TY - JOUR
AU - Zwerwer, Leslie R.
AU - Pouwels, Koen B.
AU - Walker, Ann Sarah
AU - Eyre, David W.
AU - Stroesser, Nicole
AU - Matthews, Philippa C.
AU - Wei, Jia
AU - Diamond, Ian
AU - Studley, Ruth
AU - Taylor, Nick
AU - Rourke, Emma
AU - Thomas, Tina
AU - Pienaar, Dawid
AU - Preece, Joy
AU - Crofts, Sarah
AU - Lloyd, Lina
AU - Bowen, Michelle
AU - Ayoubkhani, Daniel
AU - Black, Russell
AU - Felton, Antonio
AU - Crees, Megan
AU - Jones, Joel
AU - Sutherland, Esther
AU - Crook, Derrick W.
AU - Pritchard, Emma
AU - Vihta, Karina-Doris
AU - Howarth, Alison
AU - Marsden, Brian D.
AU - Chau, Kevin K.
AU - Martins Ferreira, Lucas
AU - Dejnirattisai, Wanwisa
AU - Mongkolsapaya, Juthathip
AU - Hoosdally, Sarah
AU - Cornall, Richard
AU - Stuart, David I.
AU - Screaton, Gavin
AU - Lythgoe, Katrina A.
AU - Bonsall, David
AU - Golubchik, Tanya
AU - Fryer, Helen
AU - Newton, John N.
AU - Bell, John I.
AU - Cox, Stuart
AU - Paddon, Kevin
AU - James, Tim
AU - House, Thomas
AU - Robotham, Julie
AU - Birrell, Paul J.
AU - Jordan, Helena
AU - Sheppard, Tim
AU - Athey, Graham
AU - Moody, Dan
AU - Curry, Leigh
AU - Brereton, Pamela
AU - Jarvis, Ian
AU - Godsmark, Anna
AU - Morris, George
AU - Mallick, Bobby
AU - Eeles, Phil
AU - Hay, Jodie
AU - VanSteenhouse, Harper
AU - Lee, Jessica
AU - White, Sean
AU - Evans, Tim
AU - Bloemberg, Lisa
AU - Allison, Katie
AU - Pandya, Anouska
AU - Davis, Sophie
AU - Conway, David I.
AU - MacLeod, Margaret
AU - Cunningham, Chris
AU - Peto, Timothy E.A.
PY - 2025
DA - May
TI - Identification of undetected SARS-CoV-2 infections by clustering of Nucleocapsid antibody trajectories
JO - Nature Communications
VL - 16
DO - https://doi.org/10.1038/s41467-025-57370-z
AB - During the COVID-19 pandemic, numerous SARS-CoV-2 infections remained undetected. We combined results from routine monthly nose and throat swabs, and self-reported positive swab tests, from a UK household survey, linked to national swab testing programme data from England and Wales, together with Nucleocapsid (N-)antibody trajectories clustered using a longitudinal variation of K-means (N = 185,646) to estimate the number of infections undetected by either approach. Using N-antibody (hypothetical) infections and swab-positivity, we estimated that 7.4% (95%CI: 7.0–7.8%) of all true infections (detected and undetected) were undetected by both approaches, 25.8% (25.5–26.1%) by swab-positivity-only and 28.6% (28.4–28.9%) by trajectory-based N-antibody-classifications-only. Congruence with swab-positivity was respectively much poorer and slightly better with N-antibody classifications based on fixed thresholds or fourfold increases. Using multivariable logistic regression N-antibody seroconversion was more likely as age increased between 30–60 years, in non-white participants, those less (recently/frequently) vaccinated, for lower cycle threshold values in the range above 30, and in symptomatic and Delta (vs. BA.1) infections. Comparing swab-positivity data sources showed that routine monthly swabs were insufficient to detect infections and incorporating national testing programme/self-reported data substantially increased detection. Overall, whilst N-antibody serosurveillance can identify infections undetected by swab-positivity, optimal use requires fourfold-increase-based or trajectory-based analysis.
PB - Springer Nature
UR - https://eprints.gla.ac.uk/362809/
KW - Coronavirus (COVID-19)
ER