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Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

2020; Elsevier BV; Volume: 396; Issue: 10250 Linguagem: Inglês

10.1016/s0140-6736(20)31483-5

1474-547X

Marina Pollán, Beatriz Pérez‐Gómez, Roberto Pastor‐Barriuso, Jesús Oteo, Miguel A. Hernán, Mayte Pérez‐Olmeda, Jose L Sanmartín, Aurora Fernández-García, Israel Cruz, Nerea Fernández de Larrea, Marta Molina, Francisco Rodríguez-Cabrera, Mariano Martín, Paloma Merino Amador, José León Paniagua, Juan F Muñoz-Montalvo, Faustino Blanco, Raquel Yotti, Faustino Blanco, Rodrigo Gutiérrez Fernández, Mariano Martín, Saturnino Mezcua Navarro, Marta Molina, Juan F Muñoz-Montalvo, Matías Salinero Hernández, Jose L Sanmartín, Manuel Cuenca‐Estrella, Raquel Yotti, José León Paniagua, Nerea Fernández de Larrea, José María Navarro‐Marí, Roberto Pastor‐Barriuso, Beatriz Pérez‐Gómez, Marina Pollán, Ana Avellón, Giovanni Fedele, Aurora Fernández-García, Jesús Oteo, Mayte Pérez‐Olmeda, Israel Cruz, Elena Fernández‐Martínez, Francisco Rodríguez-Cabrera, Miguel A. Hernán, Susana Padrones Fernández, José Manuel Rumbao Aguirre, José María Navarro‐Marí, Begoña Palop Borrás, Ana Belén Jiménez, Manuel Rodríguez‐Iglesias, Ana María Calvo Gascón, María Luz Lou Alcaine, Ignacio Donate Suárez, O. Alvarez, Mercedes Rodríguez Pérez, Margarita Cases Sanchís, Carlos Javier Villafáfila-Gomila, Lluís Carbó Saladrigas, Adoración Hurtado Fernández, Antonio Oliver, Elías Castro Feliciano, María Noemí González Quintana, José María Barrasa Fernández, María Araceli Hernández Betancor, Melisa Hernández Febles, Leopoldo Martín Martín, Luis-Mariano López López, Teresa Ugarte Miota, Inés De Benito Población, María Sagrario Celada Pérez, María Natalia Vallés Fernández, Tomás Maté, M. Arranz, Marta Domínguez-Gil González, Isabel Fernández-Natal, Gregoria Megías Lobón, Juan Luis Muñoz Bellido, Pilar Ciruela, Ariadna Mas i Casals, María Doladé, María Ángeles Marcos, Dúnia Pérez del Campo, Antonio Félix de Castro, Ramón Limón Ramírez, Maria Francisca Elías Retamosa, Manuela Rubio González, María Sinda Blanco Lobeiras, Alberto Fuentes Losada, Antonio Aguilera, Germán Bou, Yolanda Caro, Noemí Marauri, Luis Miguel Soria Blanco, Isabel del Cura-González, Montserrat Hernández Pascual, Roberto Alonso, Paloma Merino Amador, Natalia Cabrera Castro, Aurora Tomás Lizcano, Cristóbal Ramírez Almagro, M. Segovia Hernández, Nieves Ascunce Elizaga, María Ederra Sanz, Carmen Ezpeleta Baquedano, Ana Bustinduy Bascaran, Susana Tamayo, Luis Elorduy Otazua, Rebeca Benarroch Benarroch, Jesús Lopera Flores, Antonia Vázquez de la Villa,

SARS-CoV-2 and COVID-19 Research

BackgroundSpain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level.Methods35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test).FindingsSeroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay, with a specificity–sensitivity range of 3·7% (3·3–4·0; both tests positive) to 6·2% (5·8–6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years ( 10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1–92·1; both tests positive) to 91·8% (86·3–95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8–16·8) to 19·3% (17·7–21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1–24·9) to 35·8% (33·1–38·5). Only 19·5% (16·3–23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test.InterpretationThe majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave.FundingSpanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.