext